Cervical Cancer Screening Guidelines 2012 Update Changes Michael Henry MD Director of Cytopathology Mayo Clinic Rochester Minnesota Jennifer Sauter MD Cytopathology Fellow Mayo Clinic ID: 1022110
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1. American Society of Cytopathology’s CELL TalksCervical Cancer Screening Guidelines 2012 Update – Changes
2. Michael Henry, M.D.Director of CytopathologyMayo ClinicRochester, MinnesotaJennifer Sauter, M.D.Cytopathology FellowMayo ClinicRochester, MinnesotaInsert photo hereInsert photo here
3. ObjectivesUnderstand the updated cervical cancer screening guidelinesBecome familiar with primary hrHPV screening as an alternative to traditional screening methods
4. Cytopathology Milestones
5. BackgroundUpdated cervical cancer screening guidelines: Cancer J Clin. 2012;62(3):147-72J Low Genit Tract Dis. 2012;16(3):175-204Am J Clin Pathol. 2012;137(4):516-42
6. ASC/ASCCP/ASCP Guidelines (2012) Screening RecommendationsLink to article in J Low Genit Tract DisASCCP PowerPoint presentationApp ASCCP MobileAvailable for iPad/iPhone/Android
7. What are the goals of screening?Recommendations should: Maximize the benefits of screeningMinimize potential harms of screening
8. Screening PopulationGeneral populationNot high-risk populations:Cervical cancer historyExposure to DES in uteroImmunocompromised
9. What has changed?2012 Cervical Cancer Screening Update:Screening intervalsAge-specific screening strategiesManagement of discordant cotest resultsExiting from screeningImpact of HPV vaccination Potential utility of molecular screening
10. Screening IntervalsAnnual screening is not appropriateIntervals based on age and clinical history
11. Age-specific screening strategiesWomen ages 21-29:hrHPV testing should not be usedScreening MethodTime IntervalCytology aloneEvery 3 years
12. Age-specific screening strategiesWomen ages 30-65:Screening MethodTime IntervalCotesting (preferred)Every 5 yearsCytology alone (acceptable)Every 3 yearsor
13. Discordant cotest resultshrHPV positive, cytology negative:Management Repeat cotesting in 12 months:-Positive (cytology or hrHPV)Colposcopy-Negative (cytology and hrHPV)Routine screeningImmediate HPV 16 or HPV 16/18 genotype testing:-HPV 16 or 18 positiveColposcopy-HPV 16 and 18 negativeRepeat cotesting in 12 months
14. Discordant cotest resultsNegative hrHPV, ASCUS cytology:Routine screening as per age-specific guidelines
15. Exiting from screeningWho qualifies?CriteriaWomen > 65 years of ageEvidence of adequate negative prior screening requiredNo history of CIN2+ within 20 yearsFollowing hysterectomyRemoval of cervixNo history of CIN2+*Evidence of adequate negative screening not required^Once discontinued, screening should not resume for any reason
16. History of CIN2+ or AIS:Continue screening for 20 yearsEven if screening is extended past age 65
17. Impact of HPV vaccinationScreening after HPV vaccination:Screening practices should not change on the basis of HPV vaccination status
18. Utility of molecular screeningScreening with hrHPV testing alone:Women should not be screened with hrHPV testing alone
19. hrHPV Primary ScreeningFDA news releaseCobas hrHPV Test Roche Molecular Systems, Inc (Pleasanton, CA)
20. hrHPV Primary ScreeningInterim guidance report: Gyn Oncol. 2015;136(2):178-82J Low Genit Tract Dis. 2015;19(2):91-6Obstet Gynecol. 2015;125(2):330-7
21. hrHPV Primary ScreeningInterim guidance report:Primary hrHPV screening should not be initiated prior to 25 years of agePrimary hrHPV screening is safe and effectiveCytology and cotesting remain recommended screening strategies
22. hrHPV Primary ScreeningRecommended Management:hrHPV ResultManagementhrHPV 16/18 positiveColposcopyhrHPV other positiveCytologyhrHPV negativeRoutine screening (at least 3 year intervals)> ASCUS NILM ManagementColposcopy12 month F/U
23. ASC Lab Management Cell Talk: Recap2012 Cervical Cancer Screening Update:Screening intervalsAge specific screening strategiesManagement of discordant cotest resultsExiting from screeningImpact of HPV vaccinationPotential utility of molecular testing
24. Thank you!ASC FoundationASC Cytopathology Program Directors CommitteeMembers involved in CELL Talk initiative:Deborah Chute, M.D.Roseann Wu, M.D. M.P.H.Christina Kong, M.D.Anne Mills, M.D.Deborah SheldonMayo Clinic Department of CytopathologyConsultants and fellow trainees
25. Quiz Question #1A 35 year old woman undergoes cotesting with a positive hrHPV test but negative cytology. hrHPV 16/18 genotype specific testing is negative. According to the updated 2012 ASCCP guidelines, what is the proper management for this patient?Immediate colposcopyRepeat cotesting in 5 yearsRepeat cytology only in 3 yearsRepeat cotesting in 12 months
26. Quiz Question #212 months later, the same woman from question #1 undergoes repeat cotesting. Again, hrHPV test is positive, but cytology is negative. According to the updated 2012 ASCCP guidelines, what is the appropriate management of this patient?Immediate colposcopyRepeat cotesting in 5 yearsRepeat cytology only in 3 yearsRepeat cotesting in 12 months
27. Quiz Question #3A 68 year old woman has a new sexual partner. She has no history of CIN2 or greater. Her most recent hrHPV test and Pap test was performed 3 years ago. According to the updated 2012 ASCCP guidelines, what is the appropriate management of this patient?Immediate primary hrHPV screeningImmediate cytology screeningNo management necessaryHPV vaccination
28. Quiz Question #4A 28 year old woman undergoes primary hrHPV screening and is positive for hrHPV “other” (not hrHPV 16 or 18). According to the 2015 interim guidance report, what is the appropriate management?Follow up primary hrHPV screening in 12 monthsImmediate colposcopyTriage to cytologyCotesting in 5 years
29. Quiz Question #5The same woman from question #4 has an ASCUS cytology result. According to the 2015 interim guidance report, what is the appropriate management?Follow up primary hrHPV screening in 12 monthsImmediate colposcopyTriage to cytologyCotesting in 5 years