What are the American Society for Colposcopy and Cervical Pathology (ASCCP) treatment guidelines for abnormal cervical cancer screening results?

Updated: Feb 12, 2019
  • Author: Cecelia H Boardman, MD; Chief Editor: Warner K Huh, MD  more...
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Answer

In March 2013, the American Society for Colposcopy and Cervical Pathology (ASCCP) issued updated guidelines for managing women with abnormal cervical cancer screening results and diagnosed cancer precursors. The Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors include the following [57, 58] :

  • Guidance for the management of discordant co-tests: If results of either Pap smear or HPV testing are positive, but not both, co-testing is integrated into follow-up care. Colposcopy, HPV DNA typing, or both may be indicated.

  • Routine screening: A recommendation for a return to "routine" screening in women treated for cervical cancer is specified.

  • Adolescent screening: Screening is no longer recommended for adolescents. Women aged 21-24 years are at low risk for invasive cervical cancer; however, they are at high risk for HPV exposure and associated lesions. The recommended workup varies according to findings of atypical squamous cells of undetermined significance or low-grade or high-grade squamous intraepithelial lesion; this may include colposcopy.

  • Neoplasia guidance: The guidelines address whether cervical intraepithelial neoplasia grade 1 (CIN1) on endocervical canal curettage (ECC) should be treated as positive ECC or CIN1.

  • Guidance for the management of women with unsatisfactory cytologic findings and specimens that are missing endocervical or transformation zone components: Colposcopy may be required for women with positive HPV results or with repeated unsatisfactory cytologic findings.

Current US guidelines advise against using HPV testing to screen for cervical cancer in women younger than 30 years; the ACS advises that for screening in women 30-65 years of age, HPV testing alone is not currently recommended for most clinical settings in the US. Annual screening is not recommended at any age or with any method.


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