Acog Cervical ****** Screening Guidelines 2016

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Cervical cancer screening dramatically reduces the risk of developing cervical cancer. Get the latest guidelines for health care professionals and patient information for women about cervical cytology testing (Pap test or Pap smear), HPV testing, abnormal cervical cancer screening test results, cervical screening in developing countries, and cervical cancer screening for HIV patients. Ob-gyns, physicians whose primary responsibility is women’s health, play a leading role in cervical cancer screening.

Here are the key publications and resources for ob-gyns, other women’s health care providers, and patients from the American College of Obstetricians and Gynecologists (ACOG) and other sources. Jump to:Resources for Ob-Gyns and Women’s Health Care ProvidersResources for Women and Patients Resources for Ob-Gyns and Women’s Health Care Providers Practice Bulletin: Cervical Cancer Screening and Prevention (members only) “Cervical Cancer Screening and Prevention,” issued by ACOG in October 2016, provides a review of the best available evidence for cervical cancer screening.

This evidence-based guideline covers cervical cytology (Pap test) screening techniques and test reporting, and human papillomavirus (HPV) vaccination and testing. Committee Opinion: Well-Woman Visit “Well-Woman Visit,” issued by ACOG in August 2012 (reaffirmed 2014), emphasizes the importance of an annual health visit, including cervical cancer screening. This guideline states that speculum examinations for cervical cancer screening should begin at age 21 as part of this annual health assessment, irrespective of sexual activity of the patient.

Practice Bulletin: Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors (members only) “Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors,” issued by ACOG in December 2013 (reaffirmed 2016), is an evidence-based guideline that defines when to return to routine screening after treatment or resolution of abnormalities, updates the incorporation of HPV testing, and integrates new data on the risk of high-grade precursor lesions and cancer.

Statement of Policy: Cervical Cancer Prevention in Low-Resource Settings (members only) “Cervical Cancer Prevention in Low-Resource Settings,” issued by ACOG in March 2004 (reaffirmed 2011), addresses the need for more cost-effective ways to prevent cervical cancer in low-resource settings, especially developing countries. It affirms that there is growing evidence that a single-visit approach, incorporating visual inspection of the cervix with acetic acid wash (VIA), followed by an immediate offer of treatment with cryotherapy for eligible lesions, is safe, acceptable, and cost-effective.

  Practice Bulletin: Gynecologic Care for Women and Adolescents with Human Immunodeficiency Virus (Members Only) “Gynecologic Care for Women and Adolescents with Human Immunodeficiency Virus,” issued by ACOG  in October 2016 notes that women infected with HIV are at increased risk for high-risk human papillomavirus (HPV) infection and cervical neoplasms. However, among HIV-positive women who receive regular screening and recommended follow-up, the incidence of cervical cancer is no higher than in HIV-negative women, notes the evidence-based guideline.

Committee Opinion: Hereditary Cancer Syndromes and Risk Assessment  “Hereditary Cancer Syndromes and Risk Assessment,” issued by ACOG in June 2015, emphasizes risk assessment by an ob-gyn as key to identifying patients who may be at increased risk of developing certain types of cancer. It also notes that referral to a specialist in cancer genetics is recommended if risk assessment suggests an increased risk of a hereditary cancer syndrome.

Committee Opinion: Cervical Cancer Screening in Low-Resource Settings  “Cervical Cancer Screening in Low-Resource Settings,” issued by ACOG in February 2015, identifies alternative cervical cancer screening strategies, such as HPV testing or visual inspection with acetic acid, that may be implemented in low-resource settings where cytology-based screening is not feasible.  Resources for Women and Patients Cervical Cancer Screening Infographic ACOG’s  Cervical Cancer Screening Infographic, issued in February 2016, explains when women should be screened for cervical cancer and whether they should receive a Pap test or co-testing with the HPV test.

Patient Fact Sheet: “New Guidelines for Cervical Cancer Screening” “New Guidelines for Cervical Cancer Screening,” issued by ACOG in September 2013, provides women with the latest recommendations for Pap and HPV testing. Patient FAQ: Colposcopy “Colposcopy,” issued by ACOG in April 2015, explains that colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope, which shines a light into the vagina and onto the cervix.

Colposcopy is done when results of cervical cancer screening show abnormal changes in the cells of the cervix. Sometimes, a biopsy is performed at the same time.  Patient FAQ: Cervical Cancer Screening “Cervical Cancer Screening,” issued by ACOG in February 2016, explains that cervical cancer screening, used to find changes in the cells of the cervix that could lead to cancer, includes the Pap test (Pap smear) and, for some women, HPV testing.

Patient FAQ: Human Papillomavirus (HPV) Infection “Human Papillomavirus (HPV) Infection,” issued by ACOG in November 2015, covers the role of human papillomavirus (HPV) infection in genital warts and cervical cancer. It explains cervical cancer prevention with the HPV vaccine, as well as cervical cancer screening with the Pap and HPV tests. Patient FAQ: Loop Electrosurgical Excision Procedure (LEEP)  “Loop Electrosurgical Excision Procedure (LEEP),” issued by ACOG in July 2014, explains how this procedure may be used after an abnormal cervical cancer screening result for evaluation and treatment.

LEEP is one way to remove abnormal cells from the cervix. Patient FAQ: Abnormal Cervical Cancer Screening Test Results “Abnormal Cervical Cancer Screening Test Results,” issued by ACOG in January 2016, explains the types of abnormal cervical cancer screening results and their causes, what testing is needed after an abnormal test result, and treatment options for abnormal cervical cells.

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An updated practice bulletin from the American College of Obstetricians and Gynecologists (ACOG) highlights changes in cervical cancer screening and prevention recommendations. These include discussion of the role of screening with human papillomavirus (HPV) testing alone, updates on efficacy of the HPV vaccine, and revised guidelines on cancer screening in HIV-positive women. The practice bulletin was published in the January 2016 issue of Obstetrics & Gynecology.

Current guidelines came before the US Food and Drug Administration (FDA) approved a currently marketed HPV test for primary cervical cancer screening. ACOG states that this test alone can now be considered an alternative to current cytology-based cancer screening (the Papanicolaou test) in women aged 25 years and older. Screening should stop at age 65 years in women with a negative screening history.

ACOG still recommends cytology testing alone every 3 years for women aged 21 to 29 years. For women aged 30 to 65 years, cotesting with cytology and HPV testing every 5 years is preferred, and screening with cytology alone every 3 years is acceptable, according to the guidance. ACOG recommends against annual testing. David Chelmow, MD, from the Department of Obstetrics and Gynecology at Virginia Commonwealth University Medical Center in Richmond, told Medscape Medical News that HPV testing alone as an alternative screening in women aged 25 years and older, "is not part of any major society's guidelines yet.

" Dr Chelmow drafted the practice bulletin for review by the Committee on Practice Bulletins–Gynecology. He said the guidance on the HPV test as an alternative follows interim guidance in 2015 from the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology. "We include that in this practice bulletin, acknowledging that it is FDA-approved, and if people are going to use it, they should use it according to the interim guidance.

" He added, "When one of those societies revises their full set of guidelines, we'll need to see if HPV testing is included in that. I suspect it will, but we're not at that point yet." Edward Evantash, MD, says revising guidelines to recommend the HPV test alone would be a mistake. Dr Evantash, an obstetrician-gynecologist, is medical director and vice president of medical affairs at Hologic and was previously chief of the Division of General Obstetrics and Gynecology at Tufts Medical Center in Boston, Massachusetts.

He says the HPV test alone would miss cancers, and that there is very little evidence of its benefit. Results of a study that bring into question the benefit of the single HPV test were previously reported by Medscape Medical News. The evidence level in the practice bulletin is listed as level B. "There is data that shows you will have a loss of sensitivity for detection of cancer and severe precancerous abnormalities when you use only one test for HPV as opposed to both tests.

... There is more data that will be forthcoming, data that may not have been included in this, and we look forward to it being included in future practice bulletins," Dr Evantash told Medscape Medical News. Guidance for HIV-Positive Women HIV-positive women younger than 30 years can now undergo cytology testing once every 3 years instead of annually if they have had three consecutive normal annual cytology tests.

ACOG recommends against cotesting for women younger than 30 years. Women with HIV who are aged 30 years or older can undergo either testing with cytology alone or cotesting. Those with three consecutive normal annual cytology tests can then be screened annually, and those with one normal cotest result can also be screened annually. ACOG recommends against starting screening before age 21 years unless a woman is HIV-positive, regardless of the age of onset of sexual intercourse.

Only 0.1% of cases of cervical cancer occur before age 20 years, and evidence that screening is effective in this age group is lacking. The practice bulletin also includes guidance on using the new 9-valent HPV vaccine, which covers an additional five high-risk strains of the virus. "[G]iven the high degree of protection with any HPV vaccine and the risk of viral infection in unvaccinated women, eligible patients should be vaccinated with whichever vaccine is readily available to them [bivalent, quadrivalent, or 9-valent], and vaccination should not be delayed to obtain a specific vaccine type," the authors write.

"This is one of the things that gets lost when we talk about screening guidelines," Dr Chelmow said. "We have primary prevention here, and we woefully underuse the vaccine in this country: only 30% of eligible women. That's really the future of preventing cervical cancer." Dr Chelmow is editor-in-chief of Medscape's Obstetrics and Gynecology textbook. Obstet Gynecol. 2015;127:185-187. Abstract

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