Updated Cervical Cancer Screening Guidelines: 2012 Update

1. American Society of Cytopathology’s CELL Talks • Cervical Cancer Screening Guidelines • 2012 Update – Changes

2. Insert photo here Insert photo here Jennifer Sauter, M.D. Cytopathology Fellow Mayo Clinic Rochester, Minnesota Michael Henry, M.D. Director of Cytopathology Mayo Clinic Rochester, Minnesota

3. Objectives • Understand the updated cervical cancer screening guidelines • Become familiar with primary hrHPV screening as an alternative to traditional screening methods

4. Cytopathology Milestones

5. Background • Updated cervical cancer screening guidelines: • Cancer J Clin. 2012;62(3):147-72 • J Low Genit Tract Dis. 2012;16(3):175-204 • Am J ClinPathol. 2012;137(4):516-42

6. ASC/ASCCP/ASCP Guidelines (2012) • Screening Recommendations • Link to article in J Low Genit Tract Dis • ASCCP PowerPoint presentation • App • ASCCP Mobile • Available for iPad/iPhone/Android

7. What are the goals of screening? • Recommendations should: • Maximize the benefits of screening • Minimize potential harms of screening

8. Screening Population • General population • Not high-risk populations: • Cervical cancer history • Exposure to DES in utero • Immunocompromised

9. What has changed? 2012 Cervical Cancer Screening Update: • Screening intervals • Age-specific screening strategies • Management of discordant cotest results • Exiting from screening • Impact of HPV vaccination • Potential utility of molecular screening

10. Screening Intervals • Annual screening is not appropriate • Intervals based on age and clinical history

11. Age-specific screening strategies • Women ages 21-29: • hrHPV testing should not be used

12. Age-specific screening strategies • Women ages 30-65: or

13. Discordant cotest results • hrHPV positive, cytology negative:

14. Discordant cotest results • Negative hrHPV, ASCUS cytology: • Routine screening as per age-specific guidelines

15. Exiting from screening ^Once discontinued, screening should not resume for any reason

16. History of CIN2+ or AIS: • Continue screening for 20 years • Even if screening is extended past age 65

17. Impact of HPV vaccination • Screening after HPV vaccination: • Screening practices should not change on the basis of HPV vaccination status

18. Utility of molecular screening • Screening with hrHPV testing alone: • Women should not be screened with hrHPV testing alone

19. hrHPV Primary Screening • FDA news release • CobashrHPVTest • Roche Molecular Systems, Inc (Pleasanton, CA)

20. hrHPV Primary Screening • Interim guidance report: • GynOncol. 2015;136(2):178-82 • J Low Genit Tract Dis. 2015;19(2):91-6 • Obstet Gynecol. 2015;125(2):330-7

21. hrHPV Primary Screening • Interim guidance report: • Primary hrHPV screening should not be initiated prior to25years of age • Primary hrHPV screening is safe and effective • Cytology and cotesting remain recommended screening strategies

22. hrHPV Primary Screening • Recommended Management: Management • Colposcopy >ASCUS • 12 month F/U NILM

23. ASC Lab Management Cell Talk: Recap 2012 Cervical Cancer Screening Update: • Screening intervals • Age specific screening strategies • Management of discordant cotest results • Exiting from screening • Impact of HPV vaccination • Potential utility of molecular testing

24. Thank you! • ASC Foundation • ASC Cytopathology Program Directors Committee • Members 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 Sheldon • Mayo Clinic Department of Cytopathology • Consultants and fellow trainees

25. Quiz Question #1 A 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 colposcopy • Repeat cotesting in 5 years • Repeat cytology only in 3 years • Repeat cotesting in 12 months

26. Quiz Question #2 12 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 colposcopy • Repeat cotesting in 5 years • Repeat cytology only in 3 years • Repeat cotesting in 12 months

27. Quiz Question #3 A 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 screening • Immediate cytology screening • No management necessary • HPV vaccination

28. Quiz Question #4 A 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 months • Immediate colposcopy • Triage to cytology • Cotesting in 5 years

29. Quiz Question #5 The 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 months • Immediate colposcopy • Triage to cytology • Cotesting in 5 years