Screening and Treatment for Cervical Dysplasia

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ScreeningandTreatmentforCervical Dysplasia
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Background
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A
L T
S
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Ascus-
Lsil
Triage Study

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NCI funded study ALTS Four Major Medical
Centers University of Alabama,
Birmingham University of Oklahoma, Oklahoma
City Magee-Womens Hospital, Pittsburgh University
of Washington. Seattle total of about 7,200
women
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ASCCP 121 experts, 29 participating professional
organizations Bethesda, MD 2001 Consensus
Guidelines Bethesda, MD, September 2006 146
experts, 29 participating professional
organizations
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• More information from ALTS
• HPV-DNA Testing
• utilization of 2001 guidelines revealed changes
  needed in special populations
• ..a desire to streamline the guidelines and
  make them more user-friendly

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New Guidelines published 10/1/07
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Cytological Guidelines- (Screening) What to do
with abnormal Pap smear results Histological
Guidelines- (Treatment) What to do with biopsy
results
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Screening (who, when, how long, etc.)
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Recommendations for Cervical Cancer
Screening
ASCCP / ACS / USPSTF / ACOG / NCCN Age to
Start Screening 3
years after onset of sexual

activity but no later than

21 years of age
When to stop
screening? Screening after hysterectomy?

all have Screening interval?

variations in Use of HPV-DNA
test as adjunct to cytology
recommendations in women 30
years and older

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Biggest change in guidelines AGE
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OLD Colposcopy for all abnormal Pap
smears Except ASC HPV-DNA Negative (so we ordered
HPV-DNA reflex on everybody) NEW
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SCREENING Adolescents 20 years and
younger Dont order HPV-DNA at all! Women
21 years and older Order HPV-DNA reflex Women 30
and over Use HPV-DNA as adjunct to cytology
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Who needs to have colposcopy? Who needs to
only be followed? How? How often? Who needs to be
treated? How?
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Cytological (Screening) Adolescents
(ASC- LSIL, HSIL) Women (ASC, ASC-H, LSIL,
HSIL, AGC) Histological (Treatment)
Adolescents (mild, moderate- severe) Women
(mild preceded by..., moderate- severe,
adencarcinoma in-situ)
Pregnancy Use of HPV-DNA testing as
adjunct for women 30 years and older
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Management (Treatment)
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• Colposcopy and cytology at 6-month intervals for
  up to two years
• Repeat cytology at 6 and 12 months
• Cytology at 6 and 12 months OR HPV-DNA testing
  at 12 months
• Colposcopy and cytology at 6-month intervals for
  1 year
• Repeat cytology and HPV-DNA at 12 mo. if (-) or
  at 6 mo. if ()
• Repeat cytology at 12 months

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Shift to following more, treating
less- WHERE ARE WE HEADED? No
more Pap smears?
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Canadian Cervical Cancer Screening
Trial Conclusion A shift from cellular
(cytologic) to viral (molecular) testing, coupled
with education and vaccination, will contribute
to more efficient control of cervical cancer.
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Molecular Screening for Cervical Cancer- Time to
Give up Pap Tests? Carolyn Runowicz, M. D. If we
switch to HPV-DNA screening only we will need to
develop a rapid, simple, accurate, and
affordable HPV-DNA testThe ultimate goal is to
reduce the incidence of and mortality from
invasive cervical cancer worldwide.The optimal
approach will depend on the prevalence of
disease, access to screening, and available
resources. We are not there yet.
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