Nicolas Wentzensen1, Mark Schiffman, Michelle I Silver, Michelle J Khan, Rebecca B Perkins, Katie M Smith, Julia C Gage, Michael A Gold, Christine Conageski, Mark H Einstein, Edward J Mayeaux, Alan G Waxman, Warner K Huh, L Stewart Massad. 1. 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; 2Department of Obstetrics and Gynecology, Department of Adult and Family Medicine, Kaiser Permanente Northern California, San Leandro, CA; 3Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, MA; 4Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK; 5Tulsa Cancer Institute, University of Oklahoma, School of Community Medicine, Tulsa, OK; 6Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO; 7Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, NJ; 8Department of Family and Preventive Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, SC; 9Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM; 10Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL; and 11Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
Abstract
OBJECTIVES: The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy for cervical cancer prevention in the United States. MATERIALS AND METHODS: The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. This article describes the rationale, evidence, and recommendations related to risk-based colposcopy practice. RESULTS: Women referred to colposcopy have a wide range of underlying precancer risk, which can be estimated by referral screening tests including cytology and human papillomavirus testing, in conjunction with the colposcopic impression. Multiple targeted biopsies, at least 2 and up to 4, are recommended to improve detection of prevalent precancers. At the lowest end of the risk spectrum, untargeted biopsies are not recommended, and women with a completely normal colposcopic impression can be observed. At the highest end of the risk spectrum, immediate treatment is an alternative to biopsy confirmation. CONCLUSIONS: Assessing the risk of cervical precancer at the colposcopy visit allows for modification of colposcopy procedures consistent with a woman's risk. Implementation of these recommendations is expected to lead to improved detection of cervical precancers at colposcopy, while providing more reassurance of negative colposcopy results.
OBJECTIVES: The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy for cervical cancer prevention in the United States. MATERIALS AND METHODS: The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. This article describes the rationale, evidence, and recommendations related to risk-based colposcopy practice. RESULTS:Women referred to colposcopy have a wide range of underlying precancer risk, which can be estimated by referral screening tests including cytology and human papillomavirus testing, in conjunction with the colposcopic impression. Multiple targeted biopsies, at least 2 and up to 4, are recommended to improve detection of prevalent precancers. At the lowest end of the risk spectrum, untargeted biopsies are not recommended, and women with a completely normal colposcopic impression can be observed. At the highest end of the risk spectrum, immediate treatment is an alternative to biopsy confirmation. CONCLUSIONS: Assessing the risk of cervical precancer at the colposcopy visit allows for modification of colposcopy procedures consistent with a woman's risk. Implementation of these recommendations is expected to lead to improved detection of cervical precancers at colposcopy, while providing more reassurance of negative colposcopy results.
Authors: Liming Hu; David Bell; Sameer Antani; Zhiyun Xue; Kai Yu; Matthew P Horning; Noni Gachuhi; Benjamin Wilson; Mayoore S Jaiswal; Brian Befano; L Rodney Long; Rolando Herrero; Mark H Einstein; Robert D Burk; Maria Demarco; Julia C Gage; Ana Cecilia Rodriguez; Nicolas Wentzensen; Mark Schiffman Journal: J Natl Cancer Inst Date: 2019-09-01 Impact factor: 13.506
Authors: Michelle I Silver; Jeff Andrews; Charles K Cooper; Julia C Gage; Michael A Gold; Michelle J Khan; L Stewart Massad; Valentin Parvu; Rebecca B Perkins; Mark Schiffman; Katie M Smith; Nicolas Wentzensen Journal: Obstet Gynecol Date: 2018-09 Impact factor: 7.661
Authors: Alan G Waxman; Christine Conageski; Michelle I Silver; Candice Tedeschi; Elizabeth A Stier; Barbara Apgar; Warner K Huh; Nicolas Wentzensen; L Stewart Massad; Michelle J Khan; Edward J Mayeaux; Mark H Einstein; Mark H Schiffman; Richard S Guido Journal: J Low Genit Tract Dis Date: 2017-10 Impact factor: 1.925
Authors: Nicolas Wentzensen; Joan Walker; Katie Smith; Michael A Gold; Rosemary Zuna; L Stewart Massad; Angela Liu; Michelle I Silver; S Terence Dunn; Mark Schiffman Journal: Am J Obstet Gynecol Date: 2018-02-17 Impact factor: 8.661
Authors: Maria Demarco; Li C Cheung; Walter K Kinney; Nicolas Wentzensen; Thomas S Lorey; Barbara Fetterman; Nancy E Poitras; Brian Befano; Philip E Castle; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2018-04 Impact factor: 1.925
Authors: Maria Demarco; Thomas S Lorey; Barbara Fetterman; Li C Cheung; Richard S Guido; Nicolas Wentzensen; Walter K Kinney; Nancy E Poitras; Brian Befano; Philip E Castle; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2017-10 Impact factor: 1.925
Authors: Chyke A Doubeni; Nicole B Gabler; Cosette M Wheeler; Anne Marie McCarthy; Philip E Castle; Ethan A Halm; Mitchell D Schnall; Celette S Skinner; Anna N A Tosteson; Donald L Weaver; Anil Vachani; Shivan J Mehta; Katharine A Rendle; Stacey A Fedewa; Douglas A Corley; Katrina Armstrong Journal: CA Cancer J Clin Date: 2018-03-30 Impact factor: 508.702