Didem Egemen1, Rebecca B Perkins2, Megan A Clarke1, Richard Guido3, Warner Huh4, Mona Saraiya5, Debbie Saslow6, Robert Smith6, Elizabeth R Unger5, Francisco Garcia7, Nicolas Wentzensen1, Li C Cheung1. 1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD. 2. Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA. 3. Department of Obstetrics and Gynecology, Magee-Women's Hospital, Pittsburgh, PA. 4. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL. 5. Centers for Disease Control and Prevention, Atlanta, GA. 6. American Cancer Society, Atlanta, GA. 7. Community and Health Services, Chief Medical Officer, Pima County, AZ.
Abstract
OBJECTIVES: In the 2019 ASCCP Risk-Based Management Consensus Guidelines, clinical management decisions are based on immediate and 5-year cervical intraepithelial neoplasia (CIN) 3+ risk estimates. However, data for technologies other than human papillomavirus testing and cytology may be limited to clinical trials and observational studies of shorter duration than 5 years. To enable decisions about 1- or 3-year intervals, 3-year CIN 3+ risk equivalents to 5-year CIN 3+ risk thresholds were generated. MATERIALS AND METHODS: We examined screening test result scenarios around the 5-year risk thresholds of 0.15% and 0.55% and calculated the average percent increase in CIN 3+ risk from 3 to 5 years. Using this average increase, we obtained estimates of corresponding risk thresholds at 3 years. We then validated whether use of the 3-year risk threshold would have resulted in equivalent management per the 2019 recommendations. RESULTS: Around the 5-year CIN 3+ risk threshold of 0.55%, the average increase in risk from 3 to 5 years was 0.16%. Therefore, the equivalent threshold for 3-year risk was estimated as 0.39%. We found no difference in recommendations to return in 1 or 3 years using the 3-year or 5-year risk thresholds in 66 of the 67 scenarios (98.5%) in follow-up in 2019 guidelines. CONCLUSIONS: In this methodological addendum, the Enduring Guidelines Committee adopted the use of the 0.39% 3-year CIN 3+ risk threshold as equivalent of the 0.55% 5-year CIN 3+ risk threshold for technologies with fewer than 5 years of follow-up data. This allows evidence-based guidance for surveillance intervals of 1 or 3 years for new technologies with limited longitudinal data.
OBJECTIVES: In the 2019 ASCCP Risk-Based Management Consensus Guidelines, clinical management decisions are based on immediate and 5-year cervical intraepithelial neoplasia (CIN) 3+ risk estimates. However, data for technologies other than human papillomavirus testing and cytology may be limited to clinical trials and observational studies of shorter duration than 5 years. To enable decisions about 1- or 3-year intervals, 3-year CIN 3+ risk equivalents to 5-year CIN 3+ risk thresholds were generated. MATERIALS AND METHODS: We examined screening test result scenarios around the 5-year risk thresholds of 0.15% and 0.55% and calculated the average percent increase in CIN 3+ risk from 3 to 5 years. Using this average increase, we obtained estimates of corresponding risk thresholds at 3 years. We then validated whether use of the 3-year risk threshold would have resulted in equivalent management per the 2019 recommendations. RESULTS: Around the 5-year CIN 3+ risk threshold of 0.55%, the average increase in risk from 3 to 5 years was 0.16%. Therefore, the equivalent threshold for 3-year risk was estimated as 0.39%. We found no difference in recommendations to return in 1 or 3 years using the 3-year or 5-year risk thresholds in 66 of the 67 scenarios (98.5%) in follow-up in 2019 guidelines. CONCLUSIONS: In this methodological addendum, the Enduring Guidelines Committee adopted the use of the 0.39% 3-year CIN 3+ risk threshold as equivalent of the 0.55% 5-year CIN 3+ risk threshold for technologies with fewer than 5 years of follow-up data. This allows evidence-based guidance for surveillance intervals of 1 or 3 years for new technologies with limited longitudinal data.
Authors: Nicolas Wentzensen; Marc Arbyn; Johannes Berkhof; Mark Bower; Karen Canfell; Mark Einstein; Christopher Farley; Joseph Monsonego; Silvia Franceschi Journal: Int J Cancer Date: 2017-01-11 Impact factor: 7.396
Authors: Kate Cuschieri; Guglielmo Ronco; Attila Lorincz; Laurie Smith; Gina Ogilvie; Lisa Mirabello; Francesca Carozzi; Heather Cubie; Nicolas Wentzensen; Peter Snijders; Marc Arbyn; Joe Monsonego; Silvia Franceschi Journal: Int J Cancer Date: 2018-02-08 Impact factor: 7.396
Authors: Rebecca B Perkins; Richard S Guido; Philip E Castle; David Chelmow; Mark H Einstein; Francisco Garcia; Warner K Huh; Jane J Kim; Anna-Barbara Moscicki; Ritu Nayar; Mona Saraiya; George F Sawaya; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 1.925
Authors: Li C Cheung; Didem Egemen; Xiaojian Chen; Hormuzd A Katki; Maria Demarco; Amy L Wiser; Rebecca B Perkins; Richard S Guido; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842
Authors: Didem Egemen; Li C Cheung; Xiaojian Chen; Maria Demarco; Rebecca B Perkins; Walter Kinney; Nancy Poitras; Brian Befano; Alexander Locke; Richard S Guido; Amy L Wiser; Julia C Gage; Hormuzd A Katki; Nicolas Wentzensen; Philip E Castle; Mark Schiffman; Thomas S Lorey Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842