Developing guidelines for cervical cancer prevention in the face of diagnostic complexity

Adoption of new cervical cancer screening guidelines by the American Cancer Society and others in 2012 required new guidelines for the management of abnormal screening and follow-up tests. The American Society for Colposcopy and Cervical Pathology led a consensus conference including 26 professional organizations and agencies that developed new management guidelines. These guidelines are risk-based and derive from analysis of approximately 1.4 million women screened by the Kaiser Permanente Northern California medical group, with risk assessment in collaboration with NCI. New guidelines provide guidance for the conservative management of young women, for women with unsatisfactory Papanicolaou (Pap) tests and tests with limited transformation zone component, for women with discordant Pap and human papillomavirus (HPV) co-testing results, and for the incorporation of HPV 16/18 genotyping results into management decisions. The increasing number of available tests and the increasingly nuanced understanding of risk mean that clinicians will need to offset the complexity of diagnostic and treatment algorithms with technology and specialization.