With the goal of improving cervical cancer care, AACC has published a new guidance document with expert recommendations on detecting this cancer. The guidance aims to update healthcare and laboratory medicine professionals on the latest advancements in this field, and to help them select the most effective cervical cancer detection strategy for their patients.
Over the last couple decades, cervical cancer detection has evolved rapidly. Clinicians used to rely primarily on Pap testing, also known as cervical cytology, to screen for this cancer. However, in light of the fact that the human papillomavirus (HPV) actually causes the majority of cervical cancers, medical organizations now recommend screening for cervical cancer with either primary HPV testing, or by co-testing with both HPV testing and cervical cytology.
Three recent guidelines put out by the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and United States Preventative Services Task Force (USPSTF), respectively, all advocate for these new approaches. However, the three guidelines also contain nuanced differences, which could make it difficult for clinicians and labs to determine how best to update their cervical cancer detection strategies.
Further reading: Why the Triage Approach Will Improve Cervical Cancer Screening and Diagnosis
In order to help clinicians and labs navigate these guidelines, AACC’s guidance provides a clear comparison of the ACS, ASCCP, and USPSTF guidelines in the context of the latest evidence on cervical cancer detection.
Significantly, AACC’s guidance notes that there are no randomized trials comparing mortality rates among the various screening strategies recommended by these organizations. This means that certain decisions about cervical cancer screening should be based on informed discussions with the patient, while other decisions can be made based on what works best for an institution. As an example of the latter, primary HPV screening performs similarly to and with lower costs than screening with co-testing. This means that institutions can screen with HPV testing alone if they have an HPV test that is FDA-approved for primary screening, while institutions with one of the other HPV tests can continue to use co-testing.
One other feature of the guidance is an ideal lab report template for HPV and cervical cancer testing that is designed to help clinicians quickly review results and make care decisions. The guidance also examines the latest studies supporting the use of self-collected vaginal specimens for HPV testing, an approach that is not yet used in the U.S. but that could improve cervical cancer detection in underscreened populations.
“This guidance document addresses key questions related to cervical cancer screening and management and introduces the most recently updated screening guidelines, risk-based management for screening and surveillance, as well as methodologies for the diagnosis of cervical cancer,” say guidance document authors Yusheng Zhu, PhD; Sarah Feldman, MD, MPHD; Shuk On Annie Leung, MD; Michael H. Creer, MD; Joshua Warrick, MD; Nicole Williams, MD; and Stephen Mastorides, MD. “Additionally, a laboratory report template is proposed for human papillomavirus and cervical cancer detection to facilitate interpretation of results and clinical decision-making. This guidance document will help clinical laboratorians and clinicians utilize the most recent guidelines for cervical cancer screening, surveillance, and diagnosis.”