In adolescents, treat abnormalities conservatively
A major theme of the 2006 guidelines is a more conservative approach to adolescent patients (ages 13 to 20 years). Although this population has a very low risk of developing invasive cervical cancer, women 15 to 19 years of age are very likely to be diagnosed with minor cytologic abnormalities such as atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL), owing to the very high prevalence of anogenital HPV infection in this age group.
Because most anogenital HPV infections will spontaneously clear, minor cytologic abnormalities are usually of little consequence in adolescents.
Therefore, the 2006 consensus guidelines discourage the use of colposcopy in adolescents who have ASC-US and LSIL. Instead, these patients should be followed with annual repeat cytology and referred to colposcopy only when a high-grade cytologic abnormality is identified or when a low-grade cytologic abnormality persists for 24 months.
HPV testing most informative in older women
The new guidelines expand the clinical indications for HPV DNA testing and provide recommendations for managing different combinations of cytology and HPV test results when screening women 30 years and older. For example, they emphasize the use of HPV DNA testing in postmenopausal women because recent studies clearly demonstrate that the prevalence of high-risk HPV DNA positivity is lower in postmenopausal women with ASC-US or LSIL than in younger women.
Use only FDA-approved HPV tests
With the expanded indications for HPV DNA testing, the new guidelines take pains to point out that HPV test methods that have not been approved by the FDA may not produce findings consistent with approved methods. This is a very important point because many laboratories have started using unapproved testing methods. Although these methods have been validated internally by the laboratories, they have not been through the rigorous evaluation required for FDA approval. The new guidelines therefore state: “Appropriate use of these guidelines requires that laboratories utilize only HPV tests that have been analytically and clinically validated with proven acceptable reproducibility, clinical sensitivity, specificity, and positive and negative predictive values for cervical cancer and verified precancer (CIN 2,3), as documented by FDA approval and/or publication in peer-reviewed scientific literature.”
The guidelines are accessible online at the ASCCP Web site at www.asccp.org/consensus/cytological.shtml.