Clinical Question

How should abnormal test results be managed in patients who have had cervical cancer screening?

Evidence Summary

Cervical cancer incidence and mortality have decreased significantly in the United States since the introduction of cervical cancer screening.¹ In 2019, the American Society for Colposcopy and Cervical Pathology (ASCCP) published updated consensus guidelines for the management of abnormal cervical cancer screening results in asymptomatic patients. These guidelines provided recommendations that attempted to maximize cervical cancer prevention and limit harms from overtesting and overtreatment.²

The ASCCP guidelines help determine the risk of developing cervical intraepithelial neoplasia grade 3 or worse (CIN3+), including CIN3, adenocarcinoma in situ, and invasive cervical cancer, and recommend management based on the guiding principle that equal risk should receive equal management. Risk estimates were based on a prospective longitudinal cohort of more than 1.5 million patients followed for more than 10 years at Kaiser Permanente–Northern California³ and were validated in several databases that represent patients of diverse racial, ethnic, and socioeconomic backgrounds.^4–9