American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer§

Authors

  • Debbie Saslow PhD,

    Corresponding author
    1. Director, Breast and Gynecologic Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA, on behalf of the Steering Committee, Data Group, and Writing Committee
    • Director, Breast and Gynecologic Cancer, American Cancer Society, 250 Williams St NW, Suite 600, Atlanta, GA 30303
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  • Diane Solomon MD,

    1. Senior Investigator, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, on behalf of the Steering Committee
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  • Herschel W. Lawson MD,

    1. Adjunct Associate Professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, on behalf of the Data Group
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  • Maureen Killackey MD,

    1. Deputy Physician in Chief, Medical Director, Memorial Sloan-Kettering Cancer Center Regional Network, Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, on behalf of Working Group 1
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  • Shalini L. Kulasingam PhD,

    1. Assistant Professor, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, on behalf of Working Group 1
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  • Joanna Cain MD,

    1. Professor and Vice Chair, Department of Obstetrics and Gynecology, University of Massachusetts School of Medicine, Worcester, MA, on behalf of Working Group 2
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  • Francisco A. R. Garcia MD, MPH,

    1. Professor and Director, Center of Excellence in Women's Health, Mel and Enid Zuckerman College of Public Health, University of Arizona at Tucson, Tucson, AZ, on behalf of Working Group 6
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  • Ann T. Moriarty MD,

    1. Director, Department of Esoteric Testing, AmeriPath Indiana, Indianapolis, IN, on behalf of Working Group 6
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  • Alan G. Waxman MD, MPH,

    1. Professor, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, on behalf of Working Group 3a
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  • David C. Wilbur MD,

    1. Professor of Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, on behalf of Working Group 3b
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  • Nicolas Wentzensen MD, PhD, MS,

    1. Investigator, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Levi S. Downs Jr MD,

    1. Director, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN, on behalf of Working Group 4
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  • Mark Spitzer MD,

    1. Professor of Clinical Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, on behalf of Working Group 4
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  • Anna-Barbara Moscicki MD,

    1. Professor, Department of Pediatrics, University of California at San Francisco, San Francisco, CA, on behalf of Working Group 5
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  • Eduardo L. Franco DrPH,

    1. Professor, Departments of Oncology and Epidemiology, McGill University, Montreal, Quebec, Canada
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  • Mark H. Stoler MD,

    1. Professor of Pathology and Clinical Gynecology, Associate Director of Surgical and Cytopathology, Surgical Pathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA
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  • Mark Schiffman MD,

    1. Senior Investigator, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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  • Philip E. Castle PhD, MPH,

    1. Executive Director, American Society for Clinical Pathology Institute, Washington, DC, on behalf of the Writing Committee
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    • Dr. Castle and Dr. Myers are co-senior authors.

  • Evan R. Myers MD, MPH,

    1. Professor, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
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    • Dr. Castle and Dr. Myers are co-senior authors.

  • ACS-ASCCP-ASCP Cervical Cancer Guideline Committee

    1. On behalf of Working Group 1, 2, 3a, 3b, 4, 5, 6, Data Group, Steering Committee, and Writing Committee
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    • Working Group 1: Maureen Killackey, MD (Co-Chair), Memorial Sloan-Kettering Cancer Center, New York, NY; Shalini L. Kulasingam, PhD (Co-Chair), University of Minnesota, Minneapolis, MN; Patricia Fontaine, MD, MS, HealthPartners Research Foundation, Bloomington, MN; Richard S. Guido, MD, Magee-Womens Hospital of the UPMC Health System, University of Pittsburgh, Pittsburgh, PA; Abbe Herzig, PhD, Health Ratings Center, Consumer Reports, Yonkers, NY; Herschel W. Lawson, MD, Emory University School of Medicine, Atlanta, GA; Dina R. Mody, MD, The Methodist Hospital, Houston, TX; Jeffrey Waldman, MD, Planned Parenthood, University of California at San Francisco, San Francisco, CA; and Mark H. Stoler, MD (liaison), University of Virginia Health System, Charlottesville, VA.

      Working Group 2: Joanna M. Cain, MD (Co-Chair), University of Massachusetts School of Medicine, Worcester, MA; Walter Kinney, MD (Co-Chair, liaison), University of California at Sacramento, The Permanente Medical Group, Sacramento, CA; George Birdsong, MD, Emory University School of Medicine, Grady Health System, Atlanta, GA; Wendy R. Brewster, MD, PhD, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC; David Chelmow, MD, Virginia Commonwealth University School of Medicine, Richmond, VA; Valerie J. King, MD, MPH, Oregon Health & Science University, Portland, OR; Robert G. Pretorius, MD, Southern California Permanente Medical Group, Fontana, CA; Cosette M. Wheeler, PhD, University of New Mexico Health Sciences Center, Albuquerque, NM; and Barbara A. Winkler, MD, Mount Kisco Medical Group, Mount Kisco, NY.

      Working Group 3a: Alan G. Waxman, MD, MPH (Chair), University of New Mexico School of Medicine, Albuquerque, NM; Jane J. Kim, PhD, Harvard School of Public Health, Boston, MA; Nicolas Wentzensen, MD, PhD, MS, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD; and Philip E. Castle, PhD, MPH (liaison), American Society for Clinical Pathology, Washington, DC.

      Working Group 3b: David C. Wilbur, MD (Chair), Massachusetts General Hospital, Harvard Medical School, Boston, MA; J. Thomas Cox, MD, University of California at Santa Barbara, Santa Barbara, CA; Isam A. Eltoum, MD, MBA, University of Alabama at Birmingham, Birmingham, AL; Philip E. Castle, PhD, MPH (liaison), American Society for Clinical Pathology, Washington, DC

      Working Group 4: Levi S. Downs, Jr, MD (Co-Chair), Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, MN; Mark Spitzer, MD (Co-Chair), Weill Medical College of Cornell University, New York, NY; Teresa M. Darragh, MD, University of California at San Francisco, San Francisco, CA; Shirley E. Greening, CT(ASCP), CFIAC, JD, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA; Hope K. Haefner, MD, The University of Michigan Hospitals and Health Centers, Ann Arbor, MI; E. J. Mayeaux, Jr, MD, DABFP, FAAFP, Louisiana State University Health Sciences Center, Shreveport, LA; Laurie Zephyrin, MD, MPH, MBA, New York-Presbyterian/Columbia University Medical Center, New York, NY; and Debbie Saslow, PhD (liaison), American Cancer Society, Atlanta, GA.

      Working Group 5: Anna-Barbara Moscicki, MD (Co-Chair), University of California at San Francisco, San Francisco, CA; Kevin A. Ault, MD, Emory University, Atlanta, GA; Myriam Chevarie-Davis, MD, McGill University, Montreal, Quebec, Canada; Eduardo L. Franco, DrPH, McGill University, Montreal, Quebec, Canada; Michael A. Gold, MD, Vanderbilt University Medical Center, Nashville, TN; Warner K. Huh, MD, University of Alabama at Birmingham, Birmingham, AL; and Diane Solomon, MD (liaison), Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD.

      Working Group 6: Francisco A. R. Garcia, MD, MPH (Co-Chair), Center of Excellence in Women's Health, Mel and Enid Zuckerman College of Public Health, University of Arizona at Tucson, Tucson, AZ; Ann T. Moriarty, MD (Co-Chair), AmeriPath, Indianapolis, IN; Terence J. Colgan, MD, Mount Sinai Hospital, Toronto, Ontario, Canada; Mark H. Einstein, MD, MS, Montefiore Medical Center, the Albert Einstein College of Medicine, Bronx, NY; Michael R. Henry, MD, Mayo Medical Laboratories, Rochester, MN; L. Stewart Massad, MD, Washington University School of Medicine, St. Louis, MO; Kate Simon, PhD, Microbiology Division, Office of In Vitro Diagnostic Device Evaluation and Safety, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD; and Patti Gravitt, PhD, MS (liaison), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Data Group: Herschel W. Lawson, MD (Co-Chair), Emory University School of Medicine, Atlanta, GA; Debbie Saslow, PhD (Co-Chair), American Cancer Society, Atlanta, GA; Philip E. Castle, PhD, MPH, American Society for Clinical Pathology, Washington, DC; Jack Cuzick, PhD, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK; Patti Gravitt, PhD, MS, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Walter Kinney, MD, University of California at Sacramento, The Permanente Medical Group, Sacramento, CA; Evan R. Myers, MD, MPH, Duke University Medical Center, Durham, NC; Kathleen G. Poole, MALS, American Society for Colposcopy and Cervical Pathology, Hagerstown, MD; Mark Schiffman, MD, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Diane Solomon, MD, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD; and Mark H. Stoler, MD, University of Virginia Health System, Charlottesville, VA.

      Steering Committee: Diane Solomon, MD (Co-Chair), Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD; Debbie Saslow, PhD (Co-Chair), American Cancer Society, Atlanta, GA; Philip E. Castle, PhD, MPH, American Society for Clinical Pathology, Washington, DC; Carmel J. Cohen, MD, The Derald H. Ruttenberg Treatment Center, Mount Sinai School of Medicine, New York, NY; Mitchell I. Edelson, MD, Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, PA; Francisco A. R. Garcia, MD, MPH, Center of Excellence in Women's Health, Mel and Enid Zuckerman College of Public Health, University of Arizona at Tucson, Tucson, AZ; E. Blair Holladay, PhD, SCT(ASCP)CM, American Society for Clinical Pathology, Chicago, IL; Walter Kinney, MD, University of California at Sacramento, The Permanente Medical Group, Sacramento, CA; Herschel W. Lawson, MD, Emory University School of Medicine, Atlanta, GA; Kenneth L. Noller, MD, MS, American Board of Obstetrics and Gynecology, Dallas, TX; Edward E. Partridge, MD, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; Kathleen G. Poole, MALS, American Society for Colposcopy and Cervical Pathology, Hagerstown, MD; Carolyn D. Runowicz, MD, Florida International University, Herbert Wertheim College of Medicine, Miami, FL; Robert A. Smith, PhD, American Cancer Society, Atlanta, GA; and Alan G. Waxman, MD, MPH, University of New Mexico School of Medicine, Albuquerque, NM.

      Writing Committee: Philip E. Castle, PhD, MPH (Co-Chair), American Society for Clinical Pathology, Washington, DC; Evan R. Myers, MD, MPH (Co-Chair), Duke University Medical Center, Durham, NC; Debbie Saslow, PhD (Co-Chair), American Cancer Society, Atlanta, GA; David Chelmow, MD, Virginia Commonwealth University School of Medicine, Richmond, VA; Eduardo L. Franco, DrPH, McGill University, Montreal, Quebec, Canada; Francisco A. R. Garcia, MD, MPH, Center of Excellence in Women's Health, Mel and Enid Zuckerman College of Public Health, University of Arizona at Tucson, Tucson, AZ; Abbe Herzig, PhD, Health Ratings Center, Consumer Reports, Yonkers, NY; Jane J. Kim, PhD, Harvard School of Public Health, Boston, MA; Walter Kinney, University of California at Sacramento, The Permanente Medical Group, Sacramento, CA; Herschel W. Lawson, MD, Emory University School of Medicine, Atlanta, GA; Mark Schiffman, MD, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Mark Spitzer, MD, Weill Medical College of Cornell University, New York, NY; Jeffrey Waldman, MD, Planned Parenthood, University of California at San Francisco, San Francisco, CA; Nicolas Wentzensen, MD, PhD, MS, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD; and David C. Wilbur, MD, Massachusetts General Hospital, Harvard Medical School, Boston, MA.


  • This article is jointly published in CA: A Cancer Journal for Clinicians, Journal of Lower Genital Tract Disease, and American Journal of Clinical Pathology by the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology.

  • The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the National Institutes of Health, the US government, or any medical or academic institutions.

  • §

    DISCLOSURES:The following reported no financial relationships or potential conflicts of interest to disclose: D. Saslow, E. Partridge, B. Holladay, W. Kinney, H. Lawson, K. Noller, K. Poole, R. Smith, P. Fontaine, A. Herzig, M. Killackey, S. Kulasingam, D. McCoy, W. Brewster, J. Cain, D. Chelmow, V. King, R. Pretorius, B. Winkler, I. Eltoum, J. Kim, N. Wentzensen, L. Downs, S. Greening, H. Haefner, L. Zephyrin, M. Chevarie-Davis, D. Ekwueme, T. Colgan, M. Henry, S. Massad, K. Simon. P. Castle receives payment for service on the Data Monitoring and Safety Board for Merck Sharp & Dohme and has received free or discounted human papillomavirus tests for research from Qiagen and Roche. C. Cohen serves as a speaker for Merck, Inc, and receives honoraria. M. Edelson's spouse is employed by and receives a salary from Merck and Company. F. Garcia is employed by the University of Arizona, which holds contracts for the performance of research with Roche Pharmaceutical/Roche Molecular; Hologic; Third Wave Technologies; MTM Laboratories; Qiagen; Becton, Dickson and Company (BD); and MediSpectra/LUMA. He also serves on the Speakers' Bureau for Qiagen and receives honoraria. J. Cuzick serves on advisory boards and as an ad hoc consultant for Qiagen; Roche; Gen-Probe, Inc; BD; and Abbott Laboratories, with research funds provided to his institution from Qiagen; Roche; Gen-Probe, Inc; BD; and Abbott Laboratories. P. Gravitt has acted as a member of the Women's Health Advisory Board for Qiagen Corporation and has received research funding from Roche Molecular Systems and Merck, Inc within the last 5 years. E. Myers received research support for investigations for Gen-Probe, Inc, and from GlaxoSmithKline (GSK), Inc. He served as a speaker for and received honoraria from Gen-Probe, Inc, and has served as a consultant for and received honoraria from Gen-Probe, Inc; Merck and Company; and GSK. M. Schiffman holds a research agreement to serve as a medical monitor in the National Cancer Institute (NCI) vaccine trial through GSK; he also receives research support from Qiagen for careHPV research in Nigeria. D. Solomon serves as a medical monitor for the NCI's Costa Rica HPV Vaccine Trial; the trial receives vaccine from GSK. M. Stoler received fees for serving as a consultant to Merck Research Laboratories; Roche; Ventana Medical Systems, Inc; BD; Hologic; MTM Laboratories; and Gen-Probe, Inc. D. Mody conducted lectures and workshops for the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Cytopathology (ASC), for which she received honoraria and/or travel expenses. G. Birdsong's employer receives funding for contracted research performed by him for BD Diagnostics. C. Wheeler is an employee of University of New Mexico, which is contracted by GSK for its vaccine trials and receives equipment/reagents from Roche Molecular Systems, Inc, for human papillomavirus genotyping. D. Wilbur serves on the scientific advisory board for Corista, LLC. T. Darragh received ThinPrep supplies for research from Hologic. She also serves on an advisory board for OncoHealth Corporation and has received stock options as payment and serves on the advisory board of Arbor Vita Corporation. E. Mayeaux serves on the speakers' advisory board for both Merck, Inc, and PharmaDerm and receives honoraria from both companies for his service. M. Spitzer serves as a speaker for both Merck, Inc, and Qiagen and receives honoraria. K. Ault received clinical research grants from the National Institute of Allergy and Infectious Diseases; Gen-Probe, Inc; Merck, Inc; and Roche and served as a site principal investigator for the research. All grants were provided to his employer, Emory University. E. Franco received honorarium as a Study Steering Committee member for GSK; he also serves on the advisory boards of Merck, Inc; Roche; and Gen-Probe, Inc, from which he receives honoraria and has acted as an ad hoc consultant for Merck, Inc; Roche; Gen-Probe, Inc; and Qiagen, for which honoraria were paid to compensate for time away and work performed. M. Gold received honorarium for serving as a speaker and consultant for Hologic. W. Huh serves as a consultant to Roche; Qiagen; Merck, Inc; and Inovio Pharmaceuticals, Inc and receives honoraria from all 4 companies. A-B. Moscicki received honorarium for serving as a consultant to an advisory board for Merck, Inc. M. Einstein has advised or participated in educational speaking activities, but does not receive an honorarium from any companies. His employer, Montefiore Medical Center, has received payment for his time spent on activities for Merck, Inc; GSK; Roche; Bristol-Myers Squibb; Hologic; Advaxis, Inc; Aura Biosciences, Inc; Inovio Pharmaceuticals, Inc; Photocure ASA; NeoDiagnostix, Inc; and PDS Biotechnology Corporation. Montefiore has received grant funding for research related to the costs of those Merck, GSK, Roche, Advaxis, and Hologic clinical trials for which Dr. Einstein served as the Montefiore principal investigator. A. Moriarty received honorarium as a speaker for ASC. R. Guido has acted as the local principal investigator for a multicenter study (contracted research) for IKONOsys. A. Waxman receives honoraria and expenses for teaching related to the subject matter in this article from nonprofit professional organizations and governmental agencies and contractors. He is on the executive committee of the board of directors of the American Society for Colposcopy and Cervical Pathology; he lectures for them and codirects some of their courses and receives honoraria and expenses for these functions. He also lectures and directs courses for the American College/Congress of Obstetricians and Gynecologists on subjects related to this article and receives honoraria from them. Both organizations are nonprofit professional organizations. He has also received honoraria and expenses from the State of Alaska Department of Health and Social Services and several Alaska Native corporations (Southcentral Foundation, SouthEast Alaska Regional Health Corporation, Arctic Slope Regional Corporation, and Yukon-Kuskokwim Health Corporation) and the Breast Cancer Detection Center of Alaska for lecturing on material related to this article. He also received honoraria from the Center for Health Training, a contractor to Title X agencies for lecturing for the Texas Department of State Health Services. He also received a $200 honorarium from Quadrant HealthCom, Inc for writing an article related to cervical cancer screening for the journal OBG Management.

Abstract

An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing, follow-up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections. CA Cancer J Clin 2012. © 2012 American Cancer Society.

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