Search

Purpose: To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally., Methods: ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus., Results: Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement., Recommendations: Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines., Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Jose JeronimoNo relationship to disclosePhilip E. CastleHonoraria: Roche, Cepheid Consulting or Advisory Role: Cepheid, GE Healthcare, Guided Therapeutics, Merck, Genticel, Teva, Inovio PharmaceuticalsSarah TeminNo relationship to discloseLynette DennyHonoraria: GlaxoSmithKline, Merck Speakers' Bureau: GlaxoSmithKline, Merck Research Funding: GlaxoSmithKline Travel, Accommodations, Expenses: MerckVandana GuptaNo relationship to discloseJane J. KimNo relationship to discloseSilvana LucianiNo relationship to discloseDaniel MurokoraNo relationship to discloseTwalib NgomaNo relationship to discloseYoulin QiaoConsulting or Advisory Role: MSD Research Funding: GE Healthcare Travel, Accommodations, Expenses: MSDMichael QuinnConsulting or Advisory Role: Tesaro, AstraZeneca Travel, Accommodations, Expenses: Roche, Tesaro, AstraZenecaRengaswamy SankaranarayananNo relationship to disclosePeter SasieniHonoraria: Hologic Expert Testimony: Teva, Mylan, Sandoz, Dr Reddys LaboratoryKathleen M. SchmelerResearch Funding: Becton Dickinson Patents, Royalties, Other Intellectual Property: UpToDateSurendra S. ShastriNo relationship to disclose