The American Society of Clinical Oncology (ASCO) has published clinical practice guidelines for the secondary prevention of cervical cancer, recommending testing for human papillomavirus (HPV) DNA in healthcare systems at all economic levels.
The guidelines were composed by a panel of international experts in oncology, primary care, epidemiology, health economics, cancer control, public health, and patient advocacy.
The panel analyzed seven existing guidelines, as well as reviews of published data and health economics analyses to draw on evidence for the new guidelines. To make it possible for countries and healthcare systems with various levels of resources, the panel developed guidelines adapted to four economical or resource settings: Basic, limited, enhanced, and maximal.
Researchers recommend HPV DNA testing in all settings, but the type and frequency of testing differed according to age and setting. In healthcare settings with maximal resources, women aged 25-65 years should be screened every 5 years.
In enhanced settings the age at screening start was set to 30 years, and if two consecutive tests, taken at five-year intervals, were negative, screening could continue every 10 years.
Limited and basic healthcare systems should screen women between 30 and 49 years of age, once every 10 years in the limited setting, and one to three times per lifetime in the most basic systems.
In basic healthcare settings, the panel stated that visual inspection with acetic acid can be used, but in other cases, they recommended genotyping and cytology (commonly known as a pap test).
If physicians find abnormal results during basic screening, the panel recommended treatment. They also suggested that cryotherapy, or loop electrosurgical excision procedures, should be used as treatments for basic settings.
In other types of settings, however, the panel recommended that further examinations using colposcopy should be performed if abnormal results are found. Treatment should be in the form of loop electrosurgical excision procedure or ablation. For all types of healthcare settings, the panel recommended that a woman is followed for 12 months if abnormal screening results are found.
In addition to the general recommendations, the panel also stated that women with HIV infections should be screened at diagnosis, and then continue with screening twice as often as other people.
After childbirth, screening was recommended after six months in most settings except for basic systems, where screening was recommended to be performed after six weeks.
The panel also recommended that basic healthcare systems, with no current mass screening, should develop an infrastructure for HPV testing, diagnosis, and treatment.