Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors

Abstract

In Reply: Thank you for noting the inconsistencies in the legend of Figure 2.1 To address these, we are making the following modifications to the legend of Figure 2.1 REVISED FIGURE 2 LEGEND This figure demonstrates how a patient with a common minimally abnormal screening test result (human papillomavirus [HPV]-positive atypical squamous cells of undetermined significance [ASC-US]) would be managed based on risk estimates. The initial screening result would lead to colposcopy (immediate risk = 4.45%). If colposcopy shows less than cervical intraepithelial neoplasia 2, the 5-year risk is 2.9% (1-year return). At the 1-year return visit, a second HPV-positive ASC-US result has an immediate risk of 3.1% (1-year return). Note similar management would be recommended if the initial abnormality preceding colposcopy was any minimally abnormal test result (i.e., less severe than atypical squamous cells- cells–cannot exclude high-grade squamous intraepithelial lesion). If the HPV test or cotest performed for the second postcolposcopy surveillance test is negative, return in 3 years is recommended. If the second postcolposcopy surveillance test results are either a positive HPV test with any cytology result or a negative HPV test result with a cytology result of atypical squamous cells–cannot exclude high-grade squamous intraepithelial lesion or higher, colposcopy is recommended. Return in 1 year is recommended for HPV-negative ASC-US or HPV-negative low-grade squamous intraepithelial lesion results. NA indicates not applicable because stable risk estimates are not available. Rebecca B. Perkins, MD Boston University School of Medicine/Boston Medical Center Boston, MA [email protected]Richard L. Guido, MD University of Pittsburgh/ Magee-Women’s Hospital Pittsburgh, PAPhilip E. Castle, PhD Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention National Cancer Institute Bethesda, MDDavid Chelmow, MD Virginia Commonwealth University School of Medicine Richmond, VAMark H. Einstein, MD Rutgers, New Jersey Medical School Newark, NJFrancisco Garcia, MD Pima County Health & Community Services Tucson, AZWarner K. Huh, MD UAB School of Medicine Birmingham, ALJane J. Kim, PhD, MD Harvard T.H. Chan School of Public Health Boston, MAAnna-Barbara Moscicki, MD University of California Los Angeles, CARitu Nayar, MD Northwestern University Feinberg School of Medicine-Northwestern Memorial Hospital Chicago, ILMona Saraiya, MD Division of Cancer Prevention and Control Centers for Disease Control and Prevention Atlanta, GAGeorge Sawaya, MD University of California, San Francisco San Francisco, CaliforniaNicolas Wentzensen, MDMark Schiffman, MD Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention National Cancer Institute Bethesda, MD

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