ICSI - Cervical Cytology (Pap Test) and HPV Test in Adult and Adolescent Females / Preventive Services for Adults and Children

New and Recently Revised Scientific Documents
Links to scientific documents that have been developed or updated in the past three months.

September 2010
1. Cervical Cytology (Pap Test) and HPV Test in Adult and Adolescent Females, Initial Management of Abnormal
2. Preventive Services for Adults
3. Preventive Services for Children and Adolescents


1. Cervical Cytology (Pap Test) and HPV Test in Adult and Adolescent Females, Initial Management of Abnormal (Guideline)
Released 09/2010

full-text (pdf, 35 pages):
http://www.icsi.org/new_category_10659/cervical_cytology__pap_smear__and_hpv_testing__initial_management_of_abnormal__pdf_.html

Scope and Target Population:

Any woman who has undergone cervical cytological analysis (Pap test) and has received an abnormal result.


Aims:
1.All women age 21 years and older with an ASCUS cervical cytological result will receive appropriate clinical follow-up.

2.All adult women age 21 years and older with a high-grade squamous intraepithelial lesion (HSIL) cervical cytological result will have a colposcopy with endocervical curettage (ECC) or LEEP.

3.All women age 21 years or older with a low-grade squamous intraepithelial lesion (LSIL) cervical cytological result will have a colposcopy.

Clinical Highlights:
•ASCUS as an initial cytology result in women age 21 and older necessitates HPV testing. If HPV testing is unavailable, a repeat Pap test in six months or immediate colposcopy is recommended.

•AGC as an initial cytology result requires a colposcopy and endocervical curettage (ECC) and possible endometrial biopsy. AGC cytology results can, in some cases, be indicative of extracervical malignancy. Follow-up is mandatory.

•LSIL as an initial cytology result in an adult generally warrants a colposcopy. Special considerations may be made for adolescents who have had a Pap test performed.

•HSIL as an initial cytology result requires colposcopy in adolescents, or colposcopy with endocervical curettage (ECC) or loop electrosurgical excision (LEEP) in adults.

•Although cervical cancer screening in adolescents is not recommended, if a test is performed and shows ASCUS or LSIL cytological screening results, the HPV regression rate is so high that conservative management without colposcopy is recommended.

Additional Background:
The Bethesda system for reporting Pap smear results was instituted to help bring uniformity to the reporting of Pap smear results. The Bethesda system introduced new terminology which has led to some confusion regarding the appropriate management of abnormal results not only for patients but also providers. Studies have thoroughly documented that follow-up of abnormal Pap smear results has been less than satisfactory. Therefore, it is imperative to not only have a clear approach to follow-up abnormal Pap smear results based on the Bethesda system, but to also have clear procedures to encourage 100% follow-up of such results.
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Updated: 9/24/2010




2. Preventive Services for Adults (Guideline)
Released 09/2010

full-text (pdf, 79 pages):
http://www.icsi.org/preventive_services_for_adults/preventive_services_for_adults_4.html

Scope and Target Population:
The scope of this guideline is to provide a comprehensive approach to the provision of preventive services, counseling, education, and disease screening for average-risk, asymptomatic adults aged 18 and over. This guideline generally does not address the needs of:

•pregnant women

•individuals with chronic disorders

•high-risk populations (there are occasional exceptions where noted)

This guideline targets asymptomatic adults seeking health care who would benefit from preventive services. This resource is intended to assist in the prioritization of screening maneuvers, tests and counseling opportunities. It is not intended to diagnose or treat any condition. Consequently, once a health issue or condition has been uncovered, other guidelines (such as the Lipid Management in Adults guideline or Hypertension Diagnosis and Treatment guideline) will take precedence during any further diagnosis and management.

Aim:
1.Increase the percentage of adult patients on time with Level I preventive services.


Clinical Highlights:
•All clinic contacts – whether acute, chronic or for preventive services – are opportunities for prevention. Incorporate appropriate preventive services at every opportunity.

•Address or initiate adult preventive services that providers and care systems must assess the need for and offer to each patient. These have the highest priority value. (Level I)
- Alcohol abuse; hazardous and harmful drinking screening and brief counseling
- Aspirin chemoprophylaxis counseling
- Breast cancer screening
- Cervical cancer screening
- Chlamydia screening
- Colorectal cancer screening
- Hypertension screening
- Influenza immunization
- Lipid screening
- Pneumococcal immunization
- Tobacco use screening and brief intervention

•Provide timely feedback, appropriate interventions and optimal follow-up.


Additional Background:
The guideline was developed using an evidence-based approach, which emphasizes the critical evaluation of scientific evidence. The guideline also identifies those services that should not be included in light of similarly strong evidence.

Updated: 9/27/2010




3. Preventive Services for Children and Adolescents (Guideline)
Released 09/2010

full-text (pdf, 83 pages):
http://www.icsi.org/preventive_services_for_children__guideline_/preventive_services_for_children_and_adolescents_2531.html

Scope and Target Population:
The scope of this guideline is to provide a comprehensive approach to the provision of preventive services, counseling, education and disease screening for average-risk, asymptomatic individuals from birth through age 18. There are occasional exceptions to this for high-risk populations where noted.

This guideline targets asymptomatic children seeking health care who would benefit from preventive services. This resource is intended to assist in the prioritization of screening maneuvers, testing and counseling opportunities. It is not intended to diagnose or treat any condition. Consequently, once a health issue or condition has been uncovered, other guidelines (such as the ICSI Prevention and Management of Obesity [Mature Adolescents and Adults] guideline) will take precedence during any further diagnosis and management.

Aim:
1.Increase the rate of pediatric patients on time with Level I preventive services.


Clinical Highlights:
•All clinic contacts – whether acute, chronic or for preventive service – are opportunities for prevention. Incorporate appropriate preventive services at every opportunity.

•Address or initiate child preventive services that providers and care systems must assess the need for and offer to each patient. These have the highest priority value. (Level I)
- Childhood immunization series
- Chlamydia screening (sexually active age 25 years and younger)
- Neonatal screening
- Vision impairment screening (age four years and younger)

•Provide timely feedback, appropriate interventions and optimal follow-up.

Additional Background:
The guideline was developed using an evidence-based approach, which emphasizes the critical evaluation of scientific evidence. The guideline also identifies those services that should not be included in light of similarly strong evidence.
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Updated: 9/27/2010

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