ASCO GUIDELINES FOR CERVICAL CANCER SCREENING

A new global guideline on screening for cervical cancer, which provides evidence-based recommendations for screening, follow-up, and treatment for high-risk lesions, has been released by the American Society of Clinical Oncology (ASCO).

"Every woman ― no matter where she lives ― should have at least one good cervical cancer screen in her lifetime, but unfortunately, we are not even close to that," said Surendra S. Shastri, MD, MBBS, co-chair of the ASCO expert panel that developed the guideline and professor of preventive oncology at Tata Memorial Center in Mumbai, India.

"We hope that this guideline will bring us closer to the goal of providing high-quality preventive care to all women, regardless of their circumstances," said Dr Shastri in a statement.

All women in the appropriate age groups, regardless of whether they live in low-resource, middle-resource, or high-resource settings, should be screened for precursor lesions, the report emphasizes.

The aim of the guideline is to establish consistent minimum standards for screening across the globe while at the same time accounting for the wide variations in resource levels and healthcare systems.

With that in mind, the primary goal of cervical cancer screening should be the accurate detection and timely treatment of intraepithelial precursor lesions as a means of preventing cervical cancer, the authors emphasize, rather than cancer control, as is the case for many other malignancies.

The guidelines were published online October 12 in the Journal of Global Oncology. 

"These are the first guidelines for cervical cancer prevention that have stratified the recommendations based on the resources available in the settings where women live," said said Jose Jeronimo, MD, co-chair of the ASCO expert panel that developed the guideline and senior advisor for women's cancers at PATH in Seattle, Washington. "There are similar guidelines for breast cancer."

To develop the new recommendations, ASCO convened a multidisciplinary, multinational panel that included experts in oncology, primary care, epidemiology, health economics, cancer control, public health, and patient advocacy.

The team identified and reviewed the evidence base. In addition, four systematic reviews plus cost-effectiveness analyses provided indirect evidence.

What sets these recommendations apart from others is the stratification according to resource level. "The uniqueness of these new ASCO recommendations is that countries are divided in four tiers based on the resources available," Dr Jeronimo told Medscape Medical News.

He noted that countries or regions with most resources are stratified as having "maximal resources," whereas those with a good level of resources are included in the level of "enhanced resources."

"The next level is 'limited resources' for countries with some resources, but they still need to be careful and thoughtful on how to use those resources," Dr Jeronimo said. "And finally, countries or regions with very limited or basic health resources are included in the group of 'basic resources.'

"The group of global experts on cervical cancer then evaluated the best options for screening and treatment of precancer that could be suitable for each one of the levels," he added.