The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.

The approach to cervical cancer screening has changed substantially over the past decade. Current screening strategies for individuals older than 30 years include cytology (Papanicolaou tests), testing for high-risk (oncogenic) types of human papillomavirus (hrHPV), or both (co-testing). 1 However, various possible combinations of test results have led to complex management algorithms, especially for test results considered to be minimally abnormal, defined as results for which it is unclear whether the next step should be colposcopy (a magnified view of the cervix, often with biopsies) or close follow-up. This article provides an update for the approach to the initial management of minimally abnormal cervical cancer screening test results.In April 2020, 19 organizations released consensus guidelines that formalized a strategy for management of cervical cancer screening test results using a framework based on estimates of underlying high-grade precancerous lesions or cancer (known collectively as cervical intraepithelial neoplasia grade 3 or worse [CIN3+]). 2 Estimates were derived from screening outcomes observed in more than 1.5 million individuals aged 25 to 65 years enrolled in a prepaid health plan. 3 In this population, about 90% of test results were normal and about 0.75% were severely abnormal. The remainder were minimally abnormal, a category that includes an hrHPV-positive test result with a concurrent normal cytologic interpretation (negative for intraepithelial lesion or malignancy), atypical squamous cells of undetermined significance (ASC-US), and low-grade squamous intraepithelial lesion (LSIL).Underlying risks of CIN3+ were estimated for various combinations of cytology, hrHPV testing (ie, pooled testing for Ն1 of 13 or 14 hrHPV types), and HPV genotyping (ie, testing specifically for HPV-16 and HPV-18). 4,5 Because transient hrHPV infections are associated with a lower risk of CIN3+ than persistent hrHPV infections, the effect of having an hrHPV-negative test result within the past 5 years on CIN3+ risk was also evaluated; this is a new addition to the guideline. These risks were then applied to "clinical action thresholds" defined by expert consensus 2 ; 3 thresholds are relevant to individuals with minimally abnormal test results. If the immediate CIN3+ risk is 4% to 24%, colposcopy is recommended, but if the immediate risk is less than 4%, the cumulative 5-year CIN3+ risk guides the surveillance interval. Repeated testing in 1 year is recommended if the 5-year risk is greater than or equal to 0.55%, and repeated testing in 3 years is recommended if the 5-year risk is 0.15% to 0.54%. Repeated testing is specified as hrHPV testing or co-testing; if performing these tests is not feasible, cytology alone is acceptable.The most common test abnormality is a positive hrHPV test result with a concurrent normal cytologic interpretation, comprising about 4.1% of all test results. Because the estimated immediate CIN3+ risk is 2.1% and the cumulative 5-year risk is 4.8% (eTable in the Supplement), 5 repe...

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