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Edward E. Partridge, Nadeem Abu-Rustum, Anna Giuliano, Stewart Massad, Joan McClure, Mary Dwyer and Miranda Hughes

These NCCN Guidelines Insights focus on recent recommendations for cervical cancer screening and management of abnormal screening tests. When the NCCN Panel convened to update the NCCN Guidelines for Cervical Cancer Screening, they decided to adopt and endorse guidelines from other organizations to avoid duplication of effort. Therefore, in July 2013, after review and validation of consensus guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology, the NCCN Guidelines for Cervical Cancer Screening were discontinued.

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Edward E. Partridge, Nadeem R. Abu-Rustum, Susan M. Campos, Patrick J. Fahey, Michael Farmer, Rochelle L. Garcia, Anna Giuliano, Howard W. Jones III, Subodh M. Lele, Richard W. Lieberman, Stewart L. Massad, Mark A. Morgan, R. Kevin Reynolds, Helen E. Rhodes, Diljeet K. Singh, Karen Smith-McCune, Nelson Teng, Cornelia Liu Trimble, Fidel Valea and Sharon Wilczynski

OverviewDespite a significant decrease in the incidence and mortality of cervical carcinoma in the United States, an estimated 12,200 women will be diagnosed with the disease in 2010, with 4210 expected deaths.1 High-risk groups include women without access to health care and those who have immigrated to the United States from countries where cervical cancer screening is not routinely performed.2 Because cervical cytology screening is the current method for early detection of this neoplasm, the purpose of these guidelines is to provide direction for the evaluation and management of cervical cytology.These guidelines include recommendations on screening techniques, initiation, and frequency of screening, and management of abnormal screening results including colposcopy. Cervical cytology screening techniques include liquid-based cytology or conventional Papanicolaou (Pap) smears. Unless specifically noted, these techniques are collectively referred to as cervical cytology in this discussion.Human papillomavirus (HPV) DNA testing for primary cervical cancer has been approved by the FDA; several diagnostic tests are available (e.g., HPV high-risk and HPV 16/18 DNA tests, Hybrid Capture 2 HPV DNA test). However, HPV DNA testing is not recommended in women younger than 21 years.3 HPV DNA testing for high-risk virus types can also be used as a component of both primary screening and workup of abnormal cytology results; it is not useful to test for low-risk virus types.3 (See HPV DNA Testing on page 1378 for more detail about these tests.)Colposcopy, along with colposcopically directed biopsies, is the primary method for evaluating women with abnormal cervical cytologies....
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Gabrielle B. Rocque, Richard A. Taylor, Aras Acemgil, Xuelin Li, Maria Pisu, Kelly Kenzik, Bradford E. Jackson, Karina I. Halilova, Wendy Demark-Wahnefried, Karen Meneses, Yufeng Li, Michelle Y. Martin, Carol Chambless, Nedra Lisovicz, Mona Fouad, Edward E. Partridge, Elizabeth A. Kvale and the Patient Care Connect Group

Background: There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. Methods: We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014. Results: Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. Conclusions: Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.