individual patient based on their current results and past history. Algorithms and/or risk estimates are shown when available. By using the app, you agree to the Terms of Use and Privacy Policy. Unauthorized use of these marks is strictly prohibited. However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. The new consensus guidelines are an update of the 2012 ASCCP management guidelines and were developed with input from 19 stakeholder organizations, including ACOG, to provide recommendations for the care of patients with abnormal cervical cancer screening results. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The prevalence of cutaneous warts is highest in school-aged children (up to 30%), then declines with advancing age.2 HPV infection is the most common sexually transmitted infection in the United States. recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo %PDF-1.5
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Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). The 2019 ASCCP Risk-Based Management Consensus Guidelines 1 represent a paradigm shift from using primarily results-based algorithms to using risk-based management based on a combination of current screening test results and past screening history. Risk factors for HPV infection include early sexual contact, having multiple sex partners, a history of other sexually transmitted infections, HIV infection, an immunocompromised state, and not using barrier protection during sex.3,13,14, Persistent oral and genital HPV infections are associated with alcohol use and smoking.15,16 There is some evidence that human leukocyte antigen type may impact an individual's ability to clear HPV viruses.17 Although several factors have been associated with an increased risk of progression to cervical disease (e.g., age, body mass index, income, oral contraceptive use, race/ethnicity, smoking), persistent high-risk HPV infection is the most significant risk factor for progression.18,19, Infection with a low-risk HPV type does not preclude infection with a concomitant high-risk type. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. 6) The last screen shows the guidelines information for this patient. Recommendations of colposcopy, treatment, or surveillance will be based on a patient's risk of CIN 3+ determined by a combination of current results and past history (including unknown history). 2. Children and young adults age 13 through 26 who have not been vaccinated, or who haven't completed the vaccine series, should get the vaccine as soon as possible. 4 0 obj
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Vaccination is the primary method of prevention. Perkins RB, Guido RS, Castle PE, et al. Expedited treatment is preferred for nonpregnant patients 25 years or older with HSIL cytology and concurrent positive testing for HPV genotype 16 (HPV 16) (ie, HPV 16-positive HSIL cytology) and never or rarely screened patients with HPV-positive HSIL cytology regardless of HPV genotype. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. Sometimes cytology or pathology are not conclusive. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . Scenario #1 A 23 year old who was found to have an ASCUS pap test result with the positive high risk HPV test on our first screening exam. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. cervical cancer screening tests and cancer precursors. Am J Obstet Gynecol 2007;197:34655. Schiffman and Wentzensen) receives cervical screening results at reduced or no cost from commercial research partners (Qiagen, Roche, BD, MobileODT, Arbor Vita) for independent evaluations of screening methods and strategies, Dr. Moscicki: Merck and GSK, Advisory Board member, Dr. Guido: Inovio Pharmaceuticals DSMB, ASCCP Consultant. In addition to test results, CIN 3+ risk was considered for a number of individual risk factors such as screening history, age, and immunosuppression, which were reviewed by the consensus panels. p16 and Other Epithelial Cancer Biomarkers. Affiliations. The goals of the ASCCP Risk-Based Management Consensus The corresponding authors had final responsibility for the submission decision. Management Guidelines will be electronic, updates and new technologies will be incorporated at a much faster rate The writing of manuscript, and decision to submit for publication. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. ScreeningCervical cancer screening and abnormal result management recommendations for immunocompromised individuals without HIV use the guidelines developed for people living with HIV144: Cytology only screening should begin within 1 year of first insertional sexual activity Continue cytology only annually for 3 years Continue every 3 years (cytology only) until the age of 30 years Cytology alone or cotesting every 3 years after the age of 30 years for the patient's lifetime.Management of Abnormal ResultsIn immunocompromised patients of any age, colposcopy referral is recommended for all results of HPV-positive ASC-US or higher. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert and transmitted securely. Although ASCUS is the most benign pathologic categorization on a Papanicolaou (Pap) smear, approximately 50% of ASCUS findings are associated with high-risk HPV infections. 3 0 obj
risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of You may be trying to access this site from a secured browser on the server. The application uses data and recommendations from the following sources: 33 CIN (or cervical. If you are 21 to 29 Have a Pap test alone every 3 years. endobj
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Participating organizations supported travel for their participating representatives. More frequent surveillance, colposcopy, and treatment are endobj
HHS Vulnerability Disclosure, Help Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Algorithms and/or risk estimates are shown when available. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Cytology every . Provide more appropriate intervention for high-risk individuals (detect and treat more precancer) Recommend less intervention for low-risk individuals (decrease testing and treatment that won't prevent cancer and may cause . Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. Egemen D, Cheung LC, Chen X, et al. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. Who developed these guidelines? For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. Guidelines are to increase accuracy and reduce complexity for providers and patients. 2020 Jul-Aug;9(4):291-303. doi: 10.1016/j.jasc.2020.05.002. The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. Clipboard, Search History, and several other advanced features are temporarily unavailable. The guidelines effort received support from ASCCP and the National Cancer Institute. For all cytology results of LSIL or worse (including ASC-H, AGC, AIS, and HSIL), referral to colposcopy is recommended regardless of HPV test result if done.Perkins RB, Guido RS, Castle PE, et al. In this case, the patient had an ASCUS pap test result and a positive high risk test results. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w
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"m&"h-B5c;[. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. 2) Enter the patient's age and the clinical situation. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, incorporated past screening history. Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. your express consent. A full list of organizations participating in HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV 5. Bulk pricing was not found for item. A history of multiple sex partners; initiation of sexual activity at an early age; not using barrier protection; other sexually transmitted infections, including HIV; an immunocompromised state; alcohol use; and smoking have been identified as risk factors for persistent HPV infections. Bookshelf Li Z, Griffith CC, Yan S, Chen C, Ding X, Liang X, Yang H, Zhao C. Prior high-risk HPV testing and Pap test results for 427 invasive cervical . time: Negative HPV test or cotest within 5 years. This algorithm should not be used to treat pregnant women. Repeat human papillomavirus (HPV) testing or cotesting at 1 year is recommended for patients with minor screening abnormalities indicating HPV infection with low risk of underlying CIN 3+ (eg, HPV-positive, low-grade cytologic abnormalities after a documented negative screening HPV test or cotest). References to the published guideline information is also shown. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. Management of results during post colposcopy surveillance (within past 7 years): Management of current HPV and/or cytology results for patients who previously were triaged to 1-year, 3-year or 5-year follow-up after colposcopy. J Low Genit Tract Dis. government site. Dr. Einstein has advised companies and participated in educational activities, but does not receive any honoraria or payments for these activities, In some cases, his employer, Rutgers, receives payment for his time for these activities from Papivax, Cynvec, Merck, Hologic, and PDS biotechnologies. There will be an option available at no cost. J Low Genit Tract Dis 2020;24:102-31. endstream
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strategies. Scenario #2 A 26 year old patient. Drs. -, Massad LS, Einstein MH, Huh WK, et al. Wolters Kluwer Health
Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. Refers to immediate CIN 3+ risk. INTRODUCTION. Available at. 2020;24(2):102131. 2022 Dec 13;3(1):130. doi: 10.1186/s43058-022-00382-3. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Chelmow D, Herzig A, Kim JJ, Kinney W, Herschel WL, Waldman J. J Low Genit Tract Dis. The same current test results may yield different management recommendations depending on the history of recent past test results. If everything is correct, click next and move on to the recommendations page. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the 1 0 obj
5) The confirmation pageensures that all the information was entered correctly. HPV is spread by direct skin-to-skin contact and has tropisms for cutaneous or mucosal epithelial cells.1 A small subset of HPV types can cause cutaneous warts.2 The approximately 40 types that infect mucosal surfaces are typically spread through sexual contact, including vaginal, anal, or oral sex, and can be divided into low-risk and high-risk types based on their associated cancer risk. <>>>
Please try again soon. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. Available at: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities, https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.3.aspx, https://journals.lww.com/jlgtd/pages/collectiondetails.aspx?TopicalCollectionId=2, https://www.asccp.org/management-guidelines, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative, Expedited treatment or colposcopy acceptable*, Return to routine screening at 5-year intervals. Available at: ASCCP management guidelines app quick start guide. endobj
Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. In addition, several new recommendations for Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. In additional to enabling the provision of more individualized clinical care, the new risk-based management paradigm will facilitate the incorporation of new screening and management technologies into clinical decision making and accommodate changes in disease prevalence over time. Refers to 5-year CIN 3+ risk. %%EOF
J Low Genit Tract Dis. Screening recommended every 3 years for women 21-29. HPV natural history and cervical carcinogenesis. The app is only to be used by medical professionals and email addresses will be retained under the terms of the privacy policy. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk Provide more appropriate intervention for high-risk individuals (detect and treat more. endstream
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<. Unlike the 2012 ASCCP guidelines that relied on test results-based algorithms, the new consensus guidelines follow a risk-based approach to determine the need for surveillance, colposcopy, or treatment. Accessibility 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. After a diagnosis of high-grade histology or cytology, patients may undergo hysterectomy for reasons related or unrelated to their cervical abnormalities.If hysterectomy is performed for treatment, patients should have 3 consecutive annual HPV-based tests before entering long-term surveillance. hb```^6.EAd`0pHH)zeoP4T``rI< lJBUc.0S0w"I)Wz~(qLl~@`;c J Low Genit Tract Dis 2020;24:13243. these guidelines. treat). Risk tables have been generated to assist the clinician and guide practice. Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). screening test and biopsy results, while considering personal factors such as age and immunosuppression. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. Age/population. Available at: ASCCP. incorporation of future technologies as well. Use of condoms and dental dams may decrease spread of the virus. Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. Your message has been successfully sent to your colleague. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a ACS/ASCCP/ASCP guidelines 1. has advised companies and participated in educational activities but does not receive any honoraria or payments for these activities, In some cases, his employer, Rutgers, receives payment for his time for these activities from Papivax, Cynvec, Merck, Hologic, and PDS Biotechnologies. Because the new Risk-Based cotesting at intervals <5 years, or cytology alone at intervals <3 years. 2012 ASCCP Consensus Guidelines Conference. determine a patient's care. J Low Genit Tract Dis 2020;24:10231. In some patients, persistent infection with high-risk mucosal types, especially HPV-16 and HPV-18, causes anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers. of age and older. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. The other authors have declared they have no conflicts of interest. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. The web-based tool is free to use. -, Wright TC, Massad LS, Dunton CJ, et al. It is also important to recognize that these guidelines should never substitute for clinical judgment. 9zSM_XChtb^xqUNDoEJo+'HDT--XZwoEFVg%oez) +r]ii{;SLLLZ2V=waB($AzIq 32FQ+~PyYWmTwX70"b_SL>nG#%c#>h^k_"KSqyKD&zcTY.0CM[oBN!rx#jRw;44 .8+Nd6o52 //i\`ycq/ &!s 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. 3. :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY Consider management according to the highest-grade abnormality For individuals aged 25 or older screened with cytology alone, the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 are recommended for management of abnormal results. %PDF-1.6
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8600 Rockville Pike J Low Genit Tract Dis 2020;24:144-7. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Before Beyond the Management tab, there are two other tabs. Follow these Guidelines: If you are younger than 21You do not need screening. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; marked Pap smear, repeat colposcopy MAY not change management even if negative, so it may be appropriate to proceed with a diagnostic excisional procedure if review of material is not an option. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. the 2019 ASCCP risk-based management consensus guidelines. Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. In addition, a smartphone app is available at nominal cost for both Android and iOS platforms (https://www.asccp.org/mobile-app). Egemen D, Cheung LC, Chen X, et al. For more information, please refer to our Privacy Policy. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! <>
In addition, changing the paradigm of The Centers for Disease Control and Prevention reports that 79 million Americans are infected with HPV and an additional 14 million are newly infected each year.3 Data from early HPV vaccine trials suggest that the lifetime prevalence of the infection is 85% in women and 91% in men who have had at least one sex partner.8. So we enter both of them by simply touching them. time. Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Barbara Crothers, DO; Teresa Darragh, MD; Maria Demarco, PhD; Eileen Duffey-Lind, MSN; Ysabel Duron, BA; Didem USPSTF guidelines 13. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. endstream
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HPV: this term refers to Human Papillomavirus. Specifically, the 2012 guidelines recommend colposcopy for all cytology results of low grade squamous intraepithelial lesion (LSIL) or higher for individuals aged 25 and above. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. patient's risk of progressing to precancer or cancer. 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. CIN 3+ Risk Thresholds for Management. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Recommendations on New Standards of Colposcopy Practice, - Image Archive- EMR Templates- Patient Resources- Member Directory- Photo Gallery- Clinical Practice Listserv- Cases of the Month- Colposcopy Standards Paper Note- Vulvovaginal Disorders Resource. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; Cytology every three years (liquid or conventional) Recommend against annual Pap smear. Perkins RB, Guido RL, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya G, Wentzensen N, Schiffman M. J Low Genit Tract Dis. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. to develop guidelines that will apply to all situations. if <25yo Dysplasia - PMC Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Please try reloading page. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. endobj
The recommendation is for colposcopy. 2f8
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The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited When you look at the American Society for Colposcopy and Cervical Pathology (ASCCP) guideline flowsheets, it can seem like an absolute maze, and remembering what to do when is challenging. MeSH R.S.G. 3 0 obj
The ASCCP Management Guidelines applications were developed by ASCCP. to maintaining your privacy and will not share your personal information without
The following clarifications specify management for additional scenarios. Patients with symptoms such as abnormal uterine or vaginal bleeding or a visibly abnormal-appearing cervix require appropriate diagnostic testing as this may be a sign of cancer. %PDF-1.6
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For example, HPV primary testing or endobj
The risk database will continue to be updated as new testing methods and follow-up data emerge, and the new framework will allow management to be adjusted accordingly and consistently. management from one that is based on specific test results to one that is based on a patient's risk will allow for Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. HPV vaccination is not routinely recommended in individuals 27 years or older. ET). Pathology (ASCCP), and the American Society for Clinical Pathology.5 In this update of the ACS guideline for cervical can-cer screening, we recommend that cervical cancer screen-ing should begin in average-risk individuals with a cervix at age 25 years and cease at age 65 years and that the pre-ferred strategy for regular screening is primary HPV Implement Sci Commun. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. All participating consensus organizations, including the Federal government websites often end in .gov or .mil. Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions. Author disclosure: No relevant financial affiliations. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented ASCCP guidance informs the assessment and treatment of abnormal cervical cancer screening results. Women with Abnormal cervical Cancer screening Tests and Cancer Precursors has 2 HPV. Application and mobile apps and the media without the following listed authors have declared they have no conflicts interest..., Mason SM, Pratt RJ and did not specify when screening should cease declared they have no conflicts interest. Their current results and an exact risk estimate is not routinely recommended in individuals 27 years or older has. 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