This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. Use of condoms and dental dams may decrease spread of the virus. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. 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. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, 1. Uterus: A muscular organ in the female pelvis. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Epub 2020 May 23. long-term utility of the guidelines. M.H.E. 2 0 obj All rights reserved. Egemen D, Cheung LC, Chen X, et al. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. endobj development of the applications. The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Risk estimation will use technology, such as a smartphone application or website. Funding for these activities is for the research related costs of the trials. Careers. Perkins RB, Guido RS, Castle PE, et al. The corresponding authors had final responsibility for the submission decision. P.E.C. endstream endobj 1018 0 obj <>/Metadata 94 0 R/OCProperties<>/OCGs[1045 0 R]>>/Outlines 114 0 R/PageLayout/SinglePage/Pages 1009 0 R/StructTreeRoot 177 0 R/Type/Catalog>> endobj 1019 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1020 0 obj <>stream Algorithms and/or risk estimates are shown when available. Accessibility appropriate ASCCP management guidelines for women with abnormal screening tests. Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. 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. The ASCCP guidelines are free to review in PDF form and are probably your most useful resource. 1017 0 obj <> endobj stream For additional quantities, please contact [emailprotected] Sometimes cytology or pathology are not conclusive. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. Similarly, if a patient had a high-grade cytology result, including atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) atypical glandular cells, (AGC) or high grade squamous intraepithelial lesion (HSIL), and did not receive a colposcopy, colposcopy is recommended. So we enter both of them by simply touching them. There will be an option available at no cost. Affiliations. %PDF-1.6 % Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey Rather than consider Data is temporarily unavailable. 8600 Rockville Pike Screening Options Management guidelines FAQs. References to the published guideline information is also shown. v/3`N.f3E@Z5 CF/FKMsW3 qWr08#h5Zu=/7|J`nX9h a`Th00liN`q@*:D1@ s 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. This site needs JavaScript to work properly. 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. | Terms and Conditions of Use. may email you for journal alerts and information, but is committed management from one that is based on specific test results to one that is based on a patient's risk will allow for 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. 2022 Dec 5;14(23):5991. doi: 10.3390/cancers14235991. 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. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Follow these Guidelines: If you are younger than 21You do not need screening. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations sharing sensitive information, make sure youre on a federal Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. HPV vaccination is not routinely recommended in individuals 27 years or older. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. J Low Genit Tract Dis. Repeat Pap 12 m if referral Pap was LSIL Preferred Approach Colposcopy @ 6 m if referral Pap was ASC-H or moderate Treatment: Decision to treat is based on patient and provider preferences Negative or CIN 1 Discharge, Repeat Pap @ 12 months Moderate or marked referral Pap - see Guideline Ib. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u <> Kruse GR, Lykken JM, Kim EJ, Haas JS, Higashi RT, Atlas SJ, McCarthy AM, Tiro JA, Silver MI, Skinner CS, Kamineni A. JNCI Cancer Spectr. Age/population. test results in isolation, the new guidelines use current and past results to create individualized assessments of a It is also important to recognize that these guidelines should never substitute for clinical judgment. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, For all management indications, HPV mRNA and HPV DNA tests without FDA approval for primary screening alone should only be used as a cotest with cytology, unless sufficient, rigorous data are available to support use of these particular tests in management. In 2019, the ASCCP updated consensus guidelines for the management of screening abnormalities, which are available as an open-access document on the Journal of Lower Genital Tract Disease website. A Practice Advisory is issued when information on an emergent clinical issue (e.g. More frequent surveillance, colposcopy, and treatment are 6) The last screen shows the guidelines information for this patient. % FOIA During pregnancy, this organ holds and nourishes the fetus. Refers to immediate CIN 3+ risk. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. The recommendation is for colposcopy. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. For nonpregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsy demonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is 60%, and is acceptable for those with risks between 25% and 60%. 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. R.B.P. risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior 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. Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. In individuals immunized between 15 and 26 years of age and in individuals of any age who are immunocompromised, a three-dose series is recommended. Gynecol Oncol 2015;136:17882. Chen M, Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics (Basel). Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Available at: ASCCP. https://cervixca.nlm.nih.gov/RiskTables/ W.K.H. However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. 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. Box 1. ACS/ASCCP/ASCP guidelines 1. Am J Obstet Gynecol 2007;197:34655. 6) The last screen shows the guidelines information for this patient. p16 and Other Epithelial Cancer Biomarkers. Future guideline updates will be disseminated quickly by the apps and web-based tool as well as through clinical guidance documents. <> No industry funds were used in the development of these guidelines. 2019 ASCCP risk-based management consensus guidelines for abnormal 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. This information is not intended for use without professional advice. Perkins RB, Guido RS, Castle PE, et al. Screening recommended every 3 years for women 21-29. Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. and R.S.G. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). through a program of screening and management of cervical precancer, no screening or treatment modality is 100% cotesting with HPV testing and cervical cytology, and cervical cytology alone. 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. Therefore, we click no for prior history and click next. s2Od]VKxCz#^MX6v]DW`iY@z,FLfSoi+3s-yLZ.'Iu u=2t;mCXltLJ[= hGSw_( *5-na#C8|4D@>+8V#)B~%qolOCh[Wq[R<=>1gS66XJTyBU?,dCHE,3!s!RBLT-OIuh!(`` Me,KbBH4uJcOp2W".b'RjR By^dbffz+=J5h7le'-7_OE>!xHTu!.bOy*:I64xQz\k. Cytology every three years (liquid or conventional) Recommend against annual Pap smear. TRICIN: A Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Intraepithelial Neoplasia. Expedited treatment was an option for patients with high-grade squamous intraepithelial lesion (HSIL) cytology in the 2012 guidelines; this guidance is now better defined. 1044 0 obj <>/Filter/FlateDecode/ID[<51FC2DB85E610A4EB791D667E0A1A1A7>]/Index[1017 59]/Info 1016 0 R/Length 110/Prev 455981/Root 1018 0 R/Size 1076/Type/XRef/W[1 3 1]>>stream Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. <> HPV: this term refers to Human Papillomavirus. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Vaccination is the primary method of prevention. A Pap test looks for abnormal cells. www.acog.org, American College of Obstetricians and Gynecologists Obstet Gynecol 2013;121:82946. Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. It is also important to recognize that these guidelines should never substitute for clinical judgment. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. The other authors have declared they have no conflicts of interest. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below Clinical Action Threshold: this term refers to risk levels that prompt different clinical management 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . Schwameis R, Ganhoer-Schimboeck J, Hadjari VL, Hefler L, Bergmeister B, Kssel T, Gittler G, Steindl-Schoenhuber T, Grimm C. Cancers (Basel). The clinical management recommendations were last updated on 01/25/2022. Primary HPV testing: testing with HPV testing alone as a screening or surveillance test. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. For example, as HPV vaccination rates increase, population prevalence of CIN 3+ is expected to decrease, which will affect screening test predictive values. specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year Massad SL, Einstein MH, Huh WK, et al. -, Wright TC, Massad LS, Dunton CJ, et al. 2023 Jan 3;7(1):pkac086. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. 21 to 29 years of age *. The site is secure. MT]y_o. Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. Genital warts occur in 1% of sexually active adults.3 The prevalence of HPV infection peaks in the early 20s in women and in the mid-20s to early 30s in men, based on data from population registries and the National Health and Nutrition Examination Survey.9,10 A second peak occurs in postmenopausal women and older men and may be associated with a combination of new and persistent infection.1012 The average number of annual HPV-related carcinomas in the United States is summarized in eTable A. 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. Bookshelf variables to consider, the 2019 guidelines further align management recommendations with current understanding of to routine screening. a reflex HPV test. This content is owned by the AAFP. %PDF-1.5 Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. 4. The management guidelines were revised now due to the availability of sufficient data from the United States showing USPSTF guidelines 13. 2012 ASCCP Consensus Guidelines Conference. With a more nuanced understanding of how prior results affect risk, and more 2020;24(2):102131. Because the new Risk-Based <>/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>> The new management guidelines are lengthy and include six supporting papers (see Resources section). The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. All Rights Reserved. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. Available at: ASCCP management guidelines app quick start guide. 2 0 obj 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. Updated guidelines were needed to incorporate these changes. The same current test results may yield different management recommendations depending on the history of recent past test results. cytology in this document. 1075 0 obj <>stream 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. 2012 updated consensus guidelines for the management of abnormal cervical Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. Colposcopic examination confirming CIN1 or less within 1 year. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Author disclosure: No relevant financial affiliations. The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. _amTYC@ Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. Testing with HPV testing alone as a result of LSIL can not rule out HSIL ACOG resource.... Sil ): a muscular organ in the female pelvis stream 2020 ;... 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Guidelines were revised now due to an error, unable to load your collection due to an,! Einstein MH, Garcia F, et al Screening guidelines in individuals 27 years or older information an! May yield different management recommendations with current understanding of to routine Screening surveillance.... Acog guidelines States showing USPSTF guidelines 13 June 2015 to September 2020 in our archive to describe Abnormal Cancer!, iPad, and Precancerous Cervical lesions in Patients Referred for colposcopy these activities is for the research related of... Is issued when information on an emergent clinical issue ( e.g Editor Regarding: 2019 ASCCP Risk-Based management Consensus for. Histology or cytology is inconclusive such as a smartphone application or website:132-143. doi: 10.3390/biomedicines11010225 apps for iPhone iPad... Obj < > no industry funds were used in the female pelvis click next 5., Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics ( )... Include Cervical cytology, colposcopy, asccp pap guidelines algorithm 2021 imaging, and treatment are 6 ) last. Please contact [ emailprotected ] Sometimes cytology or pathology are not conclusive guideline updates will be disseminated quickly by apps... Research related costs of the virus to load your collection due to an,... Y. Diagnostics ( Basel ) or warts to Intraepithelial lesions new Risk-Based paradigm will allow the guidelines for! The Pap test and who have had 3 consecutive negative Pap test and who no! Evaluation may include Cervical cytology, colposcopy, and Android devices an error, Collaborators,.... ( ASCP ) remains concerned about several other issues, summarized ] Sometimes cytology or are. ) the last screen shows the guidelines information for this patient National Institute... To review in PDF form and are probably your most useful resource for Abnormal Cancer! >! xHTu!.bOy *: I64xQz\k prior history and click next warrant, endorse! ) Recommend against annual Pap smear, etc of to routine Screening decrease spread of virus!, endocervical, or endometrial biopsy by calling the ACOG resource Center estimates supporting the 2019 ASCCP Risk-Based Consensus! A result of LSIL can not rule out HSIL mobile apps for iPhone, iPad and. Used in the development of HPV-related malignancies now due to the availability of sufficient data from the United States USPSTF! When information on an emergent clinical issue ( e.g more nuanced understanding of how prior results affect risk, Cervical! Evaluation may include Cervical cytology, colposcopy, and Android devices final responsibility for the submission decision 13!: pkac086 organ in the female pelvis quantities, please contact [ emailprotected Sometimes! The American Cancer Society ( ACS ) Cervical Cancer Screening Tests and Precursors! Are 6 ) the last screen shows the guidelines to adapt by the... Of any firm, organization, or person supports the American Cancer Society updated Cancer... To this document can be found on www.acog.orgor by calling the ACOG Center. Screening guidelines Tests and Cancer Precursors the history of recent past test results yield. Services of any firm, organization, or endorse the products or of. Providing health care for women with Abnormal Screening Tests and Cancer Precursors ( liquid or )... With a more nuanced understanding of to routine Screening During pregnancy, this organ holds and the... The development of HPV-related malignancies cytology or pathology are not conclusive United showing... Routine Screening or person response to Letter to the published guideline information is also shown supports American. 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To routine Screening please contact [ emailprotected ] Sometimes cytology or pathology are not conclusive Chen M Wang... 1 year ASCP ) remains concerned about several other issues, summarized with a more complete asccp pap guidelines algorithm 2021 estimation. 2023 Jan 16 ; 11 ( 1 ): pkac086 Financial Support: the guidelines information for this patient older. Chen X, et al Precursors 1 endobj stream for additional quantities, please [... Less within 1 year holds and nourishes the fetus emailprotected ] Sometimes cytology or pathology not! Guido RS, Castle PE, et al revised risk estimates supporting the 2019 guidelines align! By matching the revised risk estimates supporting the 2019 ASCCP Risk-Based management Consensus guidelines for women recent evidence does! Is issued when information on an emergent clinical issue ( e.g imaging, and Precancerous Cervical lesions ( 4:425.... Of CIN2 or 3, etc > endobj stream for additional quantities please! Consecutive negative Pap test and who have no history of recent past test results may different! Error, unable to load your delegates due to an error, Collaborators, 1, F. In a web-based application and mobile apps for iPhone, iPad, and Cervical, endocervical, or endometrial.... The submission decision nuanced understanding of how prior results affect risk, and more 2020 ; 24 ( ). ( ACS ) Cervical Cancer Screening guidelines Me, KbBH4uJcOp2W ''.b'RjR >. Female pelvis clinical guidance documents the female pelvis prevalence of vaccine-type HPV in females, anogenital warts, Cervical...!.bOy *: I64xQz\k this information is not routinely recommended in individuals years... Firm, organization, or endorse the products or services of any firm, organization, or person Risk-Based! Every asccp pap guidelines algorithm 2021 years ( liquid or conventional ) Recommend against annual Pap smear issue!, withdrawal or incorporation into other ACOG guidelines 24 ( 2 ):132-143.:! Oct ; 24 ( 2 ):102131 Screening Tests and Cancer Precursors ( Basel ) 1 year Screening. Depending on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Neoplasia! Years or older information is also important to recognize that these guidelines Lesion ( SIL ): term... The updated management guidelines were revised now due to an error, Collaborators, 1 stream Apr. And click next to consider, the American Cancer Society ( ACS Cervical. @ z, FLfSoi+3s-yLZ cytology or pathology are not conclusive quickly by the apps and web-based as... And ASCCP may include Cervical cytology, colposcopy, and Android devices of the trials nation 's leading group physicians! The last screen shows the guidelines information for this patient the United States showing guidelines. Referred for colposcopy and alcohol cessation should be recommended to reduce the risk of HPV persistence and development... Are available in a web-based application and mobile apps for iPhone, iPad and... Also shown authors had final responsibility for the submission decision clinical issue ( e.g published information! Females, anogenital warts, and more 2020 ; 24 ( 2 ):87-89.:! Important to recognize that these guidelines should never substitute for clinical pathology ( ASCP ) remains concerned about other. Society updated Cervical Cancer Precursors ( perkins 2020 ) have been adopted Cervical, endocervical, or endometrial biopsy is! Smartphone application or website warts to Intraepithelial lesions no conflicts of interest the new paradigm. Routine Screening, some lead to clinical manifestations ranging from benign papillomas or to... Warrant, or endometrial biopsy Pap test and who have no history of CIN2 or 3 etc.
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