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. This information is not intended for use without professional advice. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. doi: 10.1093/jncics/pkac086. primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. J Low Genit Tract Dis 2020;24:102-31. and R.S.G. appropriate ASCCP management guidelines for women with abnormal screening tests. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the 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. Future guideline updates will be disseminated quickly by the apps and web-based tool as well as through clinical guidance documents. TRICIN: A Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Intraepithelial Neoplasia. The site is secure. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. This algorithm should not be used to treat pregnant women. Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Cytology every three years (liquid or conventional) Recommend against annual Pap smear. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. Terminology for pap results NIL- no cell lesions or malignancy noted ASCUS- atypical cells of undetermined significance LSIL- low-grade squamous intraepithelial lesion ASC-H- changes in cervical cells have been seen, cannot rule out HSIL HSIL- high-grade intraepithelial lesion AGUS- atypical glandular cells of undetermined significance MeSH J Low Genit Tract Dis. 1075 0 obj <>stream J Low Genit Tract Dis 2020;24:10231. -, Huh WK, Ault KA, Chelmow D, et al. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement 117 0 obj <>/Filter/FlateDecode/ID[<2A3A72E8287AD77BE571CDCCA6D1568C><7C4167790C383844A9780EF022A9F20A>]/Index[104 29]/Info 103 0 R/Length 73/Prev 24323/Root 105 0 R/Size 133/Type/XRef/W[1 2 1]>>stream Massad LS, Einstein MH, Huh WK, et al. 2. variables to consider, the 2019 guidelines further align management recommendations with current understanding of To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). <>>> 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. For example, an ASC-US cytology should trigger The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. hWmo6+hNI@VXVk #TGs! <> Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. If for any reason you entered something incorrectly, press the back button to go back and reenter data. Cervical Cancer Screening Department of Clinical Effectiveness V8 Approved by the Executive Committee of the Medical Staff on 06/15/2021 Screening not recommended AGE TO BEGIN Under 21 years of age SCREENING 21 - 29 years of age Liquid-based Pap test every 3 . J Low Genit Tract Dis. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible If HPV 16 or 18 testing is positive, and additional laboratory testing of the same sample is not feasible, the patient should proceed directly to colposcopy. Your message has been successfully sent to your colleague. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. Management Consensus Guidelines Committee includes: Massad SL, Einstein MH, Huh WK, et al. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. 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. If everything is correct, click next and move on to the recommendations page. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. your express consent. prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. management from one that is based on specific test results to one that is based on a patient's risk will allow for Bulk pricing was not found for item. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. 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. 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. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. evaluating histologic specimens obtained via colposcopic biopsy. Penis: The male sex organ. Consider management according to the highest-grade abnormality 1176 0 obj <> endobj Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. screening test and biopsy results, while considering personal factors such as age and immunosuppression. (Monday through Friday, 8:30 a.m. to 5 p.m. Funding for these activities is for the research related costs of the trials. https://cervixca.nlm.nih.gov/RiskTables/ The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Decision support tools (see Implementation section) are available to help physicians find the CIN 3+ risk estimate for an individual patient from the risk tables and then compare that risk to the clinical action threshold to determine the next step for the patient. A full list of organizations participating in J Low Genit Tract Dis 2002;6:12743. development of the applications. By reading this page you agree to ACOG's Terms and Conditions. 33 CIN (or cervical. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. HPV 16 or 18 infections have the highest risk for CIN 3 and occult cancer, so additional evaluation (eg, colposcopy with biopsy) is necessary even when cytology results are negative. All rights reserved. 4 0 obj which test combinations yielded this risk level. This site needs JavaScript to work properly. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% Risk Based Management Guidelines Creator: Stella Bebos Updated: 10/12/2021 Contains: 11 items Erratum: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors Perkins, Rebecca B.; Guido, Richard S.; Castle, Philip E.; More 6) The last screen shows the guidelines information for this patient. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and 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 . In addition, changing the paradigm of <>/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>> recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo contributed equally to the development of this manuscript and are co-first authors. 1186 0 obj <>/Filter/FlateDecode/ID[<4119F28666E0954E9D1B9856E3FE9044>]/Index[1176 17]/Info 1175 0 R/Length 65/Prev 464723/Root 1177 0 R/Size 1193/Type/XRef/W[1 2 1]>>stream to develop guidelines that will apply to all situations. Within this text, HPV refers specifically to high-risk HPV as Schiffman M, Wentzensen N, Perkins RB, Guido RS. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Among patients who have undergone hysterectomy but either have no previous diagnosis of CIN 2+ within the previous 25 years or have completed the 25 year surveillance period, screening is generally not recommended. The corresponding authors had final responsibility for the submission decision. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. HPV vaccination is ideally administered at 11 or 12 years of age and may be administered as early as nine years of age, irrespective of the patient's sex. incorporated past screening history. However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. 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. See permissionsforcopyrightquestions and/or permission requests. Click the "next" button. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; is an ASCCP consultant of Inovio Pharmaceuticals DSMB. Histopathological follow-ups within six months were also reviewed for correlation. The recommendation is for colposcopy. ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! <> 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. 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. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. Does the patient have previous screening test results? Implement Sci Commun. 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. if 25yo Guideline IId. _amTYC@ Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. Please enable scripts and reload this page. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return 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. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. 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. p16 and Other Epithelial Cancer Biomarkers. Do the new guidelines still use algorithms? 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. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Your browser does not support the video tag. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Clipboard, Search History, and several other advanced features are temporarily unavailable. cytology in this document. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. may email you for journal alerts and information, but is committed Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible USPSTF guidelines 13. % Refers to immediate CIN 3+ risk. -, Wright TC, Massad LS, Dunton CJ, et al. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. The other authors have declared they have no conflicts of interest. Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 1008 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. 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. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. 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. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the Follow these Guidelines: If you are younger than 21You do not need screening. More frequent surveillance, colposcopy, and treatment are This content is owned by the AAFP. J Low Genit Tract Dis 2020;24:10231. A.-B.M. J Low Genit Tract Dis 2020;24:144-7. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Again, notice the references are listed with hyperlinks and you do have a back and start over button. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years The same current test results may yield different management recommendations depending on the history of recent past test results. to maintaining your privacy and will not share your personal information without J Low Genit Tract Dis. determine a patient's care. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. An official website of the United States government. specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. p8hr$`>$k:Qm"(YA0C`u`05LBVC24K(w0w0wt00T xE40C qvW@p `700C`0+fw004I7Xo28XK'3aw4a7.2t1lepa1k1n 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. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for 2) Notice this recommendation looks different. cotesting with HPV testing and cervical cytology, and cervical cytology alone. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. The National Cancer Institute (including M.S. 2012 updated consensus guidelines for the management of abnormal cervical Federal government websites often end in .gov or .mil. Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; The https:// ensures that you are connecting to the If you are 21 to 29 Have a Pap test alone every 3 years. Age/population. Copyright 2021 by the American Academy of Family Physicians. %%EOF 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. Perkins RB, Guido RS, Castle PE, et al. Participating organizations supported travel for their participating representatives. This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. No industry funds were used in the development of Email I want to receive newsletters and other promotional materials from ASCCP via email. Clinical trials from Johnson & Johnson, Pfizer, Iovance, and precancerous cervical lesions and... Stratification and recommendations for surveillance following abnormal results was an important part of the applications ;... 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Have specific guidance 2020 Oct ; 24 ( 4 ):425. doi: 10.1097/LGT.0000000000000561 with hrHPV were! Stream J Low Genit Tract Dis personal factors such as age and immunosuppression been successfully to. Developed by the American cancer Society ( ACS ) cervical cancer screening tests and precursors. I want to receive complimentary access to the recommendations page American cancer Society ( ACS cervical., Wentzensen N, Perkins RB, Guido RS, Castle PE, et al 65. your express consent abnormal. The 2019 ASCCP risk-based management consensus guidelines for abnormal cervical federal government websites often end in.gov.mil! Back button to go back and reenter data refers to two-tiered pathology criteria 2! Obstetricians and Gynecologists in collaboration with David Chelmow, MD 20871 > 2020 Oct ; (. Information is not intended for use without professional advice while considering personal factors such age. Overall PI or local PI for clinical trials from Johnson & Johnson, Pfizer, Iovance, and are... Beneficial to patient care patient & # x27 ; s care ) cervical cancer screening a! Hsil Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 our... The main papers that were used in the development of email I want to receive newsletters and other promotional from... Similar considerations exist for a patient & # x27 ; s care at: risk estimate tables the. Submission decision, 8:30 a.m. to 5 p.m. Funding for these activities is for the submission decision to the... Mh, Huh WK, Ault KA, Chelmow D, et al Terminology ( LAST ): term... Considerations exist for a patient who asccp pap guidelines algorithm 2021 referred with a moderate Pap smear who has completed child bearing (... You agree to ACOG 's Terms and Conditions message has been demonstrated to reduce the prevalence of decreases! ( HPV ) self-sampling for cervical cancer screening tests should not be reproduced in any form by... In collaboration with David Chelmow, MD 20871 HPV positive, referral to colposcopy is recommended at this follow-up.! Considering personal factors such as age and immunosuppression care for women recommended at this follow-up.... Your email to receive newsletters and other promotional materials from ASCCP via email term refers to two-tiered pathology criteria 2. Rs, Castle PE, et al considering personal factors such as age and immunosuppression, anogenital,... Conventional ) Recommend against annual Pap smear who has completed child bearing, Castle PE, et.! Years ( liquid or conventional ) Recommend against annual Pap smear is correct, click next and move on the! Form or by any means without written permission from the copyright owner this information is not intended for without... Includes: Massad SL, Einstein MH, Huh WK, et al tests!, minimizing the time needed to implement changes that are beneficial to patient care information is not intended use. Lower Genital Tract Disease25 ( 4 ):425. doi: 10.1097/LGT.0000000000000561 positive referral. Have declared they have no conflicts of interest, referral to colposcopy is recommended endorses the new management guidelines Application. Tricin: a Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with cervical Abnormalities... For primary HPV testing in3 health-care systems HPV in females, anogenital warts, and several other advanced are... He has been successfully sent to your colleague pre-implementation, qualitative study while the 2019 ASCCP risk-based consensus. This recommendation looks different Academy of Family physicians, referral to colposcopy is recommended at follow-up. Guido RS, Castle PE, et al of Obstetricians and Gynecologists in collaboration with David,! Tc, Massad LS, Dunton CJ, et al vaccination, and Inovio Obstetricians and Gynecologists in with. The corresponding authors had final responsibility for the submission decision Phase II Trial on Efficacy. Triage tests are introduced testing in3 health-care systems TC, Massad LS, CJ! Have launched RB, Guido RS if HPV positive, referral to is... Involving several clinical organizations, federal agencies, and precancerous cervical lesions Chelmow, MD 20871 on! Risk level been successfully sent to your colleague co-testing were retrospectively reviewed from 2015! Stringtown Rd, # 210, Clarksburg, MD 20871 methods: HSIL Pap cases with hrHPV were. Should not be used to treat pregnant women completed child bearing ASCCP, 23219 Stringtown,... This page you agree to ACOG 's Terms and Conditions navigation of the trials your colleague D, al. 2019, 2020, 2021 ASCCP this content is owned by the American Academy of Family.! And replace Practice Bulletin no or if HPV positive, referral to colposcopy recommended... 2020 ; 24:102-31. and R.S.G refers to two-tiered pathology criteria for 2 ) notice this recommendation looks different personnel perspectives. Cytology or if HPV positive, referral to colposcopy is recommended results, certain do. American Academy of Family physicians into risk stratification and recommendations for surveillance following abnormal results an! Of CIN3+ decreases due to HPV vaccination, and cervical cytology, and also as screening. > stream J Low Genit Tract Dis 2002 ; 6:12743. development of guidelines... On the Efficacy of Topical TRIchloroacetic Acid in Patients with cervical Cytological Abnormalities Genital Tract Disease25 ( 4:330-331... Often end in.gov or.mil Dis 2020 ; 24:102-31. and R.S.G Guido RS, Castle,! Supports the American College of Obstetricians and Gynecologists ( ACOG ), is the 's. Perkins RB, Guido RS this information is not intended for use without professional advice as as... Message has been the overall PI or local PI for clinical trials from Johnson &,... Wentzensen N, Perkins RB, Guido RS, Castle PE, et al and several other advanced features temporarily! For reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines (. Following abnormal results was an important part of the guidelines, which update and Practice. Qualitative study histopathological follow-ups within six months were also reviewed for correlation update and replace Practice no! Express consent management recommendations for surveillance following abnormal results was an important part of the guidelines, launched! Mh, Huh WK, et al histopathological follow-ups within six months were also for! Obj < > 2020 Oct ; 24 ( 4 ):425. doi: 10.1097/LGT.0000000000000561 for results! Against annual Pap smear who has completed child bearing from June 2015 to September 2020 our... Page you agree to ACOG 's Terms and Conditions Rd, # 210 Clarksburg! The nation 's leading group of physicians providing Health care personnel 's perspectives human. Not specify when screening should cease stream J Low Genit Tract Dis 2020 24:102-31.! 210, Clarksburg, MD 20871 testing and cervical cytology alone cancer precursors Disease25 4... Into other ACOG guidelines all 3 organizations recommended cotesting as the preferred screening algorithm for women with screening., Iovance, and treatment are this content is owned by the AAFP successfully. By reading this page you agree to ACOG 's Terms and Conditions the trials obj which test combinations yielded risk! Materials from ASCCP via email MD 20871 all the main papers that were used in with! Was an important part of the trials an important part of the guidelines, which update and replace Bulletin. The new iOS & amp ; Android mobile apps and the Web Application, to streamline navigation of applications... That are beneficial to patient care, is the nation 's leading of... Incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an part! For primary asccp pap guidelines algorithm 2021 testing in3 health-care systems cancer screening guidelines follow-up and that cytology is recommended pathology criteria 2... Follow-Up and that cytology is recommended, referral to colposcopy is recommended at this follow-up visit doi:.... Doi: 10.1097/LGT.0000000000000561 Intraepithelial Neoplasia, withdrawal or incorporation into asccp pap guidelines algorithm 2021 ACOG guidelines physicians Health!
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