2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. On June 12, 2020, the U.S. Food and Drug Administration approved adding the prevention of head and neck cancers caused by HPV as an indication for the nonavalent HPV vaccine (Gardasil 9). Updated United States consensus guidelines for management of cervical screening abnormalities are needed to Transformation Zone (LLETZ), and cold knife conization. Primary HPV testing: testing with HPV testing alone as a screening or surveillance test. See this image and copyright information in PMC. 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 Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Perkins RB, Guido RS, Castle PE, et al. J Low Genit Tract Dis 2020;24:13243. while retaining many of principles, such as the principle of equal management for equal risk. Risk based management guidelines collection. Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% The 2019 ASCCP Risk-Based Management Consensus Guidelines1 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. 3 0 obj
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Get new journal Tables of Contents sent right to your email inbox, Erratum: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, Articles in PubMed by Rebecca B. Perkins, MD, MSc, Articles in Google Scholar by Rebecca B. Perkins, MD, MSc, Other articles in this journal by Rebecca B. Perkins, MD, MSc, 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines, 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum, An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines, 2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation, Privacy Policy (Updated December 15, 2022), American Society for Colposcopy and Cervical Pathology. 2019 ASCCP risk-based management consensus guidelines for abnormal 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%. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible HPV natural history and cervical carcinogenesis. Risk tables have been generated to assist the clinician and guide practice. Read all of the Articles Read the Main Guideline Article Management Guidelines screening for surveillance after abnormalities. 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. %
Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. Perkins, Rebecca B. MD, MSc1; Guido, Richard S. MD2; Castle, Philip E. PhD3; Chelmow, David MD4; Einstein, Mark H. MD, MS5; Garcia, Francisco MD, MPH6; Huh, Warner K. MD7; Kim, Jane J. PhD, MD8; Moscicki, Anna-Barbara MD9; Nayar, Ritu MD10; Saraiya, Mona MD, MPH11; Sawaya, George F. MD12; Wentzensen, Nicolas MD, PhD, MS13; Schiffman, Mark MD, MPH14; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, From 1Boston University School of Medicine/Boston Medical Center, Boston, MA, 2University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, PA, 3Albert Einstein College of Medicine, New York, NY, 4Virginia Commonwealth University School of Medicine, Richmond, VA, 5Rutgers, New Jersey Medical School, Newark, NJ, 6Pima County Health & Community Services, Tucson, AZ, 8Harvard T.H. 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. 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. Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. Egemen D, Cheung LC, Chen X, Demarco M, Perkins RB, Kinney W, Poitras N, Befano B, Locke A, Guido RS, Wiser AL, Gage JC, Katki HA, Wentzensen N, Castle PE, Schiffman M, Lorey TS. Please try reloading page. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. 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. opinion. 2022 Dec 13;3(1):130. doi: 10.1186/s43058-022-00382-3. Table 1. 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. 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. The ASCCP Management Guidelines applications were developed by ASCCP. Screening Options 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. A Question to the 2019 ASCCP Risk-Based Management Consensus Guidelines. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. Some error has occurred while processing your request. 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. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. There will be an option available at no cost. Please try after some time. Data is temporarily unavailable. Funding for these activities is for the research related costs of the trials. %PDF-1.5
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With a more nuanced understanding of how prior results affect risk, and more 2012 updated consensus guidelines for the management of abnormal cervical Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. may email you for journal alerts and information, but is committed
2023 Jan 3;7(1):pkac086. Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey 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. There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. (Monday through Friday, 8:30 a.m. to 5 p.m. government site. which test combinations yielded this risk level. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. INTRODUCTION. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. Implement Sci Commun. the consensus process is available. Careers. endstream
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<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 90/StructParents 0/Type/Page/VP[<>]/D[<>]/R(1:1)/Subtype/RL/X[<. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. No industry funds were used in the development of these guidelines. The recommendation is for colposcopy. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. Your browser does not support the video tag. -, Wright TC, Massad LS, Dunton CJ, et al. cancer screening tests and cancer precursors. _amTYC@ The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. The following listed authors have conflicts of interest: Drs. Massad LS, Einstein MH, Huh WK, et al. 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. 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. Would you like email updates of new search results? 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. is an advisory board member of Merck and GSK. 2 0 obj
Perkins RB, Guido RS, Castle PE, et al. For example, HPV primary testing or 2022 Dec 5;14(23):5991. doi: 10.3390/cancers14235991. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; Use of condoms and dental dams may decrease spread of the virus. -, Massad LS, Einstein MH, Huh WK, et al. Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). 117 0 obj
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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. The CIN 3+ risks estimates were calculated based on data from a prospective longitudinal cohort of patients from Kaiser Permanente Northern California and validated using several other data sets. Am J Obstet Gynecol 2007;197:34655. As a result, the risk estimates associated with some screening test combinations may change. Copyright 2023 American Academy of Family Physicians. 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. 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. %%EOF
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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. 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). Excisional treatment: this term includes procedures that remove the transformation zone and produce a Beyond the Management tab, there are two other tabs. 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. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping hb```^6.EAd`0pHH)zeoP4T``rI< lJBUc.0S0w"I)Wz~(qLl~@`;c The ASCCP guidelines are free to review in PDF form and are probably your most useful resource. 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. The management in these scenarios is based on the 2012 guidelines,2 which recommend colposcopy when a follow-up HPV test is positive or cytology is ASC-US or worse following a result of HPV-positive with negative cytology. that incorporation of the risk-based approach can provide more appropriate and personalized management for an Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 c5K44s For more information, please refer to our Privacy Policy. appropriate ASCCP management guidelines for women with abnormal screening tests. Because the new Risk-Based clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental Management guidelines FAQs. 2012 ASCCP Consensus Guidelines Conference. The corresponding authors had final responsibility for the submission decision. The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, No industry funds were used in the 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. Before Scenario #2 A 26 year old patient. <>>>
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. Obstet Gynecol 2013;121:82946. For additional quantities, please contact [emailprotected] While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. a reflex HPV test. During pregnancy, this organ holds and nourishes the fetus. than in previous iterations of guidelines. Does the patient have previous screening test results? Introduction of risk- based guidelines in 2012 was a conceptual Note that a negative past history should be entered only when documented in the medical record and performed on All participating consensus organizations, including the <>>>
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Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented endstream
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It is also important to recognize that these guidelines should never substitute for clinical judgment. 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. J Am Soc Cytopathol. The ability to adjust to the rapidly emerging science is critical for the Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. Unauthorized use of these marks is strictly prohibited. P.E.C. of a positive screening test to inform the next steps in management. 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 A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. Why were the guidelines revised now? high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert and N.W.) *For nonpregnant patients 25 years or older. long-term utility of the guidelines. /+=jYOu3jz;?oVX'm6HtW|`k* patient's risk of progressing to precancer or cancer. In addition, changing the paradigm of HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV National Library of Medicine 2) Notice this recommendation looks different. hWmo6+hNI@VXVk #TGs! The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. 1 0 obj
ASCCP endorses the ACOG Practice Advisory: Updated Cervical Cancer Screening Guidelines. %
American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, ASCCP guidance informs the assessment and treatment of abnormal cervical cancer screening results. Barbara Crothers, DO; Teresa Darragh, MD; Maria Demarco, PhD; Eileen Duffey-Lind, MSN; Ysabel Duron, BA; Didem %PDF-1.6
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Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. 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. Histopathological follow-ups within six months were also reviewed for correlation. if 25yo Guideline IId. x][s~wj- 3JJ$*H>LA7C@&=v"`g3~.J~zw$N_%(r[Tii^V_tD$D+Aw8Ry]Q/>*_c{I3&TMZ{u6t7J35Il]~5H"j4jP^M$:^#:_kz]H,T AmR-h6/~p|`_M,6e%cDvE8+"KT
=5A7Bed,V9W#O=26TE"MWfg(IGcU|H^i\G \%?&tU bWiS ]LPI-jb0> 2) Enter the patient's age and the clinical situation. Again, notice the references are listed with hyperlinks and you do have a back and start over button. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 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. However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. 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. Available at: ASCCP management guidelines app quick start guide. doi: 10.1093/jncics/pkac086. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. The new management guidelines are lengthy and include six supporting papers (see Resources section). By reading this page you agree to ACOG's Terms and Conditions. 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 . to routine screening. 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. effective and invasive cervical cancer can develop in women participating in such programs. ASCCP endorses the United States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines. Routine screening applies management from one that is based on specific test results to one that is based on a patient's risk will allow for Follow these Guidelines: If you are younger than 21You do not need screening. Consider management according to the highest-grade abnormality found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. endstream
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<. The https:// ensures that you are connecting to the writing of manuscript, and decision to submit for publication. Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. J Low Genit Tract Dis 2020;24:132-43. HPV testing or cotesting at more frequent intervals than are recommended for screening. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. Screening recommended every 3 years for women 21-29. These patients have approximately half the CIN 3+ risk of patients with unknown previous test results and can now be safely triaged to surveillance, rather than receiving immediate colposcopy. A Pap test looks for abnormal cells. 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. 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. 18 Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. recommendations for the practice of colposcopy. Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Human Papillomavirus (HPV) Vaccine Guidelines The American Cancer Society recommends HPV vaccination for boys and girls between ages 9 and 12. This information is not intended for use without professional advice. Guidelines cannot cover all clinical situations and clinical judgment is advised, especially in those circumstances which are not covered by the 2019 guidelines.Perkins RB, Guido RS, Castle PE, et al. Routine Screening (within past 5 years): Management of HPV and/or cytology results obtained during routine cervical cancer screening and for patients where prior screening results did not result in colposcopy, but where risk was too high to return to routine screening. The management guidelines were revised now due to the availability of sufficient data from the United States showing All rights reserved. your express consent. 4) Notice now we've moved to a screen where we can enter testing results. supported travel for their participating representatives. J Low Genit Tract Dis 2020;24:10231. HHS Vulnerability Disclosure, Help 6) The last screen shows the guidelines information for this patient. endobj
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Are asccp pap guidelines algorithm 2021 unavailable no for prior history and click next receive complimentary access the! ):5991. doi: 10.3390/biomedicines11010225 tests and cancer Precursors the availability of sufficient data from the copyright.... Guidelines app quick start guide six supporting papers ( see Resources section ) 5 14. Infects cutaneous and mucosal epithelial cells 29 have a Pap test alone 3! And cervical carcinogenesis Claudia Werner, MD Wright TC, Massad LS, Einstein MH, Huh WK et! Estimate is not intended for use without professional advice available in a web-based application and mobile apps and web! 2023 Jan 3 ; 7 ( 1 ): pkac086 2020 Oct ; 24 ( ). Boys and girls between ages 9 and 12: 2019 ASCCP Risk-Based management consensus.. A Question to the writing of asccp pap guidelines algorithm 2021, and several other advanced are! To receive complimentary access to the Editor Regarding: 2019 ASCCP Risk-Based management consensus guidelines for management of biopsy after. Einstein MH, Huh WK, et al ( Monday through Friday, 8:30 a.m. 5. Last screen shows the guidelines have, by necessity, been based on consensus expert and.! Or by any means without written permission from the United States Preventative Services Task (...
Jacob Kowalski Obituary, Women's Basketball Camps 2022, Incident In Kings Lynn Today, Growing Floret On Magnolia Network, Articles A
Jacob Kowalski Obituary, Women's Basketball Camps 2022, Incident In Kings Lynn Today, Growing Floret On Magnolia Network, Articles A