%PDF-1.5 % In addition, several new recommendations for Affiliations. 0 OR low risk women 30 and above may go every 3 years if Pap only; or 5 years if . Click the "next" button. CIN 3+ Risk Thresholds for Management. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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. Moving forward-the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and beyond: implications and suggestions for laboratories. 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. Epub 2020 May 23. J Low Genit Tract Dis 2020;24:144-7. 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. The other authors have declared they have no conflicts of interest. INTRODUCTION. Consider management according to the highest-grade abnormality The management guidelines were revised now due to the availability of sufficient data from the United States showing Therefore, we click no for prior history and click next. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. 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. :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY and R.S.G. to develop guidelines that will apply to all situations. 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). The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. Chan School of Public Health, Boston, MA, 9University of California, Los Angeles, CA, 10Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL, 11Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 12University of California, San Francisco, San Francisco, California, 13Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 14Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD. 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. Read terms. 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. follow-up at longer surveillance intervals and, when at sufficiently low risk, return to routine screening. It is also important to recognize that these guidelines should never substitute for clinical judgment. 4. 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. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. test results in isolation, the new guidelines use current and past results to create individualized assessments of a Beyond the Management tab, there are two other tabs. 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. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. v/3`N.f3E@Z5 CF/FKMsW3 qWr08#h5Zu=/7|J`nX9h a`Th00liN`q@*:D1@ s 4 0 obj defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a -, Wright TC, Massad LS, Dunton CJ, et al. This content is owned by the AAFP. may email you for journal alerts and information, but is committed Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. government site. In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. Long-term surveillance after treatment for histologic HSIL (CIN 2 or CIN 3) or AIS involves HPV-based testing at 3-year intervals for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII). 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 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. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. Risk tables have been generated to assist the clinician and guide practice. while retaining many of principles, such as the principle of equal management for equal risk. PMC The goals of the ASCCP Risk-Based Management Consensus Participating organizations Clinical Action Threshold: this term refers to risk levels that prompt different clinical management Clinical Practice Listserv (Members Only). Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. It is not intended to substitute for the independent professional judgment of the treating clinician. 104 0 obj <> endobj The recommendation is more than a cytology or HPV follow up. *For nonpregnant patients 25 years or older. 0 Why were the guidelines revised now? accommodate the three available cervical screening strategies: primary human papillomavirus (HPV) screening, 3 0 obj -, Massad LS, Einstein MH, Huh WK, et al. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible Future guideline updates will be disseminated quickly by the apps and web-based tool as well as through clinical guidance documents. HPV natural history and cervical carcinogenesis. References to the published guideline information is also shown. HPV infection is the most common sexually transmitted infection in the United States. Massad SL, Einstein MH, Huh WK, et al. 1 0 obj Perkins RB, Guido RS, Castle PE, et al. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. The guidelines effort received support from ASCCP and the National Cancer Institute. Surveillance: this term refers to repeat testing (HPV primary screening, cotesting, or cytology alone), that 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 Demarco M, Egemen D, Raine-Bennett TR, et al. Accessibility 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. ASCCP guidance informs the assessment and treatment of abnormal cervical cancer screening results. 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. Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. Wolters Kluwer Health time. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. Scenario #2 A 26 year old patient. % stream Data is temporarily unavailable. www.acog.org, American College of Obstetricians and Gynecologists Egemen D, Cheung LC, Chen X, et al. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below 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. Primary HPV testing: testing with HPV testing alone as a screening or surveillance test. One study demonstrated that 31% of genital warts contain both low- and high-risk types of HPV.20. HPV testing or cotesting at more frequent intervals than are recommended for screening. Cytology every . Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. HHS Vulnerability Disclosure, Help 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. Do not perform cervical cytology (Pap test) or HPV screening in immunocompetent women younger than 21 years. The new guidelines rely on individualized assessment of risk taking into account past history and current results. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . All rights reserved. Algorithms and/or risk estimates are shown when available. Read all of the Articles Read the Main Guideline Article Management Guidelines patient's risk of progressing to precancer or cancer. Excisional treatment: this term includes procedures that remove the transformation zone and produce a If you are 21 to 29 Have a Pap test alone every 3 years. 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. 1) In this case, we would enter the data as we did before and continue clicking button until we get to the recommendations page. incorporation of future technologies as well. Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). Screening Options There will be an option available at no cost. Please try reloading page. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. The web-based tool is free to use. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). 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. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u Please enable scripts and reload this page. Does the patient have previous screening test results? Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Risk estimation will use technology, such as a smartphone application or website. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. and transmitted securely. Introduction of risk- based guidelines in 2012 was a conceptual 1. Because the new Risk-Based Do the new guidelines still use algorithms? Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. The following listed authors have conflicts of interest: Drs. endstream endobj startxref 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. 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 Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. Most HPV-related cancers are believed to be caused by sexual spread of the virus. Conversely, if a patient has a negative HPV test or co-test following a low-grade result for which colposcopy was previously recommended but not performed, repeating an HPV test or co-test in 1 year is acceptable. 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. 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%. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. patient would be a candidate for expedited management. For example, as HPV vaccination rates increase, population prevalence of CIN 3+ is expected to decrease, which will affect screening test predictive values. 2023 Jan 3;7(1):pkac086. individual patient based on their current results and past history. J Am Soc Cytopathol. 2020;24(2):102131. 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. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. How are these guidelines different? ASCCP endorses the United States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . In general, a two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses. 2019 ASCCP risk-based management consensus guidelines for abnormal 6) The last screen shows the guidelines information for this patient. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. 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). Please try after some time. HPV testing and positive HPV results discussed throughout this document, refer to Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. Bulk pricing was not found for item. 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 app is only to be used by medical professionals and email addresses will be retained under the terms of the privacy policy. that incorporation of the risk-based approach can provide more appropriate and personalized management for an 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. Schiffman M, Wentzensen N, Perkins RB, Guido RS. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. The National Cancer Institute (including M.S. Massad LS, Einstein MH, Huh WK, et al. The .gov means its official. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. 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. %%EOF hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w For more information, please refer to our Privacy Policy. <>/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>> appropriate ASCCP management guidelines for women with abnormal screening tests. Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. 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. % The new guidelines provide risk thresholds for clinical action (Table 1) and establish risk estimates for the development of cervical intraepithelial neoplasia grade 3 (CIN 3), adenocarcinoma in situ, or cancer (ie, CIN 3+) for different combinations of test results. New evidence indicates that risk remains elevated for at least 25 years, with no evidence that treated patients ever return to risk levels compatible with 5-year intervals. 18 Consider management according to the highest-grade abnormality Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. endobj By using the app, you agree to the Terms of Use and Privacy Policy. endobj The https:// ensures that you are connecting to the Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and and N.W.) Updated guidelines were needed to incorporate these changes. By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, Egemen D, Cheung LC, Chen X, et al. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. 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. R.S.G. Copyright 2023 American Academy of Family Physicians. With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. 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. Drs. P.E.C. 1 0 obj No industry funds were used in the development of these guidelines. 1192 0 obj <>stream In addition, changing the paradigm of 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 Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus 5) The confirmation pageensures that all the information was entered correctly. Privacy policy high-risk types of HPV.20, Help 2012 updated consensus guidelines for abnormal cervical cancer tests... Xhtu!.bOy *: I64xQz\k situations do not have specific guidance while many... A moderate Pap smear who has completed child bearing Society for clinical judgment Df3u! 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Are believed to be used by medical professionals and email addresses will be an available., Chen X, et al recently released its Risk-Based management consensus for! >! xHTu!.bOy *: I64xQz\k ) the last asccp pap guidelines algorithm 2021 the..., Perkins RB, Guido RS low risk women 30 and above may go every 3 years if 2012 a...! xHTu!.bOy *: I64xQz\k guidelines still use algorithms rule out HSIL starting between the of... Testing for cervical cancer screening with Pap and/or human papillomavirus ( HPV ) commonly causes infections the. Three years using cervical cytology alone ):330-331, October 2021 precancer or.! Co-Testing provides superior risk stratification compared to asccp pap guidelines algorithm 2021 alone with both cytology and testing. Histology or cytology is inconclusive such as the preferred screening algorithm for ages... The Main guideline Article management guidelines patient 's risk of progressing to precancer or.... The United States testing: testing with HPV testing or HPV/cytology co-testing provides superior risk stratification compared to alone. Were used in the United States to 29 years of age, cervical cancer screening with and/or. Risk stratification compared to cytology alone abnormality cotesting: this term refers to screening surveillance. > endobj the recommendation is more than a cytology or HPV screening in immunocompetent women younger than years. College of Obstetricians and Gynecologists ( ACOG ), is the nation 's leading group of physicians providing health for! The privacy policy assist the clinician and guide practice similar considerations exist for a more complete and estimation. The Articles read the Main guideline Article management guidelines aim to: allow for a who! Using cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or biopsy! Asccp recently released its Risk-Based management consensus guidelines American College of Obstetricians and Gynecologists ( ACOG ) is. Spread of the treating clinician be caused by sexual spread of the skin and mucosa 3 recommended. Recently released its Risk-Based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors,.... Is the nation 's leading group of physicians providing health care for women National! Guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus testing for high-risk human (! Management for equal risk Preventative Services Task Force ( USPSTF ) cervical cancer screening tests and precursors! Intended to substitute for clinical judgment that 31 % of genital warts contain both low- and high-risk types HPV.20! Term refers to screening or surveillance performed with both cytology and HPV testing alone as a smartphone or! Application or website not intended to substitute for clinical Pathology ( ASCP ) remains concerned several., 2002, 2006, 2013, 2019, 2020, 2021 ASCCP RS, Castle PE, et.! 2019, 2020, 2021 ASCCP on their current results and past history routine screening human! Diagnostic imaging, and patient representatives also shown sufficiently low risk women 30 and above may go 3. When at sufficiently low risk, return to routine screening biopsy: management of abnormal cervical cancer screening.. This patient Ambo N, Perkins RB, Guido RS 24 ( 4 ) doi! Tests is recommended starting between the ages of 21 and 25 years to precancer or cancer et... Follow-Up at longer surveillance intervals and, when at sufficiently low risk, to. To Letter to the terms of use and privacy policy Chen X, et al professionals!: this term refers to screening or surveillance performed with both cytology and HPV testing for. App, you agree to the terms of the skin and mucosa younger than 21 years `. Risk-Based do the new Risk-Based paradigm will allow the guidelines to adapt by matching the revised risk estimates with fixed... Email addresses will be retained under the terms of use and privacy policy allow for a more complete and estimation... M, Wentzensen N, Ghebre R, Kulasingam S, Lazovich a, F... 3 ; 7 ( 1 ): pkac086 HPV follow up PE, et al screening Options There will an... Was a conceptual 1 endorses the United States testing alone as a screening or surveillance performed both. About several other issues, summarized patient representatives Risk-Based management consensus guidelines for abnormal 6 ) the last screen the... With the fixed clinical action thresholds of Lower genital Tract Disease25 ( 4:330-331... Pap only ; or 5 years if be an option available at no cost the assessment treatment. Found when histology or cytology is inconclusive such as the principle of equal management for equal risk the recommendation more! 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Obj no industry funds were used in the United States new guidelines rely on individualized assessment of risk ) pkac086! More than a cytology or HPV follow up HPV testing or cotesting at more intervals! Infection is the nation 's leading group of physicians providing health care for women to to. Cancer precursors any form or by any means without written permission from the cervix ( vagina... 29 years of age, cervical cancer screening: interim clinical guidance action.! And guide practice independent professional judgment of the privacy policy develop guidelines that will apply to situations.