Cervical cancer screening rates also are below expectations, with the lowest levels reported among individuals younger than 30 years 17 18 . include protected health information. Inadequate cervical cancer screening remains a significant problem in the United States, with persistent health inequities across the entire spectrum of cervical cancer care 10 17 19 . . However, the Pap smear test is not 100% accurate. Given these significant health equity concerns and the current suboptimal rates of cervical cancer screening and HPV vaccination, ACOG, ASCCP, and SGO continue to recommend initiation of cervical cancer screening at age 21 years. Mayo Clinic Minute: Screening for cervical cancer, Mayo Clinic Q and A: Cervical cancer and HPV screening, 4 ways to reduce risks of cervical cancer, Mayo Clinic Minute: Why Black women need to be screened for cervical cancer, Mayo Clinic Minute: The importance of cancer screenings for LGBTQ community. A Pap smear can alert your doctor to the presence of suspicious cells that need further testing. 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. The Choosing Wisely campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation to improve health care quality. Office on Women's Health. information highlighted below and resubmit the form. During a Pap smear, a doctor or practitioner collects cells from the cervix.The cervix is the opening . In this video, Dr. Lisa Richardson, Dr. Robert W. Carlson, and Dr. Laura Makaroff talk about the importance of routine cancer screenings. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Here's a quick summary of ACOG guidelines for cervical cancer screening ( read this FAQ for the full details): Women age 21 to 29 should have a Pap test alone every 3 years. Pap smears are not helpful in women after hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes. It is not a substitute for a treating clinicians independent professional judgment. A pap smear is a test that's conducted during a pelvic exam. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. You will be subject to the destination website's privacy policy when you follow the link. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. The Pap smear is usually done in conjunction with a pelvic exam. Read More. What Causes Immunotherapys Heart-Related Side Effects? Pap tests have lower sensitivity compared with HPV tests, so they may miss some precancers and have to be repeated frequently. The USPSTF issued the following recommendation statements (1): The excerpt below is from USPTF summary statement: The American College of Obstetricians and Gynecologists (ACOG) joins ASCCP and the Society of Gynecologic Oncology (SGO) in endorsing the U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations 1 , which replace ACOG Practice Bulletin No. After your Pap smear, you can go about your day without restrictions. | Terms and Conditions of Use. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Pap tests also can find cervical cancer early, when the chance of being cured is very high. The HPV test and the Pap test can help prevent cervical cancer or find it early. Reducing Cancers Global Burden: A Conversation with NCIs Dr. Satish Gopal, If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. Talk to your doctor about which testing option is right for you, Your doctor may tell you that you dont need to be screened anymore if. There is more interest now in looking at people who had an abnormal screening test result at an older age to see if they require more years of screening or more frequent screening. If you have a low income or do not have health insurance, you may be able to get a free or low-cost screening test through the National Breast and Cervical Cancer Early Detection Program. http://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening. Follow Pap smear guidelines to know when to start this test, when to stop, and how often to get it. The 2012 ASCCP guidelines were based on which test a patient got and what the results were. Changing recommendations and guidelines for pap smear , clinical breast exam and mammograms. "Squamous cell cancer" refers to cancers arising in the flat surface cells of the vagina or cervix. There is a problem with The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. CA: A Cancer Journal for Clinicians. American College of Obstetricians and Gynecologists Obstet Gynecol 2020;136:e1521. Data from clinical trial, cohort, and modeling studies demonstrate that among average-risk patients aged 2565 years, primary hrHPV testing and co-testing detect more cases of high-grade cervical intraepithelial neoplasia than cytology alone, but hrHPV-based tests are associated with an increased risk of colposcopies and false-positive results 1 6 7 . Saving Lives, Protecting People, Cindys Story: Preventing Cervical Cancer (:90), Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. And it detects a lot of minor changes that have a very low risk of turning into cancer. Although cytology alone is the recommended screening method for individuals aged 2129 years, ACOG, ASCCP, and SGO advise that primary hrHPV testing every 5 years can be considered for average-risk patients aged 2529 years based on its FDA-approved age for use and primary hrHPV testings demonstrated efficacy in individuals aged 25 years and older. Depending on the type of Pap testing you're undergoing, your doctor transfers the cell sample collected from your cervix into a container holding a special liquid to preserve the sample (liquid-based Pap test) or onto a glass slide (conventional Pap smear). Cervical cancer screening. Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. Treatment for cervical cancer or precancer can permanently alter the cervix. Factors that can cause a false-negative result include: Although it's possible for abnormal cells to go undetected, time is on your side. This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present. Other guidelines, statements, and recommendations related to anogenital and HPV-related diseases. information is beneficial, we may combine your email and website usage information with Using all the information that we have on the risk of cervical cancer and precancer, the guidelines create a framework that helps doctors make decisions about follow-up care based on a patients total risk level. The Pap (Papanicolaou) Test The Pap test is a procedure that collects cells from the cervix so that they can be looked at closely in the lab to find cancer and pre-cancer. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. MMWR Morb Mortal Wkly Rep 2021;70:41520. JAMA Oncol 2017;3:8337. screening and follow up pap smear results . Screening for cervical cancer with high-risk human papillomavirus testing: updated evidence report and systematic review for the US Preventive Services Task Force. et al. What I Tell Every Patient About the HPV Vaccine, Why Annual Pap Smears Are History But Routine Ob-Gyn Visits Are Not, Copyright 2023 American College of Obstetricians and Gynecologists, Privacy Statement Abnormal test results can lead to more frequent testing and invasive diagnostic procedures, such as colposcopy and cervical biopsy. Two HPV tests have been approved by the Food and Drug Administration (FDA) for use as a primary HPV test, meaning it is not part of an HPV/Pap cotest. If you are getting a Pap test, you can take steps to make sure the test results are accurate. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Follow these Guidelines: If you are younger than 21You do not need screening. Review/update the Doctors generally agree that women can consider stopping routine Pap testing at age 65 if their previous tests for cervical cancer have been negative. Cervical cancer takes several years to develop. Older age. The tissue sample is then sent to a laboratory for analysis and a definitive diagnosis. Ho GY, Bierman R, Beardsley L, et al. These recommendations also do not apply to individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (eg, individuals with human immunodeficiency virus). In 2018, the CDC announced new guidelines for Pap smear and HPV testing. Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. By reading this page you agree to ACOG's Terms and Conditions. So, the vaccines have led to a drop in HPV infections and cervical precancer in this age group. anal cancer with anal Papanicolaou ( Pap) smears is controversial, we agree with the Infectious Disease Society of America guidelines, which recommend anal Pap tests for HIV-positive MSM, HIV-positive women . The results of the second test will help decide if you need a colposcopya procedure to look at the cervix with a magnifying lens and take samples from spots on the cervix that look abnormal. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Although cervical cancer screening options have expanded, cervical cytology, primary hrHPV testing, and co-testing are all effective in detecting cervical precancerous lesions and cancer. A combination of both tests done together, known as "co-testing". These recommendations differ slightly from those given by ACS in 2012 and by the US Preventive Services Task Force (USPSTF) in 2018. Bulk pricing was not found for item. Rationale for new changes To balance needed and unnecessary treatment . A diagnosis of cervical cancer or a Pap smear that showed precancerous cells, Exposure to diethylstilbestrol (DES) before birth, Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use, Blood or inflammatory cells obscuring the abnormal cells. The specific strategy selected is less important than consistent adherence to routine screening guidelines. Increasing Receipt of Ovarian Cancer Care from a Gynecologic Oncologist, U.S. Department of Health & Human Services. 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 introduction of vaccines targeting the most common cancer-causing HPV genotypes has advanced the primary prevention of cervical cancer. In a Pap test, your doctor uses a vaginal speculum to hold your vaginal walls apart and to see the cervix. A screening pap smear and related medically necessary services provided to a woman for the early detection of cervical cancer (including collection of the sample of cells and a physician's interpretation of the test results) and pelvic examination (including clinical breast examination) are covered under Medicare Part B when . What happens if I receive a positive result for cervical cancer? When to get a PAP test New Pap Smear Guidelines Cervical Cancer Screening Guidelines *USMLE STEPs 1, 2 \u0026 3* The Doctor is In: Abnormal Pap Smear Cervical cytology; 2 2 New Pap Smear Guidelines 2013 Acog 1-03-2023 introduction, history and screening There are several types of screening tests for cervical cancer: The Papanicolaou or "Pap" test (sometimes called a "Pap smear") A human papillomavirus or "HPV" test. 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Pap Smear Screening begins at age 21 regardless of when sexual activity starts. J Womens Health (Larchmt) 2019;28:2449. A positive result doesn't mean you have cervical cancer. JAMA 2018;320:687705. While pap smears can be uncomfortable, theyre hugely necessary. Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection Colposcopy Standards Other Guidelines *These recommendations apply to individuals with a cervix who do not have any signs or symptoms of cervical cancer, regardless of their sexual history or HPV vaccination status. A Pap smear is vital for a woman's health. Pap screening may end at age 65 if the Pap history is unremarkable and the patient is low risk. No. Accessed May 28, 2018. Scheduling a routine exam and a pap smear is also a great opportunity to talk about any other concerns you may have. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. CDCs National Breast and Cervical Cancer Early Detection Program offers free or low-cost mammograms and Pap tests nationwide. So, many people who get an abnormal Pap test result actually have a very low chance of developing cervical cancer. The cervix is the opening to the uterus located at the top of the vagina. 2013;17(suppl):S1. Thats why ACS recommends starting screening at age 25. J Natl Med Assoc 2020;112:22932. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. A swab is taken from the cervix, the small opening to the uterus from the vagina, and collects cells that are later tested for cervical cancer. This content does not have an Arabic version. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. Now, doctors say that for most women, your first pap smear doesnt need to happen until youre 21. They also detect a range of abnormal cell changes, including some minor changes that are completely unrelated to HPV. 1998;338(7):423428. If, in the past, you had an abnormal result or anything suspicious on a screening test, or had treatment for cervical cancer or precancer, then you should continue to be screened. Despite the demonstrated efficacy and efficiency of primary hrHPV testing, uptake of this screening method has been slow because of the limited availability of FDA-approved tests and the significant laboratory infrastructure changes required to switch to this screening platform. 2018;320:674. Have an HPV test every 5 years. If you are getting an HPV test, the cells will be tested for HPV. MMWR Morb Mortal Wkly Rep 2020;69:110916. In general, doctors recommend beginning Pap testing at age 21. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don't clearly suggest that precancerous cells are present. If you're sexually active with multiple partners, your doctor may recommend continuing Pap testing. This term is used to indicate that the cells collected from the Pap smear may be precancerous. The Pap test can find abnormal cells in the cervix which may turn into cancer. If HPV testing alone is not available, people can get screened with an HPV/Pap cotest every 5 years or a Pap test every 3 years. For an HPV/Pap cotest, an HPV test and a Pap test are done together. You should return for your next screening test in 3 years. While many women say that pap smears are more uncomfortable than they are painful, theyre a critical part of maintaining your overall health. A Practice Advisory constitutes ACOG clinical guidance and is issued only on-line for Fellows but may also be used by patients and the media. A Pap Smear is a test used to find changes in the cells of the cervix that could lead to cancer. These risk factors include: You and your doctor can discuss the benefits and risks of Pap smears and decide what's best for you based on your risk factors. To ensure that your Pap smear is most effective, follow these tips prior to your test: The ovaries, fallopian tubes, uterus, cervix and vagina, also called the vaginal canal, make up the female reproductive system. It tests for the presence of precancerous or cancerous cells on your cervix. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes. Available at: Beavis AL, Gravitt PE, Rositch AF. A Pap smear is used to screen for cervical cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. Both tests can be done in a doctors office or clinic. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Before getting a pap smear, there are a few things to keep in mind. That may raise the risk of serious complications in a future pregnancy, including pregnancy loss and preterm birth. (Monday through Friday, 8:30 a.m. to 5 p.m. If the changes are low grade, it means the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it's likely to be years away from becoming a cancer. ACS carefully evaluated the potential benefits and harms of each screening test for each age group to come up with their updated recommendations. Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening. Currently, there are two hrHPV tests approved by the FDA for primary screening in individuals aged 25 years and older. Screening tests and follow-up tests can cause physical discomfort. Both issues, and more, are common for many women, and during your pap smear, your doctor can perform an internal exam to see if theres anything of concern going on. morphological examination (Pap test) at some time in their screening history and should not be screened solely with HPV tests. Given these concerns, ACOG, ASCCP, and SGO continue to recommend cervical cancer screening initiation at age 21 years. There are many reasons why test results might not be normal. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Cindys Story: Preventing Cervical Cancer, Centers for Disease Control and Prevention. Pap test. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. The test also looks for cell abnormalities, which can eventually turn into cancer, and identifies certain sexually transmitted infections. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If no high-risk viruses are present, the abnormal cells found as a result of the test aren't of great concern. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. Clinical Practice Listserv (Members Only), new iOS& Android mobile apps and the Web application. You and your doctor can decide when it's time for you to begin Pap testing and how often you should have the test. A Practice Advisory is a brief, focused statement issued to communicate a change in ACOG guidance or information on an emergent clinical issue (eg, clinical study, scientific report, draft regulation). American College of Obstetricians and Gynecologists. In most cases, treatment prevents cervical cancer from developing. Screening for ovarian,external icon pancreatic,external iconprostate,external icon testicular,external icon and thyroidexternal icon cancers has not been shown to reduce deaths from those cancers. The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer (D recommendation). 168, Cervical Cancer Screening and Prevention, as well as the 2012 ASCCP cervical cancer screening guidelines 2 . A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. MMWR Morb Mortal Wkly Rep 2021;70:2935. Here are some terms your doctor might use and what your next course of action might be: Atypical squamous cells of undetermined significance (ASCUS). CDC twenty four seven. These cookies may also be used for advertising purposes by these third parties. Screening with cervical cytology or HPV testing can lead to physical and emotional harms. In some cases, the HPV test may be done instead of a Pap smear. Approximately 90 percent of HPV infections in girls and young women spontaneously clear within two years. HPV vaccines are very good at preventing HPV infections, particularly infection with HPV types 16 and 18, the types that cause most cervical cancers. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. Accessed May 28, 2018. For an HPV/Pap cotest, an HPV test and a Pap test are done together. Saslow D, Runowicz CD, Solomon D, et al. Curry SJ, et al. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test. A Pap smear, also called a Pap test, is a screening procedure that can detect cervical cancer. "Adenocarcinoma" refers to cancers arising in glandular cells. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The first cohort of women who received the HPV vaccine when they were younger are now in their 20s and are eligible for cervical cancer screening. You may opt-out of email communications at any time by clicking on Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding, ACOG Booklets: Download Health Guides on Key Topics, Your Pregnancy and Childbirth: A Guide to Pregnancy From the Nation's Ob-Gyns. While pap smears might not be the highlight of your day, theyre incredibly important. Now, doctors can use any combination of test results to determine an individuals risk and decide whether that person should, for example, get a colposcopy or come back in a year to repeat the screening test. Declines in prevalence of human papillomavirus vaccine-type infection among females after introduction of vaccineUnited States, 2003-2018. 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). While pap smears can be uncomfortable, theyre hugely necessary. All these improvements have allowed us to make more accurate predictions of a persons chances of getting cervical precancer and cancer. The Papanicolaou-stained (Pap) smear was introduced in 1949 by a pathologist named George Papanicolaou. For more information on pap smears and well-woman exams,schedule an appointmentwith us today or call 678-210-7677 to speak with one of our patient coordinators. The new iOS& Android mobile apps and the Web application,to streamline navigation of the guidelines, have launched. It's best to avoid this time of your cycle, if possible. Detecting these abnormal cells early with a Pap smear is your first step in halting the possible development of cervical cancer. One is to start screening at a slightly older age, and the other is to preferentially recommend a type of screening test called an HPV test. an abnormal Pap smear.5,6 Because sensitivity of a single Pap test for high-grade lesions may only be 60% to 80%, however, most organizations in the U.S. recommend that annual Pap smears be performed until a specified number (usually 2 or 3) are cytologically normal before lengthening the screening interval.2 The ACS guidelines 2 Screening tests can find precancerous polyps, so they can be removed before they turn into cancer. 2009;114:1409-1420. Your doctor may tell you that you can wait several years for your next cervical cancer screening test. U.S. Preventive Services Task Force. These recommendations only apply to women who have a cervix. 2019 Advanced Gynecology. Its a very dynamic situation, and thats for multiple reasons. This site complies with the HONcode standard for trustworthy health information: verify here. https://www.womenshealth.gov/a-z-topics/pap-test. Upon . This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. It can take as long as three weeks to receive your test results. Indications and Limitations of Coverage. In women older than age 30, the Pap test may be combined with a test for human papillomavirus (HPV) a common sexually transmitted infection that can cause cervical cancer. There are a few factors that would require more frequent pap smears. Read the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors, access the mobile app, and refer to the historical 2012 and 2006 guidelines. Some of those include: Pap smears typically take place during a gynecological pelvic exam. This content does not have an English version. Please contact [emailprotected] with any questions. A Pap test may also come back as unsatisfactory. . Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Screening Guidelines Access the screening guidelines for the prevention and early detection of cervical cancer. A Pap smear is an important part of a cervical cancer . Vaccine Recommendations The latest CDC guidelines for the HPV vaccine. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. Inserting the speculum may cause a sensation of pressure in your pelvic area. 168, October 2016) Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement, AAFP recommendations for preventive services guideline, American Board of Internal Medicine (ABIM) Foundation, Learn more about the AAFP support of the Choosing Wisely campaign. USPSTF Recommendations for Routine Cervical Cancer Screening. All information these cookies collect is aggregated and therefore anonymous. It's possible to receive false-negative results meaning that the test indicates no abnormality, even though you do have abnormal cells. Your doctor will gently insert an instrument called a speculum into your vagina. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. HPV-associated cervical cancer rates by race and ethnicity. The Pap test identifies the presence of precancerous and cancerous cells, while the HPV test looks for high-risk strains of HPV that can lead to cervical cancer. N Engl J Med. Breast Cancer Screening Guidelines. Read terms. If you have had a hysterectomy in which your cervix was removed and: You have a history of cervical cancer or moderate to severe cervical changesContinue to have screening for 20 years after your surgery. Pap smear is often recommended for cervical cancer screening. 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. Instead of an annual pap, you can get oneevery three yearsuntil youre 65. Obstetrics & Gynecology. Adolescents/young women 20 and below are not recommended to have a Pap test or HPV testing. If you have your period, dont worry. As per the new guidelines: What is cervical precancer? Available at: https://jamanetwork.com/journals/jama/fullarticle/2697704. Age 21 to 24 - Screen every 3 years with Pap smear. If you are younger than 21You do not need screening. Available at: Human papillomavirus vaccination. 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. Data from Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. ASCCP and the Society of Gynecologic Oncology endorse this Practice Advisory. Until primary hrHPV testing is widely available and accessible, cytology-based screening methods should remain options in cervical cancer screening guidelines. You have human immunodeficiency virus (HIV). Please try reloading page. Massad LS, et al. JAMA 2018;320:67486. Normal Pap test results: No abnormal cervical cells were found. The American Cancer Society changes its cervical cancer screening guidelines to HPV tests instead of Pap tests and starting at age 25, every 5 years to 65. . CDC Guidelines for Pap Smear and HPV Testing. 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. Finding abnormal cells or cancer early is the best way to combat it and prevent it from spreading. Active with multiple partners, your first Pap smear appear so abnormal the... Sgo continue to recommend cervical cancer third parties Receipt of Ovarian cancer Care from a Gynecologic Oncologist U.S.. Located at the top of the vagina purposes by these third parties but may be. Three weeks to receive your test results might not be screened solely with HPV tests of. In HPV infections and cervical precancer in this age group done instead of Pap! 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