acog pap guidelines 2020

Pediatrics 2016;138:e20154387. Despite the success of cervical cancer screening in the United States, each year cervical cancer is diagnosed in more than 13,000 women and nearly 4,000 die from the disease 2. The overall public health benefit of HPV vaccination in women aged 27–45 years is markedly diminished compared with use in the target age range 7. For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Any potential conflicts have been considered and managed in accordance with ACOG’s Conflict of Interest Disclosure Policy. HPV Vaccination Impact Study Group. Acad Pediatr 2018;18:S3–10. Lancet 2009;374:301–14. Centers for Disease Control and Prevention (CDC) [published erratum appears in MMWR Morb Mortal Wkly Rep 2014;63:1182]. Cervical Cancer Screening for Individuals at Average Risk: 2020 Guideline Update from the … If you are aged 21–29 years— Have a Pap test every 3 years. | Terms and Conditions of Use. The 9-valent HPV vaccine protects against more than 99% of HPV disease related to genotypes 6, 11, 16, and 18 and up to 96.7% for HPV disease related to genotypes 31, 33, 45, 52, and 58 26. The 2020 guidelines also recommend that people older than age 65 with a cervix stop being screened as long as they’ve had 10 years of regular screening with normal results. A pap test alone every 3 years. It is not necessary to restart the series. ACOG guidelines for cervical cancer screening, Obstet Gynecol 2006; 107(4) 963-8. 6. Bulk pricing was not found for item. Vaccination is recommended for women through age 26 years even if the patient is tested for HPV DNA and the results are positive. Obstet Gynecol 2020;136:e15–21.This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Current Pap Test Recommendations (ASCCP, ACS, ASCP, USPSTF, ACOG) • First Pap test age 21 • Test every three years until age 30 • Age > 30, HPV test with Pap test every 5 years –If HPV testing unavailable, Pap every 3 years • No more testing after hysterectomy (if cervix has been removed) or age 65 –With negative Pap history Fontham, ETH, Wolf, AMD, Church, TR, 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. Obstetrician–gynecologists are encouraged to stock and administer HPV vaccine in their offices when feasible. Practice guideline, PAP Smear referral, PAP smear, CLAC guideline Lancet 2019;394:497–509. MMWR Morb Mortal Wkly Rep 2015;64:300–4. A 12-year follow-up on the long-term effectiveness of the quadrivalent human papillomavirus vaccine in 4 Nordic countries. If a vaccine series is started and a patient then becomes pregnant, completion of the vaccine series should be delayed until that pregnancy is completed. Centers for Disease Control and Prevention (CDC). Join ACOG today to access career support, the latest clinical guidance in women's health, patient education materials, and more. Any updates to this document can be found on acog.org or by calling the ACOG Resource Center.While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ASCP Guidelines 2009) 330-337. 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. Additionally, HPV vaccination may decrease the incidence of oropharyngeal cancer. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. and postpartum women can be found in ACOG’s practice guidelines and other educational materials. The bivalent and quadrivalent vaccines have been shown to be extremely effective at preventing HPV-related disease 20 25. Additionally, a marked reduction in genital warts has occurred in countries with high HPV vaccine coverage 33. Compared with many other countries, HPV vaccination rates in the United States are unacceptably low 5. Studies show that two doses of HPV vaccine given 6 months apart in individuals aged 9–14 years resulted in antibody titers equal to those in individuals aged 15–26 years who were given three doses. For information and resources on establishing an immunization program in your clinical practice, see the American College of Obstetricians and Gynecologists’ (ACOG) guidance on Immunization Implementation Strategies for Obstetrician–Gynecologists at https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/03/immunization-implementation-strategies-for-obstetrician-gynecologists. Obstetrician–gynecologists should assess and vaccinate adolescent girls and young women with the HPV vaccine during the catch-up period (ages 13–26 years), regardless of sexual activity, prior exposure to HPV, or sexual orientation, if they were not vaccinated in the target age of 11–12 years. Evidence of immune memory 8.5 years following administration of a prophylactic human papillomavirus type 16 vaccine. Of the more than 150 HPV genotypes, 13 genotypes have been shown to cause cervical cancer 1. They encourage Pap tests every three years from ages 21 to 29, then co-testing of Pap test and HPV primary test from 30 to 65 every five years, or … Available at: FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Unvaccinated women age 26 years and younger should receive the HPV vaccine series regardless of sexual activity, prior exposure to HPV, or sexual orientation. All rights reserved. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Munoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, et al. Any potential conflicts have been considered and managed in accordance with ACOG’s Conflict of Interest Disclosure Policy. Committee Opinion No. Human papillomavirus vaccination. Screening in women has decreased the incidence and mortality of cervical cancer. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. Virology 2013;445:2–10. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). Evidence based recommendations on human papilloma virus (HPV) vaccines schedules. Guideline IIa: Guidelines for the Management of Abnormal Colposcopic Evaluations IIa: Satisfactory Colposcopy Evaluation CIN 1 Negative or CIN 1 ->Discharge , Pap in 12 months Discharge , Pap in 12 months if referral Pap was LSIL Preferred Approach Satisfactory Colposcopy Evaluation CIN 1 Moderate or marked referral PAP see Guideline Ib. You could not isolated going later books gathering or library or borrowing from your associates to open them. MMWR Morb Mortal Wkly Rep 2013;62:591–5. Women should get their first pap smear at age … ACOG Committee Opinion No. N Engl J Med 2017;376:1223–33. American College of Obstetricians and Gynecologists, 409 12th Street SW Washington, DC 20024-2188. MMWR Morb Mortal Wkly Rep 2010;59:626–9. 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 American College of Obstetricians and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product. All rights reserved. Repeat Pap test or co-test—A repeat Pap test or a repeat co-test (Pap test and a test for high-risk types of HPV) is recommended as a follow-up to some abnormal test results. Immunization against seasonal influenza (flu) and other vaccine-preventable diseases is an essential component of women’s health care. Human papillomavirus also is associated with genital warts. MMWR Morb Mortal Wkly Rep 2019;68:718–3. For some women aged 27–45 years who are previously unvaccinated, obstetrician–gynecologists and other health care professionals may use shared clinical decision making regarding HPV vaccination, considering the patient’s risk for acquisition of a new HPV infection and whether the HPV vaccine may provide benefit. Committee Opinion No. Pregnancy registries for the quadrivalent HPV vaccine and bivalent HPV vaccine have been closed. J Natl Cancer Inst 2013;105:469–74. Obstet Gynecol 2011;117:1247–9. Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013—United States. Sustained immunogenicity and efficacy of the HPV-16/18 AS04-adjuvanted vaccine: up to 8.4 years of follow-up. Vaccine 2012;30(suppl 5):F123–38. Quadrivalent Human Papillomavirus Vaccine Phase III Investigators. The vaccine series does not need to be restarted in the case of a delay in administration of the second or third dose, regardless of the amount of time of the delay. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. ASCCP c/o SHS Services, LLC 131 Rollins Ave, Suite 2 Rockville, MD 20852. The HPV vaccine is a prophylactive vaccine used to prevent disease. For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. In the United States, the prevalence of vaccine-type HPV infection decreased 71% among women aged 14–19 years between 2006 (when the quadrivalent HPV vaccine was introduced) and 2014 31. ACOG’s latest guidelines were last updated in November 2019, so it is possible that they may change when they are revised. Studies are ongoing currently as to whether it may be helpful to prevent recurrent disease, but current data does not support its use as a therapeutic vaccine 34. The 9-valent HPV vaccine is costly and in short supply globally. Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB. Therapeutic vaccines for high-risk HPV-associated diseases. For immunocompetent girls and boys who receive their first dose of HPV vaccine before 15 years of age, only two doses are needed because the immune response that develops at this age provides antibody levels equivalent to those in patients who receive three doses at the age of 15 years or older 11. American Cancer Society. Obstetrician–gynecologists and other health care professionals should strongly recommend HPV vaccination to eligible patients and stress the benefits and safety of the HPV vaccine. Acog Guidelines For Pap Smears 2012 Getting the books acog guidelines for pap smears 2012 now is not type of inspiring means. [published erratum appears in MMWR Morb Mortal Wkly Rep 2010;59:1184]. Table 1. Drolet M, Benard E, Perez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. 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. Women should get their first pap smear at age … 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.All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. The HPV vaccine significantly reduces the incidence of anogenital cancer and genital warts in women and in men 31 32. This includes prevention of cervical, vaginal, vulvar, and anal disease caused by these HPV types. For some women aged 27–45 years who are previously unvaccinated, obstetrician–gynecologists and other health care professionals may use shared clinical decision making regarding HPV vaccination, considering the patient’s risk for acquisition of a new HPV infection and whether the HPV vaccine may provide benefit. Ideally, the HPV vaccine should be given in early adolescence because vaccination is most effective before exposure to HPV through sexual activity. Most cases of cervical cancer occur in women who have had inadequate screening. The following tests may be done depending on your age and your initial Pap test result (see Table 1): . Precancerous cervical lesions (cervical intraepithelial neoplasias) and cervical carcinomas are … Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. J Acquir Immune Defic Syndr 2010;55:197–204. The target age for HPV vaccination is 11–12 years. Although obstetrician–gynecologists are not likely to care for many patients in the recommended HPV vaccination target population, they have the opportunity to provide catch-up vaccination for girls and women age 13 and older and to discuss HPV vaccination with parents of children in the target age. Further, obstetrician–gynecologists are encouraged to stock and administer HPV vaccines in their offices when feasible. Geneva: WHO; 2014. The number of deaths from cervical cancer in the United States have decreased substantially since the implementation of widespread cervical cancer screening and continue to decline, from 2.8 per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015. Although the vaccine is less effective in previously infected individuals, it is expected that some benefit will be experienced because prior exposure to all nine vaccine types is highly unlikely 17 18. Anyone who has had a life-threatening allergic reaction to any component of the HPV vaccine, or to a previous dose of the HPV vaccine, should not get the vaccine. The Advisory Committee on Immunization Practices and ACOG recommend routine HPV vaccination for girls and boys at the target age of 11–12 years (but it may be given from the age of 9 years) as part of the adolescent immunization platform to reduce the incidence of anogenital cancer and genital warts associated with HPV infection 8. Centers for Disease Control and Prevention (CDC). According to the Vaccine Adverse Events Reporting System, more than 270 million doses of HPV vaccine have been distributed worldwide since 2006, and there are no data to suggest that there are any severe adverse effects or adverse reactions linked to vaccination 27. Donovan B, Franklin N, Guy R, Grulich AE, Regan DG, Ali H, et al. If you are aged 30–65 years—You can choose one of three options: Have a Pap test and an HPV test (co-testing) every 5 years; Have a Pap test alone every 3 years; Have an HPV test alone every 5 years When the vaccine has been inadvertently administered to a pregnant woman, safety data are reassuring, although the data are somewhat limited because the vaccine is not used routinely in pregnancy 19 20 21. If the interval between the two doses is less than 5 months, a third dose is recommended 8. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Human papillomavirus (HPV) causes significant morbidity and mortality in women and men. Human papillomavirus infection is associated with anogenital cancer (including cervical, vaginal, vulvar, penile, and anal) and oropharyngeal cancer (back of tongue, tonsil) ( See Table 1 Number of Human Papillomavirus‒Associated and Estimated Number of Human Papillomavirus‒Attributable Cancer Cases Per Year). Background paper for SAGE discussions . Zimet GD, Mays RM, Winston Y, Kee R, Dickes J, Su L. Acceptability of human papillomavirus immunization. (Monday through Friday, 8:30 a.m. to 5 p.m. Currently, the 9-valent vaccine is the only HPV vaccine available in the United States 7. ACOG Committee Opinion No. The 6-month interval between these two doses is critical for ensuring adequate immune titers and durability of protection. It is not with reference to the costs. (Monday through Friday, 8:30 a.m. to 5 p.m. Furthermore, for every year that HPV vaccination rates do not increase, an additional 4,400 women will develop cervical cancer. J Clin Virol 2012;53:239–43. Quadrivalent human papillomavirus vaccine effectiveness: a Swedish national cohort study. The American College of Obstetricians and Gynecologists is the premier professional membership organization for obstetrician–gynecologists. These vaccines cover 2, 4, or 9 HPV serotypes, respectively. The American College of Obstetricians & Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) have issued new guidelines replacing previous guidance on prenatal genetic screening. The OBG Project has a ton of helpful articles on Pap smear management as well! HPV PATRICIA Study Group [published erratum appears in Lancet 2010;376:1054]. 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. A review of clinical trials of human papillomavirus prophylactic vaccines. Use of Primary High-Risk human papillomavirus testing for cervical cancer screening. Safety and immunogenicity of a 9-valent HPV vaccine in females 12–26 years of age who previously received the quadrivalent HPV vaccine. (Red flags include, but are not limited to, severe or … MMWR Morb Mortal Wkly Rep 2019;68:698–702. This is an enormously easy means to specifically acquire lead by on-line. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2018. American Cancer Society. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Cancer Prevention & Early Detection Facts & Figures 2019-2020. de Villiers EM. Cross-roads in the classification of papillomaviruses. Moreira EDJr, Block SL, Ferris D, Giuliano AR, Iversen OE, Joura EA, et al. In addition to the ability to use two doses instead of three doses, earlier vaccination also is preferred because HPV vaccines are most effective when given before exposure and infection with HPV, which coincide with the onset of sexual activity. “ACOG looks forward to comprehensively reviewing the ACS recommendations and the supporting evidence in order to determine whether a similar update to our clinical guidance document on cervical cancer screening is needed,” the organization said … If obstetrician–gynecologists or other health care professionals do not know or do not have the same HPV vaccine product previously administered, or are in settings that are transitioning to the 9-valent HPV vaccine, any available HPV vaccine product may be used to continue or complete the series for women for protection against HPV genotypes 16 and 18; the 9-valent HPV vaccine or the quadrivalent HPV vaccine may be used to continue or complete the series for men 26. Available data demonstrate no safety concerns in individuals who were vaccinated with the 9-valent HPV vaccine after having been vaccinated with the quadrivalent HPV vaccine 29 30. Atlanta, GA: ACS; 2018. You may not be perplexed to enjoy every book collections acog guidelines for pap smears 2014 that we will utterly offer. Legislation to increase uptake of HPV vaccination and adolescent sexual behaviors. Obstet Gynecol 2014;123:389–93. Obstetrician–gynecologists and other health care professionals should educate parents in their decision making regarding vaccinations for their daughters and sons. The College’s activities include producing practice guidelines for providers and educational materials for patients, providing practice management and career support, facilitating programs and initiatives aimed … 7. (Today, ACOG says many patients 30 and over can be tested every five years, if they get an HPV test along with the Pap.) Available at: Schiller JT, Castellsague X, Garland SM. The Vaccine Adverse Events Reporting System reports from December 2014 to December 2017 demonstrated no additional or unexpected safety concerns related to the 9-valent HPV vaccine 28. In children with a history of sexual abuse or assault, the HPV vaccine should be given as early as possible, starting at age 9 years. Obstetrician–gynecologists and other health care professionals should strongly recommend HPV vaccination to eligible patients and stress the benefits and safety of the HPV vaccine. 2020 RECOMMENDATIONS FOR WELL-WOMAN CARE MEMBERS OF THE ADVISORY PANEL SUPPORT THE WPSI If you have an abnormal cervical cancer screening test result, you may need further testing. ABSTRACT: Human papillomavirus (HPV) causes significant morbidity and mortality in women and men. J Low Genit Tract Dis. In addition, routine HPV vaccination of all women age 27–45 would be expected to have a very limited effect on the global fight to prevent cervical cancer. Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, et al. Obstetrician–gynecologists play a critical role and should assess and vaccinate adolescent girls age 11–12 years and previously unvaccinated young women during the catch-up period (ages 13–26 years). 587. Papillomavirus Res 2018;5:46–58. 809. We’re working to improve and strengthen women’s health care around the world with programs dedicated to global health, social issues, advocacy, and more. If followed, guidelines would reduce ability of women and their doctors to choose widely adopted Pap-based testing strategies that have proven highly effective July 31, 2020 … Statistics show that 20% of 9th graders and more than 55% of 12th graders have engaged in sexual intercourse 12 13. The American College of Obstetricians and Gynecologists (ACOG) makes the following recommendations and conclusions: The Advisory Committee on Immunization Practices and ACOG recommend routine human papillomavirus (HPV) vaccination for girls and boys at the target age of 11–12 years (but it may be given from the age of 9 years) as part of the adolescent immunization platform. Ideally, the HPV vaccine should be given in early adolescence because vaccination is most effective before exposure to HPV through sexual activity. This Committee Opinion was developed by the Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group and the Committee on Adolescent Health Care, with the assistance of Linda O’Neal Eckert, MD. Obstetrician–gynecologists and other health care professionals should assess patients for severe allergies, including but not limited to an allergy to yeast or prior HPV vaccine dose. Human papillomavirus vaccination is not associated with an earlier onset of sexual activity 15 16 or increased incidence of sexually transmitted infections 12. Further, obstetrician–gynecologists are encouraged to stock and administer HPV vaccines in their offices when feasible. (ACOG) guidelines for pap smears acog, many people afterward will infatuation to buy the sticker album sooner. Obstet Gynecol 2020;136:e15–21. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. We present guidelines for pap smears acog and numerous book collections from fictions to scientific research in any way. High rates of HPV vaccination will reduce the burden of HPV-related disease in the United States. MMWR Recomm Rep 2014;63:1–30. In the case of pap smear guidelines, ... "ACOG’s current screening guidelines reflect a balance of benefit and potential harms ... Kayla Rivas is a Health reporter and joined Fox News in April 2020. For additional quantities, please contact sales@acog.org 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. *** It’s also important to know we’re anticipating a change in these guidelines sometime in 2020 from the ASCCP, so stay tuned! ET), Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative. Unvaccinated women age 26 years and younger should receive the HPV vaccine series regardless of sexual activity, prior exposure to HPV, or sexual orientation. Vaccine 2015;33:6855–64. Health care professionals should use shared clinical decision making with previously unvaccinated women aged 27–45 years to assess the benefit of HPV vaccination. (In October 2020, ACOG released a practice advisory supporting the new ASCCP guidance and withdrew its previous practice bulletin on cervical cancer screening management. Human papillomavirus vaccination is not recommended during pregnancy; however, routine pregnancy testing is not recommended before vaccination. J Natl Cancer Inst 2010;102:325–39. Further, obstetrician–gynecologists and other health care professionals should educate parents in their decision making regarding vaccinations for their daughters and sons. This post summarizes Practice Bulletin No. Walker TY, Elam-Evans LD, Yankey D, Markowitz LE, Williams CL, Fredua B, et al. Patients and obstetrician–gynecologists or other health care professionals are encouraged to register women exposed to the 9-valent HPV vaccine around the time the pregnancy began or during pregnancy by contacting the manufacturer www.merckpregnancyregistries.com/gardasil9.html. Importance. The guidelines generally advise a reduction in the number of tests women get over their lifetime to better ensure that they receive the benefits of testing while minimizing the harms, and include a preference for co-testing using the Pap test and HPV test for women age ages 30 to 65. The IMPACT Program seeks to improve access to abortion care in the U.S. American College of Obstetricians and Gynecologists 1 Most cases of cervical cancer occur among women who have not been adequately … Safety and immunogenicity of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine in HIV-infected children 7 to 12 years old. The presence of immunosuppression, like that experienced in patients with human immunodeficiency virus infection or organ transplantation, is not a contraindication to HPV vaccination. Human Papillomavirus Vaccination Timing and Number of Doses, Patient Education and Vaccination Efforts, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/03/immunization-implementation-strategies-for-obstetrician-gynecologists, www.merckpregnancyregistries.com/gardasil9.html, https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf, https://www.who.int/immunization/sage/meetings/2014/april/1_HPV_Evidence_based_recommendationsWHO_with_Appendices2_3.pdf?ua=1, https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-vaccine-facts-and-fears.html, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. Influenza ( flu ) and 6–12 months De Borba P, Teixeira JC, De P. Individual with a moderate or severe febrile illness should wait until the illness improves before receiving a.... 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This is an enormously easy means to specifically acquire lead by on-line of 7 phase III clinical of... Recommendations have the strongest influence in the distance quirk to acquire the book, even if the between. Papillomavirus testing for HPV DNA and the results are positive papillomavirus type 6/11/16/18 vaccine: updated recommendations of the doses. The vaccine 7 develop cervical cancer the other organizations, conflict of interest Disclosure Policy is!

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