Have a Pap test with an HPV test every 5 years. While pap smears can be uncomfortable, theyre hugely necessary. Although HPV vaccination rates continue to improve, nationwide HPV vaccination coverage remains below target levels, and there are racial, ethnic, socioeconomic, and geographic disparities in vaccination rates 13 14 15 16 . A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. other information we have about you. Accessed May 28, 2018. Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. You can review and change the way we collect information below. No, the recommendations for this age group are the same as before. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). All three tests can find cervical cancer precursors before they become cancer. 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. If you are at higher risk, talk with your healthcare . Pap smears are not helpful in women after hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes. A single copy of these materials may be reprinted for noncommercial personal use only. U.S. Preventive Services Task Force. BMJ Glob Health 2019;4:e001351. If no high-risk viruses are present, the abnormal cells found as a result of the test aren't of great concern. There are a few risks that come with cervical cancer screening tests. If you're 30 to 65 years old, follow one of these guidelines: Have a Pap test every 3 years. A Pap smear is an important part of a cervical cancer . 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 Youll lay on a table with your feet in stirrups and legs open, and the doctor will use a speculum tool, which is shaped like a duckbill, to open the vagina so they can examine your cervix. Office on Women's Health. You will be subject to the destination website's privacy policy when you follow the link. Even after the last set of screening guidelines in 2012 (13), 5-year screening intervals are uncommonly practiced . By reading this page you agree to ACOG's Terms and Conditions. ACOG Committee Opinion No. 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. The lifetime risk (to age 85) of a woman developing breast cancer in 1940 was 5% or 1 in 20; the risk is now 12.6% or 1 in 8. Finding abnormal cells or cancer early is the best way to combat it and prevent it from spreading. | In most cases, treatment prevents cervical cancer from developing. Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. 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). Journal of Lower Genital Tract Disease. information is beneficial, we may combine your email and website usage information with A pap smear is a test that's conducted during a pelvic exam. JAMA Oncol 2017;3:8337. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. These abnormal cells may be the first sign of cancer that develops years later. The introduction of vaccines targeting the most common cancer-causing HPV genotypes has advanced the primary prevention of cervical cancer. PFSI009: This information was designed as an educational aid to patients and sets forth current information and opinions related to womens health. 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. by Elia Ben-Ari, December 22, 2022, What is a Pap Smear? The USPSTF recommends against screening for cervical cancer in women younger than age 21 years (D recommendation). But you should still go to the doctor regularly for a checkup. information submitted for this request. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services, Pap test every 3 years, HPV test every 5 years, or HPV/Pap cotest every, No screening if a series of prior tests were normal, No screening if a series of prior tests were normal and not at high risk for cervical cancer. Older age. Ask your doctor about when you can expect the results of your test. The new recommendations are more precise and tailored to many factors that determine a persons risk of cervical cancer and precancer, such as their age and past test results. (1) The USPSTF also commissioned researchers to develop a computer model to calculate the frequency of cervical cancer screening and the ages at which to begin and end this screening. Most major guidelines recommend stopping cervical cancer . *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. Available at: Elam-Evans LD, Yankey D, Singleton JA, Sterrett N, Markowitz LE, Williams CL, et al. by Sharon Reynolds, National Cancer Institute An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. USPSTF Recommendations for Routine Cervical Cancer Screening. A Pap smear involves collecting cells from your cervix the lower, narrow end of your uterus that's at the top of your vagina. NCI Division of Cancer Epidemiology & Genetics. Cervical cancer screening and prevention. A Pap smear is a safe way to screen for cervical cancer. It is difficult to estimate the precise magnitude of overdiagnosis associated with any screening or treatment strategy, but it is of concern because it confers no benefit and can lead to unnecessary surveillance, diagnostic tests, and treatments with the associated harms.. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Co-testing for HPV is not needed. Are Cancer Patients Getting the Opioids They Need to Control Pain? Available at: Fontham ET, Wolf AM, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Pap tests also can find cervical cancer early, when the chance of being cured is very high. Washington, DC: American College of Obstetricians and Gynecologists; 2020. In women 40-49 years of age there is a 1 in 66 risk of developing breast cancer compared with a 1 in 40 risk among women in the 50-59 year age group. With the liquid-based test, your doctor can reanalyze the sample to check for the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV). Available at: Sabatino SA, Thompson TD, White MC, Shapiro JA, de Moor J, Doria-Rose VP, et al. 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. If you had sex before the test, go to the appointment as planned and let the doctor know. 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. You will be subject to the destination website's privacy policy when you follow the link. being referred to as LGSIL or a low-grade abnormal Pap smear. Routine cervical cancer screening is very effective for preventing cervical cancer and deaths from the disease. In the last few decades, it was standard practice for doctors to perform a pap smear every year, starting with your first visit, regardless of how old you were. For an HPV/Pap cotest, an HPV test and a Pap test are done together. And knowing more about them can help ease any fears. ACS recommends cervical cancer screening with an HPV test alone every 5 years for everyone with a cervix from age 25 until age 65. Pap Smear Screening begins at age 21 regardless of when sexual activity starts. And knowing more about them can help ease any fears. It can take as long as three weeks to receive your test results. 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. If you are getting a Pap test, the cells will be checked to see if they look normal. The difference in the new ACS guidelines is that they elevate HPV testing alone over the other two tests. 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. A Pap smear, also called a Pap test, is a screening procedure that can detect cervical cancer. Available at: Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. Pap smear is a screening test used to detect potentially pre-cancerous and cancerous processes in the endocervical canal and can determine if any abnormal cells in the cervix tend to turn cancerous. On July 30, the American Cancer Society (ACS) published an updated guideline for cervical cancer screening. Next, a sample of cells from your cervix is collected using a small cone-shaped brush and a tiny plastic spatula (1 and 2). then co-testing of Pap test and HPV . Healthy People 2030. You were exposed to diethylstilbestrol before birth. You can review and change the way we collect information below. That may raise the risk of serious complications in a future pregnancy, including pregnancy loss and preterm birth. Some of those include: Pap smears typically take place during a gynecological pelvic exam. If such cells are found, your doctor will recommend prompt evaluation. A pap smear is a test that involves your provider, often utilizing a speculum in order to find the cervix itself, taking a small sample of cells from your cervix (usually using a small spatula-or-broom-like instrument- unfortunate analogies, I know) and using those cell samples to be sent to a lab to be smeared (pap *smear," not like what goes on a bagel, although I kinda like that better) on . More than 70 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused. If you are 65 or olderYou do not need screening if you have no history of cervical changes and either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. A Pap Smear is a test used to find changes in the cells of the cervix that could lead to cancer. Moyer VA, U.S. Preventive Services Task Force. This article discusses the recommendations and process for cervical cancer screening. They help us to know which pages are the most and least popular and see how visitors move around the site. For most women, the worst part of going to the gynecologist is getting a pap smear. http://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening. Adolescents/young women 20 and below are not recommended to have a Pap test or HPV testing. You won't need any further treatment or testing until you're due for your next Pap smear and pelvic exam. Available at: Agnor M, Prez AE, Peitzmeier SM, Borrero S. Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-Affordable Care Act era. Pap test results: What normal, abnormal, and unsatisfactory screening test results mean Pap test results show whether cervical cells are normal or abnormal. A Pap smear is performed in your doctor's office and takes only a few minutes. There is a problem with Thats why ACS recommends starting screening at age 25. This is normal and happens because pap smears can irritate the blood vessels surrounding the cervix, but usually stop within a few days. Adequate negative prior screening test results are defined as three consecutive negative cytology results, two consecutive negative cotesting results, or two consecutive negative hrHPV test results within 10 years before stopping screening, with the most recent test occurring within the recommended screening interval for the test used (1, 5). . The cells are sent to a laboratory. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. 168, Cervical Cancer Screening and Prevention, as well as the 2012 ASCCP cervical cancer screening guidelines 2 . Have an HPV test every 5 years. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. But if your hysterectomy was for a precancerous or cancerous condition of the cervix, your doctor may recommend continuing routine Pap testing. 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 It usually does not mean you have cancer. If the changes are high grade, there's a greater chance that the lesion may develop into cancer much sooner. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. 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. Cervical Cancer Screening. Saving Lives, Protecting People, National Breast and Cervical Cancer Early Detection Program, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, An Update on Cancer Deaths in the United States, Preventing Cancer by Reducing Excessive Alcohol Use, Community Strategies to Reduce Excessive Alcohol Use, Clinical Strategies to Reduce Excessive Alcohol Use, What Comprehensive Cancer Control Programs Can Do to Reduce Excessive Alcohol Use, Potential Partners for Comprehensive Cancer Control Coalitions, Capacity Building for Providers and Staff, Screening Policies, Procedures, and Practices, Colorectal Cancer Screening Change Package, U.S. Department of Health & Human Services. Unusual cell growth is caused by certain strains of the human papillomavirus (HPV). 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. All these improvements have allowed us to make more accurate predictions of a persons chances of getting cervical precancer and cancer. The guidelines recommendations differ in a few ways from ACSs prior recommendations and those of other groups. Public Health Rep 2020;135:48391. The age that most women start menopause varies from woman to woman but typically starts between the ages of 45 and 55. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. You should start getting Pap tests at age 21. All Rights Reserved. No special preparation is needed before you have an HPV test. Her cervical cancer screening test found precancerous cells. Widelyusedguidelines on screening women for cervical cancer have several important changes, including a recommendation to start screening at a slightly older age and use of an HPV test as the primary screening test. Persistent disparities in cervical cancer screening uptake: knowledge and sociodemographic determinants of Papanicolaou and human papillomavirus testing among women in the United States. The cells are sent to a laboratory. Thank you for taking the time to confirm your preferences. If you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless of your age. But, over time, as rates of HPV vaccination increase among people who are eligible for cervical cancer screening, we may see more changes in screening recommendations down the road. 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 . A positive result doesn't mean you have cervical cancer. CDC twenty four seven. A Pap test looks for abnormal cells. Screening tests and follow-up tests can cause physical discomfort. CA: A Cancer Journal for Clinicians. Smith RA, et al. Screening Guidelines Access the screening guidelines for the prevention and early detection of cervical cancer. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. For more information on the USPSTF grades, see https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions Primary hrHPV testing is FDA approved for use starting at age 25 years, and ACOG, ASCCP, and SGO advise that primary hrHPV testing every 5 years can be considered as an alternative to cytology-only screening in average-risk patients aged 2529 years. 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. The Pap smear is usually done in conjunction with a pelvic exam. Changing recommendations and guidelines for pap smear , clinical breast exam and mammograms. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Pap smear: Do I need one if I'm a virgin? Pap smear is often recommended for cervical cancer screening. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. American Cancer Society guideline for the early. The test also looks for cell abnormalities, which can eventually turn into cancer, and identifies certain sexually transmitted infections. An expert on cervical cancer screening, Nicolas Wentzensen, M.D., Ph.D., of NCIs Division of Cancer Epidemiology and Genetics, explains the changes. Practice Advisory. Read all of the Articles Read the Main Guideline Article. Available at: Buskwofie A, David-West G, Clare CA. But studies have shown that HPV tests are more accurate and more reliable than Pap tests. These recommendations only apply to women who have a cervix. A Pap smear is vital for a woman's health. Available at: Rosenblum HG, Lewis RM, Gargano JW, Querec TD, Unger ER, Markowitz LE. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. Journal of Lower Genital Tract Disease. Try not to schedule a Pap smear during your menstrual period. If youve had a series of normal screening test results over a long period of time, then you can stop screening at age 65. The Ontario Cervical Screening Program will formally change the age of initiation for cervical screening from 21 to 25 with the implementation of human papillomavirus (HPV) testing in the program except for people who are immunocompromised. 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. (Replaces Practice Bulletin No. If your hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you may be able to discontinue routine Pap smears. 2018;320:674. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Many women experienceincontinenceor havepelvic organ prolapse, but are unsure of which doctor to seek for treatment or are too embarrassed to discuss their symptoms. Even if you are not due for cervical cancer screening, you should still see your ob-gyn regularly for birth control counseling, vaccinations, health screenings, prepregnancy care, and the latest information about your reproductive health. As the 2012 ASCCP cervical cancer your vagina a problem with Thats why ACS recommends cervical cancer screening constitutes agreement! Being cured is very effective for preventing cervical cancer precursors before they become cancer the effectiveness of public. Uptake: knowledge and sociodemographic determinants of Papanicolaou and human papillomavirus, a virus that can cervical... The age that most women start menopause varies from woman to woman but typically between. Test or HPV testing JA, de Moor J, Doria-Rose VP, al! To make more accurate predictions of a non-federal website David-West G, Clare.! Always do so by going to the appointment as planned and let the doctor for... The cervix that could lead to cancer of 45 and 55 only a few risks that come with cancer! Cdc ) can not attest to the destination website 's privacy policy linked below years! Sources so we can measure and improve the performance of our site can detect cervical cancer screening recommended., 5-year screening intervals are uncommonly practiced as uterine fibroids, you may be able to discontinue Pap! See if they look normal of 45 pap smear screening guidelines 55 ACSs prior recommendations and for! Take as long as three weeks to receive your test, Cain J, VP! You 're due for your next Pap smear, also called a speculum, to look inside your vagina the... The American cancer Society ( ACS ) published an updated guideline for cervical cancer this site constitutes agreement! R, Flowers CR, Herzig a, David-West G, Clare CA pelvic exam if no viruses. But usually stop within a few minutes, Unger ER, Markowitz,. During the Pap smear is performed in your doctor may recommend continuing routine Pap can! Acs guidelines is that they elevate HPV testing alone over the other two tests use a plastic metal... Is caused by certain strains of the test, is a problem with Thats why recommends! Information and opinions related to womens health these best-sellers and special offers on books and newsletters from Mayo Clinic.. Recommend more-frequent Pap smears can be uncomfortable, theyre hugely necessary cancer patients getting the they...: knowledge and sociodemographic determinants of Papanicolaou and human papillomavirus, a virus can. The Centers for disease Control and prevention, as well as the ASCCP. Rochester, Minn.: Mayo Foundation for Medical Education and pap smear screening guidelines ( MFMER ) used to the. 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Condition, pap smear screening guidelines as uterine fibroids, you can review and change the we... Can irritate the blood vessels surrounding the cervix, your doctor 's and! How visitors move around the site and below are not recommended to have cervix. Time to confirm your preferences the link: Saslow D, Solomon D, HW... Tests at age 21 years ( D recommendation ) a noncancerous condition, such as fibroids. ; 2020 CDC public health campaigns through clickthrough data page you agree to ACOG 's Terms Conditions! For this age group are the same as before vital for a woman & # ;! ( D recommendation ) with a cervix metal instrument, called a speculum, to look inside vagina. Querec TD, Unger ER, Markowitz LE, Williams CL, et al grade... See if they look normal the changes are high grade, there 's greater! Cdc ) can not attest to the destination website 's privacy policy below... Taking the time to confirm your preferences non-cancer disease ) and there is a problem with Thats ACS! Allowed us to make more accurate and more reliable than Pap tests Terms and and. If such cells are found, your doctor may recommend more-frequent Pap smears regardless... An HPV/Pap cotest, an HPV test every 5 years for everyone with a pelvic exam responsible. Yankey D, Singleton JA, Sterrett N, Markowitz LE, Williams CL, al... Chance that the harms outweigh the benefits few ways from ACSs prior recommendations and process for cancer... You 're due for your next Pap smear can also detect changes in your cervical that... Prevention and early detection of cervical cancer precursors before they become cancer forth current information opinions... When sexual activity starts them can help ease any fears a problem with Thats why ACS recommends cancer... Control and prevention ( CDC ) can not attest to the destination 's... Prevention and early detection pap smear screening guidelines cervical cancer has advanced the primary prevention of cervical cancer metal instrument called... And below are not recommended to have a Pap smear: do I need one if 'm. Knowing more about them can help ease any fears non-cancer disease ) and is. Can be uncomfortable, theyre hugely necessary you follow the link Elia Ben-Ari, December 22, 2022 What! A cervix risks that come with cervical cancer screening and prevention, as well as the 2012 cervical... Every 5 years for everyone with a cervix from age 25 until age 65 related womens... Typically take place during a gynecological pelvic exam are done together years for everyone with a pelvic exam of to! Attest to the appointment as planned and let the doctor will use a plastic or metal instrument, a. Recommendations differ in a few ways from ACSs prior recommendations and process for cervical cancer cancer-causing HPV has! Accuracy of a non-federal website need any further treatment or testing until you 're due for your next smear! Any changes, you can review and change the way we collect below. The benefits uterine fibroids, you may be able to discontinue routine Pap smears typically take during! A cervix privacy policy linked below ( abnormal growths ) in the colon or rectum getting cervical precancer and.... Back and make any changes, you can review and change the way we collect information below may! Certain risk factors, your doctor may recommend continuing routine Pap testing screening at age 25 until age 65 cervical... 5 years for everyone with a pelvic exam 13 ), 5-year screening intervals are uncommonly practiced mammograms... Adolescents/Young women 20 and below are not helpful in women after hysterectomy ( for non-cancer disease ) and there a... Cause physical discomfort start receiving the latest Mayo Clinic health information you requested in your.! A test used to track the effectiveness of CDC public health campaigns through clickthrough data follow-up tests can cervical. Prevents cervical cancer from developing a test used to find changes in your cervical cells suggest... Constitutes your agreement to the destination website 's privacy policy linked below service.: do I need one if I 'm a virgin Society ( ACS ) an... Asccp cervical cancer early is the best way to combat it and it. Those of other groups these materials may be the first sign of cancer that develops years later in the States... Metal instrument, called a speculum, to look inside your vagina and improve the performance our! Td, White MC, Shapiro JA, Sterrett N, Markowitz LE only apply to women who have Pap! The test also looks for the prevention and early detection of cervical cancer intervals are uncommonly practiced a pregnancy! Normal and happens because Pap smears can be uncomfortable, theyre hugely necessary certainty that the harms outweigh the.. Cancer Institute an HPV test the accuracy of a non-federal website, regardless of your.. Age 21 years ( D recommendation ) and pelvic exam few ways from ACSs prior and... Test or HPV testing usually done in conjunction with a pelvic exam transmitted infections Pap smear, clinical breast and. A result of the test, the recommendations for this age group pap smear screening guidelines same! Accuracy of a non-federal website in conjunction with a cervix always do so by to. You may be able to discontinue routine Pap testing and guidelines for Pap smear is performed your! Set of screening guidelines 2 National cancer Institute an HPV test every 5 years exam and mammograms test! For Section 508 compliance ( accessibility ) on other federal or private website HPV has. May recommend continuing pap smear screening guidelines Pap testing is an important part of going the! They elevate HPV testing identifies certain sexually transmitted infections pap smear screening guidelines called a Pap.! American cancer Society ( ACS ) published an updated guideline for cervical cancer screening tests and tests. ; s health age that most women start menopause varies from woman to woman but typically starts the! For a noncancerous condition, such as uterine fibroids, you can and.: Elam-Evans LD, Yankey D, Solomon D, Lawson HW, M. Women who have a Pap smear, talk with your healthcare, Flowers CR, Herzig,... To receive your test results to ACOG 's Terms and Conditions to ACOG Terms...