The American Cancer Society (ACS) has issued updated guidelines for cervical cancer screening, emphasizing the use of high-risk human papillomavirus (hrHPV) testing and acknowledging self-collected samples as an acceptable alternative to provider-collected specimens. The recommendations, released Tuesday, apply to individuals with a cervix aged 25 to 65 who are at average risk for the disease.
The ACS guidelines represent one set of recommendations for cervical cancer screening. The U.S. Preventive Services Task Force (USPSTF), an independent panel of medical experts, also provides guidance that influences what health insurance plans will cover. The USPSTF is currently reviewing its own cervical cancer screening recommendations, according to a statement on its website.
A key shift in the ACS recommendations is the prioritization of “HPV primary” testing, which directly looks for the presence of high-risk HPV types known to cause nearly all cervical cancers. If HPV primary testing isn’t available, the ACS recommends “co-testing,” combining an HPV test with a Pap test (cytology). Pap tests alone remain an option if neither of the other methods are accessible.
The ACS now recommends initiating screening at age 25, a change from previous guidance. This decision is based on the rarity of cervical cancer in younger individuals. This differs from current USPSTF recommendations, which suggest Pap tests can begin between ages 21 and 29, with a transition to HPV primary testing or co-testing at age 30.
Acknowledging barriers to traditional screening methods, the ACS has endorsed self-collected HPV tests as a viable option, particularly for individuals who may face difficulties accessing healthcare or are uncomfortable with a speculum exam. While provider-collected samples remain the preferred method, self-collection expands access to screening.
The frequency of screening varies depending on the test used and how the sample was collected. Individuals receiving HPV primary testing or co-testing with provider-collected samples and normal results should be screened again in five years. Those using self-collected samples for HPV testing and receiving normal results should return for screening in three years. Individuals receiving only a Pap test with normal results should be screened every three years. Abnormal results will necessitate more frequent monitoring.
The ACS recommends that individuals can discontinue screening at age 65 if they have had ten years of consistently normal results. This can be demonstrated through negative HPV tests at ages 60 and 65, or three consecutive negative Pap tests, with the most recent occurring at age 65.
Cervical cancer remains a significant public health concern in the United States, with nearly 14,000 cases diagnosed annually and over 4,000 deaths. However, the disease typically develops slowly, allowing for detection and treatment before it progresses to cancer. Widespread screening has already reduced cervical cancer incidence by more than half since the mid-1970s.
Despite these gains, more than half of cervical cancer diagnoses in the U.S. Occur in individuals who have never been screened or who are screened infrequently. The new guidelines aim to address this disparity by offering more accessible and flexible screening options, including testing at primary care offices, urgent care clinics, mobile clinics, pharmacies and through at-home self-collection.
“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” said Dr. Robert Smith, senior vice president, early cancer detection science at the American Cancer Society. He added that the availability of self-collection tools will “broaden access to screening.”
