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Cervical Cancer Screening

Cervical cancer screening is a well-established preventive strategy that can reduce the lifetime risk of cervical cancer from up to 5% in unscreened populations to less than 0.5% with effective screening and treatment of precancers.[1] Guidelines differ: ACS prefers primary hrHPV testing, while the current final USPSTF statement (2018; update in progress) includes three screening options for ages 30–65 without designating HPV testing as preferred.[2][3]

Screening methods​

Three strategies are endorsed:[2]

  • Primary HPV testing (preferred by ACS) — uses an FDA-approved hrHPV test alone. HPV-based testing is generally more sensitive than cytology, but accuracy and cancer outcomes depend on the assay, population, screening interval and follow-up pathway.[1][2]
  • Cotesting — HPV testing combined with cytology. Provides increased sensitivity and long-term negative predictive value vs. cytology alone, but adds limited incremental benefit over HPV testing alone since 97% of precancers are HPV-positive.[1][2]
  • Cytology alone (Pap test) — remains a recommended option under the final USPSTF statement; ACS reserves it for settings where other options are unavailable. Requires more frequent screening (every 3 years) due to lower sensitivity.[2]

Current guideline recommendations by age​

AgeUSPSTF final 2018ACS 2025/2026 update
<21 yearsNo screeningNo screening
21–24Cytology every 3 yearsNo screening before age 25
25–29Cytology every 3 yearsPrimary HPV every 5 years (clinician-collected) or 3 years (self-collected)
30–65HPV every 5 years, cotesting every 5 years, or cytology every 3 yearsClinician-collected HPV every 5 years preferred; self-collected HPV every 3 years, cotesting every 5 years or cytology every 3 years are alternatives
>65Discontinue with adequate prior negative resultsAdequate negative results near ages 60 and 65, with the appropriate test-specific interval and no high-risk exception; see below
After hysterectomy with cervix removalNo screening if no history of CIN2+ or cervical cancerSame
[2][4][5]

Key points of agreement and divergence:

  • Under 21 years, average risk — routine screening is not recommended.[2][4]
  • Ages 21–24 — USPSTF recommends cytology every 3 years; ACS recommends no screening before age 25.[2]
  • Ages 25–29 — USPSTF continues cytology every 3 years; ACS recommends primary HPV testing every 5 years (clinician-collected) or every 3 years (self-collected).[2]
  • Ages 30–65 — distinguish ACS preference from the USPSTF final statement, which accepts HPV, cotesting or cytology at their respective intervals.[2]
  • Over 65 — screening can be discontinued with adequate prior negative results. ACS now recommends a forward-looking approach: negative primary HPV testing (preferred) or negative cotesting at ages 60 and 65, with the final test at age 65 or older. Self-collected testing retains its three-year interval before exit; if HPV-based testing is unavailable, three appropriately spaced negative cytology tests are an alternative. These exit rules do not replace longer surveillance after CIN2+ or individualized high-risk screening.[2][5]
  • After hysterectomy with cervix removal — no screening if no history of CIN2+ or cervical cancer.[2][4]

HPV self-collection — a major recent advance​

The FDA approved the first self-collected vaginal specimens for HPV testing in clinical settings in May 2024, and the first at-home self-collection device (Teal Wand) in May 2025.[6][2]

  • Self-collected and clinician-collected samples show similar accuracy for detecting high-grade cervical lesions (pooled overall agreement ~89%).[2][6]
  • Clinician-collected specimens remain preferred because they allow reflex cytology from the same sample if HPV-positive. A positive self-collected result usually needs additional clinician evaluation; genotype and risk determine whether this is cytology/triage, colposcopy or another follow-up pathway.[6]
  • After a negative self-collected HPV test, repeat screening is recommended in 3 years (vs. 5 years for clinician-collected) — a margin of safety while U.S. longitudinal data accrue.[2][6]
  • Self-collection is not appropriate for immunocompromised patients, those with HIV, DES exposure, history of cervical cancer, or those requiring cytology-based surveillance.[6][3]
  • HRSA’s update includes self-collection for average-risk ages 30–65 and applies to most covered plans beginning with plan years starting in 2027; it is not a universal January 1 change for every policy.[3][12]

Management of abnormal results — ASCCP risk-based framework​

The 2019 ASCCP guidelines introduced a paradigm shift from results-based to risk-based management, using the estimated risk of CIN3+ (CIN3, adenocarcinoma in situ, or cancer) to guide clinical action:[1][7]

Immediate CIN3+ riskRecommended action
<4%Surveillance (1, 3, or 5 years depending on result)
4–24%Colposcopy
25–59%Colposcopy or excisional treatment acceptable
≥60%Expedited excisional treatment without a prior confirmatory biopsy preferred when eligible

Expedited-treatment thresholds apply to nonpregnant patients aged 25 or older, with shared decision-making about reproductive goals and treatment risks. Colposcopy at treatment still guides the procedure; symptoms or certain high-risk results can require evaluation outside the simplified table.[1][11]

A prior negative HPV test within 5 years reduces the CIN3+ risk by approximately 50% for new low-grade abnormalities, potentially allowing deferral of colposcopy.[7][8] After treatment for CIN2+, obtain three negative HPV tests or cotests at 6, 18 and 30 months before moving to three-year surveillance for at least 25 years.[7][13]

Special populations​

HIV, transplant, systemic lupus erythematosus and some other immunosuppressive conditions or treatments require dedicated screening pathways. The schedule and test depend on age, diagnosis and therapy; not all patients with inflammatory bowel disease have the same risk, and cotesting is not required at every age (for example, younger patients with HIV use cytology-based screening). Do not extrapolate average-risk self-collection or screening-exit rules to these groups. Vaccination does not remove the need for indicated screening.[4][6][13][14]

Screening gaps and disparities​

Despite effective screening, over 50% of cervical cancers in the U.S. are diagnosed in individuals overdue for screening.[9] Up-to-date screening rates have declined to approximately 75% and have not rebounded post-pandemic.[6] Disparities persist among uninsured, rural, and racial / ethnic minority populations — making self-collection a particularly promising strategy for these groups.[6][10]

See Also​

References​

1. Perkins RB, Wentzensen N, Guido RS, Schiffman M. "Cervical cancer screening: a review." JAMA. 2023;330(6):547–558. doi:10.1001/jama.2023.13174

2. Wiser A, Quinlan JD. "Cervical cancer screening." Am Fam Physician. 2026;113(2):137–144.

3. Christine B, Bush M, Thurakal A, Sheehy AM. "New cervical cancer screening guidelines from the US Department of Health and Human Services." JAMA. 2026. doi:10.1001/jama.2025.26456

4. US Preventive Services Task Force, Curry SJ, Krist AH, et al. "Screening for cervical cancer: US Preventive Services Task Force recommendation statement." JAMA. 2018;320(7):674–686. doi:10.1001/jama.2018.10897

5. American Cancer Society. "Screening for cervical cancer." CA Cancer J Clin. 2026;76(1):e70049. doi:10.3322/caac.70049

6. Perkins RB, Wolf AMD, Church TR, et al. "Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: an update to the American Cancer Society cervical cancer screening guideline." CA Cancer J Clin. 2026;76(1):e70041. doi:10.3322/caac.70041

7. American College of Obstetricians and Gynecologists, Chelmow D. Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. American College of Obstetricians and Gynecologists; 2024.

8. Espinosa K. "ASCCP management guidelines for abnormal cervical cancer screening." Am Fam Physician. 2024;109(3):275–276.

9. Winer RL, Lin J, Anderson ML, et al. "Strategies to increase cervical cancer screening with mailed human papillomavirus self-sampling kits: a randomized clinical trial." JAMA. 2023;330(20):1971–1981. doi:10.1001/jama.2023.21471

10. Montealegre JR, Hilsenbeck SG, Bulsara S, et al. "Self-collection for cervical cancer screening in a safety-net setting." JAMA Intern Med. 2025;185(9):1119–1127. doi:10.1001/jamainternmed.2025.2971

11. ASCCP. Tips for Best Practice on Role of Expedited Treatment. 2024. Official practice pearl.

12. HRSA. Women's Preventive Services Guidelines: updated cervical cancer screening guidance and implementation by plan year. Official guidance.

13. Perkins RB, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023. J Low Genit Tract Dis. 2024;28:3–6. Full guideline update.

14. ASCCP. Updated Review for Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection. 2025. Official guideline review.