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Cervical Cancer Screening

Cervical cancer screening is a preventive strategy for asymptomatic people with a cervix; abnormal bleeding or other symptoms concerning for cervical cancer prompt diagnostic evaluation.[4][6] In unscreened populations, lifetime cervical cancer risk may reach 5%, compared with less than 0.5% with effective screening and treatment of precancers.[1] ACS prefers clinician-collected primary hrHPV testing, while the final USPSTF statement (2018; update in progress) prefers cytology every 3 years or primary hrHPV testing every 5 years at ages 30–65 and accepts cotesting every 5 years; all three carry Grade A.[2][3][4][6] For average-risk patients, ACOG's 2026 statement retains cytology every 3 years at ages 21–29 and prefers clinician-collected primary hrHPV testing every 5 years at ages 30–65; patient-collected testing every 3 years may be considered at ages 30–65 when the patient prefers it and systems for result notification, documentation, and follow-up are in place.[17]

Screening methods​

Three strategies are endorsed:[2]

  • Primary HPV testing (preferred by ACS) uses an FDA-approved hrHPV test alone.[6] 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 combines HPV testing with cytology. It increases sensitivity and long-term negative predictive value compared with cytology alone, but adds limited benefit over HPV testing alone, because 97% of precancers are HPV-positive.[1][2]
  • Cytology alone (Pap test) remains an option under the final USPSTF statement; ACS reserves it for settings where other options are unavailable. It is repeated every 3 years because of its 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 yearsClinician-collected primary HPV every 5 years preferred; self-collected HPV every 3 years or cotesting every 5 years acceptable; cytology every 3 years if HPV-based options are unavailable
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]

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 recommends cytology every 3 years. ACS prefers clinician-collected primary HPV testing every 5 years; self-collected HPV testing every 3 years or cotesting every 5 years is acceptable, and cytology every 3 years is an alternative if HPV-based options are unavailable.[2][4][6]
  • Ages 30–65. ACS prefers clinician-collected primary HPV testing. The USPSTF final statement accepts HPV testing, cotesting or cytology at their respective intervals.[2]
  • Over 65. Screening can be discontinued with adequate prior negative results. For average-risk people with a cervix, the 2026 ACS update permits exit after two consecutive negative primary HPV tests or cotests at the recommended interval, with the last at age ≥65.[6] 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. Screening or surveillance continues after 65 for patients with HIV or immunosuppression, an HPV-positive or LSIL-or-worse result within 10 years, CIN2, CIN3, or AIS within 25 years, or any history of cervical cancer; for cervical cancer survivors, a gynecologic oncologist determines the long-term screening and exit plan.[2][5][6]
  • After hysterectomy with cervix removal. No screening if no history of CIN2+ or cervical cancer.[2][4]

HPV self-collection — a major recent advance​

In May 2024, the FDA approved cobas HPV testing of vaginal specimens self-collected in a health care setting when a cervical specimen could not be obtained.[6][20] In May 2025, it authorized the Teal Wand for home specimen collection and transport for laboratory HPV testing.[2][21]

  • PCR-based HPV testing on self-collected vaginal specimens has similar sensitivity for CIN2+ detection to testing on clinician-collected cervical specimens.[2][6] In a six-study synthesis, pooled sensitivity was 89.7% (95% CI 84.2–93.5%) versus 92.9% (95% CI 88.6–95.5%), respectively.[15]
  • Clinician-collected specimens remain preferred because they allow reflex cytology from the same sample when HPV is positive. In average-risk screening, HPV16/18 detected on a self-collected sample prompts colposcopy with concurrent cytology (AII); other oncogenic types generally need clinician-collected cytology or dual-stain triage (AII). HPV56, 59, or 66 without another oncogenic type on an extended-genotyping assay leads to repeat HPV testing in one year (AII), with colposcopy if positive at follow-up (CIII).[6][15]
  • After a negative self-collected HPV test, repeat screening is recommended in 3 years (versus 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, patients with HIV, DES exposure or a history of cervical cancer, or patients who need cytology-based surveillance.[6][3]
  • HRSA’s update includes self-collection for average-risk ages 30–65; for most covered plans, coverage starts with plan years beginning in 2027, which may start after January 1.[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%Use five-year CIN3+ risk to choose return: <0.15% at 5 years, 0.15% to <0.55% at 3 years, and ≥0.55% at 1 year; HPV18-positive NILM and HPV-negative ASC-H require colposcopy (AII).[16]
4% to <25%Colposcopy (AII)[16]
25% to <60%Colposcopy or expedited excisional treatment acceptable (AII)[16]
≥60%Expedited excisional treatment without a prior confirmatory biopsy preferred when eligible; colposcopy with biopsy acceptable (BII)[16]

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]

For a new low-grade abnormality, a negative HPV test or cotest within the preceding 5 years is associated with approximately 50% lower estimated CIN3+ risk, potentially allowing deferral of colposcopy.[7][8] After treatment for histologic HSIL (CIN2 or CIN3), three negative HPV tests or cotests at 6, 18, and 30 months precede three-year surveillance for at least 25 years.[7][13][16] After fertility-sparing AIS excision with negative margins, cotesting with endocervical sampling is performed every six months for at least three years, then annually for at least two years; after five years of negative cotests and endocervical samples, three-year surveillance is acceptable and continues for at least 25 years.[16]

Special populations​

HIV, transplant, systemic lupus erythematosus and some other immunosuppressive conditions or treatments require dedicated screening pathways. For people with HIV, NIH recommends cervical cytology from age 21 (AII), cytology or cotesting from age 30 (BIII), and screening beyond 65 when life expectancy and health status warrant it (BIII).[19] The 2025 ASCCP review recommends the HIV schedule for solid-organ transplant, end-stage renal disease, hematopoietic stem-cell transplant, and systemic lupus erythematosus regardless of immunosuppressive therapy, and for inflammatory bowel disease, rheumatoid arthritis, and multiple sclerosis during immunosuppressive therapy. For those three conditions without immunosuppressive therapy, general-population screening applies with shared decision-making about enhanced surveillance.[14] Vaccination does not remove the need for indicated screening.[4][6][13][14]

Screening gaps and disparities​

In a U.S. randomized trial in an integrated health system, mailing HPV self-sampling kits raised screening completion by 14.1 percentage points among patients due for screening and by 16.9 points among those overdue, compared with education alone.[9] In the 2021 National Health Interview Survey, 75% of U.S. females aged 21–65 without a hysterectomy were up to date with cervical cancer screening under USPSTF criteria.[18] The ACS guideline reports that screening rates had not rebounded by 2023.[6] WPSI recommends individualized patient navigation for cervical screening and follow-up, drawing on 42 randomized trials of navigation for breast and cervical screening and follow-up.[22] Disparities persist among uninsured, rural, and racial and ethnic minority populations; self-collection is used to reduce screening barriers among underscreened groups.[6] In a randomized safety-net trial of 2,474 underscreened patients, mailed kits increased six-month screening participation (kit return or clinic screening) to 41.1% (340/828) versus 17.4% (144/828) with telephone reminders; 55 of 84 HPV-positive self-collectors completed indicated follow-up within six months.[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. PMID 41839104

3. Christine B, Bush M, Thurakal A, Sheehy AM. "New cervical cancer screening guidelines from the US Department of Health and Human Services: strengthening women's preventive health." JAMA. 2026;335(8):661–662. 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. PMID 38574222

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. doi:10.1097/lgt.0000000000000788

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

15. Wentzensen N, Massad LS, Clarke MA, et al. "Self-collected vaginal specimens for HPV testing: Recommendations from the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee." J Low Genit Tract Dis. 2025;29(2):144–152. doi:10.1097/LGT.0000000000000885

16. Perkins RB, Guido RS, Castle PE, et al. "2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors." J Low Genit Tract Dis. 2020;24(2):102–131. doi:10.1097/LGT.0000000000000525

17. American College of Obstetricians & Gynecologists' Committee on Clinical Consensus–Gynecology. "Screening for cervical cancer." Obstet Gynecol. 2026;148(1):e63–e67. doi:10.1097/AOG.0000000000006257

18. American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2026. 2026. Table 6C.

19. National Institutes of Health. "Human Papillomavirus Disease: Adult and Adolescent Opportunistic Infections." Updated July 9, 2024; reviewed March 16, 2026. Official guideline.

20. U.S. Food and Drug Administration. "cobas HPV for use on the cobas 5800/6800/8800 Systems (P190028/S009)." May 14, 2024. FDA approval.

21. U.S. Food and Drug Administration. "DEN240045: Teal Wand." May 9, 2025. FDA De Novo authorization.

22. Witkop CT, Picardo C, Vosooney A, et al. "Recommendations From the Women's Preventive Services Initiative on Breast Cancer Screening for Women at Average Risk and Patient Navigation Services for Breast and Cervical Cancer Screening." Obstet Gynecol. 2025;146(3):315–322. doi:10.1097/AOG.0000000000006011