HPV Self-Collection Endorsed for Cervical Cancer Screening

New cervical cancer screening guidelines released by the American Cancer Society (ACS) at the end of 2025 and endorsed by the Health Resources and Services Administration (HRSA) in January 2026 have established self-collection as an acceptable alternative for HPV testing. These guidelines aim to increase screening access for individuals who cannot or do not wish to undergo a traditional pelvic exam.

The shift toward primary HPV testing and the acceptance of self-sampling reflect a broader effort to reduce the number of unscreened or under-screened individuals in the United States, where the majority of cervical cancers occur.

Preferred Screening Methods and Consensus

Both the ACS and HRSA recommend the HPV primary test as the preferred screening method for patients of average risk between the ages of 30 and 65. This specific test identifies types of human papillomavirus known to cause approximately 70% of cervical cancers.

In instances where a primary HPV test is unavailable, both organizations recommend co-testing, which involves performing an HPV test and a Pap test (cytology) simultaneously. If neither option is available, a Pap test alone is considered a viable alternative.

While the ACS maintains a preference for samples collected by a healthcare provider during a speculum exam, it recognizes that such exams can be difficult for some patients or unavailable in certain regions. Both the ACS and HRSA now recognize self-collected HPV tests as an acceptable option.

Implementation and Access to Self-Collection

The FDA expanded approvals on May 14, 2024, for two specific tests—Onclarity HPV by Becton, Dickinson and Company (BD) and cobas HPV by Roche Molecular Systems—to allow for self-collection within a healthcare setting. This includes primary care offices, pharmacies, urgent care centers, and mobile clinics.

The use of a swab or brush for self-collection is intended to widen access for populations with low screening rates. While current FDA approvals focus on healthcare settings, the National Cancer Institute’s “Last Mile” Initiative is working toward future approvals that would allow individuals to collect samples in their own homes.

Guidelines on Screening Intervals and Age

The timing for follow-up screenings varies based on the method of collection and the results received:

• Individuals with normal results from a provider-collected HPV primary test or co-test should be screened every five years.
• The ACS specifies that those who use self-collection and receive normal results should be screened again in three years.
• Individuals who receive only a Pap test with normal results should be screened every three years.

Both organizations agree that screening can generally end at age 65 if previous results were normal. The ACS provides specific criteria for this, requiring a decade of normal results, such as negative HPV tests at ages 60 and 65, or three consecutive negative Pap tests with the final one occurring at age 65.

Key Differences in Starting Age

A notable divergence exists between the two organizations regarding when screening should begin. The ACS recommends that screening start at age 25, regardless of the test used, citing the rarity of cervical cancer in younger populations.

In contrast, HRSA guidelines suggest that individuals receive Pap tests every three years between the ages of 21 and 29, transitioning to HPV primary testing or co-testing at age 30.

Impact on Patients and Insurance

These guidelines are expected to influence the types of tests providers offer and how insurance companies handle coverage. Most private insurance companies are required to cover recommended testing and follow-up options without copays, with these specific recommendations affecting policies starting in 2027.

By expanding screening beyond traditional gynecologist offices to include pharmacies and mobile clinics, the medical community aims to support those who are uncomfortable with vaginal exams or lack access to specialized care.