New Cervical Cancer Screening Guidelines: HPV Testing & Self-Collection Options
- New recommendations from the American Cancer Society (ACS) are aiming to simplify and improve cervical cancer screening, with a significant focus on Human Papillomavirus (HPV) testing and the...
- The ACS is one of two leading organizations providing cervical cancer screening recommendations.
- The ACS now recommends “HPV primary testing” as the preferred method of screening.
New recommendations from the American Cancer Society (ACS) are aiming to simplify and improve cervical cancer screening, with a significant focus on Human Papillomavirus (HPV) testing and the acceptance of self-collected samples. These guidelines apply to individuals with a cervix who are at average risk and provide clarity on when screening should begin, and end.
The ACS is one of two leading organizations providing cervical cancer screening recommendations. The other is the United States Preventative Services Task Force (USPSTF), an independent group of medical professionals whose recommendations influence health insurance coverage. The USPSTF is currently revising its own guidelines as well.
HPV Primary Testing: The New Standard
The ACS now recommends “HPV primary testing” as the preferred method of screening. This involves testing for the presence of high-risk HPV types known to cause nearly all cases of cervical cancer. If HPV primary testing isn’t available, the ACS suggests “co-testing,” which combines an HPV test with a Pap test (also known as cytology). If neither of these options are accessible, a Pap test alone remains an acceptable alternative.
Starting Screening at 25
A key change in the ACS recommendations is the suggested starting age for screening: . This is based on the fact that cervical cancer is relatively rare in younger individuals. This differs from current USPSTF recommendations, which suggest Pap tests can begin between ages and , followed by HPV primary testing or co-testing starting at age .
Self-Collection: Expanding Access to Screening
Traditionally, samples for both HPV and Pap tests were collected by healthcare providers during a speculum exam. While provider collection remains the preferred method, the ACS acknowledges that this can be a barrier for some individuals. The updated guidelines recognize self-collected HPV tests as an acceptable alternative, potentially increasing access to screening for those who face difficulties with traditional methods or lack access to a gynecologist.
Follow-Up Intervals Based on Test Type and Collection Method
The frequency of follow-up screening depends on the type of test(s) performed and how the sample was collected. Individuals who undergo HPV primary testing or co-testing with provider-collected samples and receive normal results should be rescreened in five years. Those who self-collect samples for HPV testing and have normal results should be rescreened in three years. Individuals who receive only a Pap test and have normal results should also be rescreened in three years. Abnormal results will likely necessitate more frequent screening.
Ending Screening at 65 with Consistent Normal Results
The ACS recommends that individuals can discontinue screening at age if they have had a decade of consistently normal results. So either negative HPV tests at ages and , or three consecutive negative Pap tests, with the most recent occurring at age .
The Importance of Cervical Cancer Screening
Cervical cancer affects nearly people in the United States each year, resulting in over deaths annually. However, cervical cancer typically develops slowly, allowing for detection and treatment before it progresses to a more advanced stage. This underscores the critical importance of regular screening.
Widespread cervical cancer screening has already had a significant impact, reducing the number of cases by more than half since the mid-s. Currently, over half of cervical cancer diagnoses in the U.S. Occur in individuals who have never been screened or who are screened infrequently.
Increased Accessibility Through Multiple Testing Options
The new guidelines aim to make screening more accessible through a variety of options, including self-collection. Testing can potentially be conducted at primary care provider offices, urgent care clinics, mobile clinics, and even some pharmacies. The option of self-collecting a sample at home is particularly beneficial for those who lack access to a gynecologist or feel uncomfortable with vaginal exams.
“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” explained Dr. Robert Smith, senior vice president, early cancer detection science at the American Cancer Society. Dr. Smith further stated that the development of self-collection tools will “broaden access to screening.”
Dr. Robert Smith, Senior Vice President, Early Cancer Detection Science, American Cancer Society
These updated guidelines represent a significant step towards improving cervical cancer prevention by offering more flexible and accessible screening options.