Cervical cancer screening guidelines have been updated by the American Cancer Society (ACS), placing a greater emphasis on testing for the human papillomavirus (HPV) – a virus responsible for nearly all cases of the disease – and, significantly, approving the use of self-collected samples for testing. These new recommendations, applicable to anyone with a cervix at average risk, aim to improve access to screening and reduce cervical cancer rates, which remain a concern despite decades of progress. The updated guidelines clarify at what age screening should begin and end, and offer more flexible testing options.
Cervical cancer, while largely preventable through screening, continues to affect thousands of people in the United States each year. According to the ACS, approximately 14,000 cases are diagnosed annually, resulting in over 4,000 deaths. Early detection is crucial, as cervical cancer typically develops slowly, allowing for effective treatment before it progresses.
HPV Primary Testing and Screening Options
The core of the updated ACS recommendations centers around “HPV primary testing,” which directly looks for the presence of high-risk HPV types known to cause cervical cancer. If HPV primary testing isn’t available, the ACS recommends “co-testing,” combining an HPV test with a Pap test (also known as cytology). A Pap test examines cells from the cervix for abnormalities, but does not detect the virus itself. If neither HPV primary testing nor co-testing is accessible, a Pap test alone remains an acceptable option.
The ACS guidelines also acknowledge the work of the United States Preventative Services Task Force (USPSTF), another key organization that issues cancer screening recommendations. The USPSTF is currently revising its own cervical cancer screening guidelines, and their recommendations often influence what health insurance plans will cover. The USPSTF currently recommends Pap tests for women ages 21 to 29, transitioning to HPV primary testing or co-testing at age 30, a difference from the ACS’s recommendation to begin screening at age 25 regardless of the test used.
Starting Screening at 25 and the Option of Self-Collection
A key change in the ACS guidelines is the recommendation to begin cervical cancer screening at age 25. This is based on the understanding that cervical cancer is relatively rare in younger individuals. Traditionally, samples for both HPV and Pap tests were collected by a healthcare provider during a pelvic exam. Though, recognizing that access to healthcare and comfort levels vary, the ACS now approves self-collected HPV tests as an acceptable alternative, particularly for those who may face barriers to traditional screening methods.
This self-collection option could prove particularly beneficial for individuals who do not have regular access to a gynecologist or who experience discomfort with pelvic exams. Samples can potentially be collected at a primary care provider’s office, urgent care clinic, mobile clinic, or even at home, expanding access to this vital preventative care.
Follow-Up Frequency and When to Stop Screening
The frequency of follow-up screening depends on the type of test used and how the sample was collected. Individuals who receive HPV primary testing or co-testing with provider-collected samples and have normal results should be screened again in five years. Those who self-collect samples for HPV testing and have normal results should be screened every three years. If only a Pap test is performed and the results are normal, screening should occur 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 a decade of consistently normal results. This means either negative HPV tests at ages 60 and 65, or three consecutive negative Pap tests, with the most recent one at age 65.
“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 also emphasized that the development of self-collection tools will “broaden access to screening.”
Widespread cervical cancer screening in the U.S. Has already led to a more than 50% decrease in cancer cases since the mid-1970s. However, over half of cervical cancer diagnoses today occur in individuals who have never been screened or who are screened infrequently, highlighting the ongoing need for improved access and adherence to screening guidelines.
The ACS guidelines offer a range of options, including the convenience of self-collection, to make cervical cancer screening more accessible and encourage more people to participate in this life-saving preventative measure. For more information and to discuss your individual screening needs, consult with your healthcare provider.
Disclaimer: This article provides general information and should not be considered medical advice. Please consult with a qualified healthcare professional for personalized guidance on cervical cancer screening.
The USPSTF is expected to release its updated cervical cancer screening recommendations later in 2024, which may further refine the landscape of preventative care for this disease. Stay informed and discuss the best screening plan for you with your doctor.
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