Updated cervical cancer screening guidelines: What to know

This week, the American Cancer Society (ACS) released updated cervical cancer screening guidelines for individuals at average risk. They now recommend that cervical cancer screening begin at age 25, instead of 21, and place a greater emphasis on human papillomavirus (HPV) testing as the preferred primary screening strategy. 

“Cervical cancer is very rare in women under age 25, and most abnormalities resolve on their own at this age,” says Andrea Milbourne, M.D., professor of Gynecologic Oncology and Reproductive Medicine. “Pushing the screening age back to 25 would put the U.S. in line with the rest of the world and with our own science.”

The previous ACS guidelines recommended cervical cancer screening begin at age 21 with a Pap test every three years until age 29, then a Pap test every three years or co-testing with a Pap test and HPV test every five years from age 30 to 65. 

The new ACS guidelines recommend that individuals with a cervix at average risk for cervical cancer begin screening at age 25 with a primary HPV test alone every five years. This applies to most women. Milbourne notes that HPV testing alone detects more abnormalities than Pap alone, especially in young women. The guidelines include co-testing with a Pap test and HPV test every five years or a Pap test every three years as acceptable options.

“This is the first time that HPV testing alone has been a part of the primary recommendation for cervical cancer screening, and in fact, is the preferred screening,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center.

HPV causes almost all cervical cancer cases

HPV is the cause of almost all cervical cancers. The HPV vaccine prevents most cervical, anal, vaginal and vulvar cancers, and reduces the risk of most HPV-related cancers of the throat and penis.

The new guidelines, which were last updated in 2012, come as the number of young adults vaccinated for HPV continues to rise in the U.S. According to the most recent National Immunization Survey-Teen, more than half of adolescents ages 13 to 17 have received at least one dose of the HPV vaccine. Our experts agree it’s safe and important to have your children vaccinated for HPV during the COVID-19 pandemic.  

About 80% of men and women will get an HPV infection in their lifetime. Most people with HPV don’t know they’re infected and their bodies are able to clear the virus before it causes any health problems. But in some cases, the infection persists and leads to cancer. The goal of cervical cancer screening is to find cervical cancer at an early, or precancerous, stage, when the chances for successful treatment are the greatest.

Emphasis on HPV testing offers potential to reach even more women

Thanks to cervical cancer screening, cervical cancer rates have fallen by 70% in the U.S. since the 1950s, but the American Cancer Society estimates more than 13,000 new cases will be diagnosed in 2020.

“Cervical cancer is most common in underscreened and unscreened women,” Milbourne says. “Screening with a Pap test requires a visit to the doctor’s office, but making HPV testing the preferred screening method might open the door to self-screening, which might get more women screened.”

While at-home HPV testing is already promoted in other countries, including Australia, which has some of the lowest cervical cancer rates in the world, it hasn’t received Food and Drug Administration approval in the U.S. yet.

“The new ACS cervical cancer screening guidelines are the first step toward HPV testing alone being the only primary screening modality,” Bevers says. “It also carries the possibility of women eventually being able to do cervical cancer screening in the privacy of their own home and only going to the doctor for a Pap test if the HPV test is positive.”

Experts expect that convenient, at-home HPV testing could increase the number of women to receive cervical cancer screening and prevent even more cancer deaths. Studies to assess the possibility of at-home HPV testing in the U.S. are underway in early stages.

“Remember the old days of pregnancy tests? You had to go to a doctor to get one,” Bevers says. “Now you can do a pregnancy test at home and see the obstetrician only if the test is positive. These guidelines carry that possibility for cervical cancer screening in the future.”

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