Newly updated guidelines from the American Cancer Society (ACS) call for delaying the start of cervical cancer screening from age 21 to 25 and using a primary human papilloma virus (HPV) test (a stand-alone test) as the preferred method of screening.
Previous ACS guidelines called for screening every three years with a Pap smear alone beginning at age 21 and recommended HPV testing combined with a Pap smear (co-testing) every five years as the preferred screening method for women ages 30 to 65.
HPV screening involves collecting cervical cells and testing for the genetic material of high-risk types of the virus. Almost all cervical cancers are caused by persistent infections with high-risk HPV. The Pap smear, also known as cytology, is a cervical cancer screening test that involves collecting a sample of cells from the cervix and examining them using a microscope for potentially precancerous changes. When detected early, precancerous areas can be treated before they become cancerous.
The updated ACS guidelines now emphasize primary HPV testing (a stand-alone HPV test) as a simpler, accurate screening strategy for women and transgender individuals who retain cervixes. This strategy is recommended for individuals who have average risk for cervical cancer and no symptoms or prior history of the disease.
ACS recommends using one of two HPV tests approved by the Food and Drug Administration (FDA) as primary screening tests, but these may not be available in all areas. For this reason, ACS guidelines say co-testing every five years or Pap smear alone every three years are acceptable options for now. But ACS adds that co-testing or Pap smear as screening strategies "should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers."
Timing of Screening
The updated guidelines recommend an initial HPV test at age 25, followed by the HPV test every five years, continuing through age 65. Lowering the age for HPV testing from age 30 to 25 is expected to detect more cases of cervical cancer and prevent more deaths.
On the other hand, the recommendation to delay the start of screening from age 21 to 25 came about because young people vaccinated against HPV as preteens are now reaching the age that they are eligible for screening. HPV vaccination has resulted in a dramatic reduction in precancerous cervical lesions that can progress to cancer. Additionally, research has shown little benefit from starting screening at the younger age.
The 2020 ACS guidelines also recommends stopping screening at age 65 in women who have had 10 years of normal results on regular screenings. Those who have had cervixes removed for reasons other than cervical cancer don't need screening. ACS screening guidelines continue to apply to people who have had HPV vaccines.
Evolving science and technology in recent years has led to changes in recommendations and a complicated collection of cervical cancer screening guidelines from multiple health organizations.
In contrast to the updated ACS guidelines, for example, a 2018 U.S Preventive Service Task Force (USPSTF) recommendation calls for starting screening at age 21 years with Pap smear alone. At ages 30 through 65, USPSTF recommends HPV testing every five years or Pap smear alone every three years with co-testing as an alternative option. The American Academy of Family Physicians has endorsed the 2018 USPSTF recommendations.
The 2016 American College of Obstetricians and Gynecologists (ACOG) guidelines call for Pap smears for women ages 21 through 29 every three years. For women ages, 30 through 65, ACOG stated that co-testing every five years or a Pap test alone every 3 years is still recommended by most major societies, but HPV testing alone could be considered as an alternative for women age 25 and older. An ACOG public statement recently affirmed these recommendations but noted the organization will review the ACS recommendations to determine whether it should similarly update its own.
Though recommendations for the best screening strategy may continue to evolve as health organizations update their guidance, it is important to remember to get cervical cancer screening. You may wish to have a discussion with your healthcare practitioner about the different screening strategies so you can decide which approach is best for you.