By Alexandria Cull Weatherer, MPH, Outreach Specialist
The American Cancer Society (ACS) recently updated its cervical cancer screening recommendations to better align screening practices with the most up-to-date science.
The new guidelines, released July 30, replace cytology testing (also known as a Pap smear or Pap test) and co-testing (HPV testing in combination with cytology) with Primary HPV testing alone as the preferred method of screening.
These recommendations apply to adults with a cervix who have no symptoms of cervical cancer, have never been diagnosed with cervical cancer or precancer, and do not have a health condition that weakens the immune system. People who have received the HPV vaccine should continue to get screened according to their age.
A comparison of the new and previous guidelines (adapted from ACS):
| Population | New guidelines | Old guidelines |
| Age <25 years | No Screening | Cytology (e.g., Pap test or Pap smear) alone every 3 years, beginning at age 21 |
| Age 25-65 years | Preferred: Primary HPV test alone every 5 years Acceptable Options: Co-testing every 5 yearsCytology alone every 3 years | Until age 29 years: Continue cytology alone every 3 years Age 30-65 years: Preferred: Switch to co-testing Acceptable Option: Cytology alone every 3 years |
| Age >65 years | No screening if adequate negative prior screening. In the absence of prior screening, continue screening until criteria for cessation are met. | No screening if adequate negative prior screening. |
| After hysterectomy (with removal of cervix) | No screening in individuals with no history of CIN2 or a more severe diagnosis in the past 25 years, or cervical cancer ever. | No screening in individuals with no history of cervical cancer or serious precancer in the past 20 years. |
The shift from cytology testing to primary HPV testing is based, in part, on the fact that almost all cervical cancers are caused by HPV infection. FDA-approved HPV tests used for primary testing, such as cobas® HPV and Onclarity HPV, can detect several HPV genotypes, including those that cause cancer; have improved sensitivity for precancers; and can better predict future risk for cervical precancer and cancer based on current and past test results.
Co-testing or cytology testing alone still may be used when access to primary HPV testing is limited or unavailable, as the United States transitions to primary HPV testing. Screening with cytology alone has declined in recent years because of the increased use of co-testing and primary HPV testing.
Patients who screen positive for HPV should be treated in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines.
Of note, the new ACS guidelines differ from current USPSTF guidelines, which can affect insurance coverage.
Regular screening has been shown to prevent cervical cancer, detect cancer early, and save lives. Timely cervical cancer screenings and routine HPV vaccinations are essential tools to reduce the burden of cervical cancer. Getting screened regularly, no matter which test, remains important.