Several prominent professional organizations have issued specific guidelines on cervical cancer screening. Guidelines presented by the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), American Society for Clinical Pathology (ASCP), U.S. Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists (ACOG) address the time to start screening, the screening methods and intervals, the time to stop screening, and the use of the HPV test.
CDC Screening Summary available at:
Below is a summary of the recommendations currently included in the guidelines, including the updated 2020 USPSTF recommendations. The 2022 recommendations are being updated and are not finalized during the course review.
When to begin cervical cancer screening
Most guidelines recommend screening with a Pap test once a woman becomes sexually active. However, women under age 21 should not be screened for cervical cancer.
Intervals for screening with Pap smear or liquid-based cytology
Most recommendations are to screen women ages 21 to 29 every three years using a Pap test or liquid-based cytology. No co-testing with HPV test is recommended for this age group because, typically, HPV infection is common and is often cleared by the immune system.
HPV co-test
All organizations agree that HPV co-testing should not be used for women aged <30 years. However, in women aged 30 to 65, recommendations among the organizations provide for co-testing using HPV and Pap tests every five years as an option.
Use of HPV Test (HR-HPV) as a primary screening method
Before 2018, no professional organization had recommended the use of HPV testing alone. They did recommend against screening for cervical cancer with HPV (alone or in combination with cytology) in women aged <30 years. However, the USPSTF in 2018 led the way in recommending the HPV test (HR-HPV) as an option as the primary cervical cancer screening test for women ages 30 to 65. The USPSTF guidelines for this age group recommended three screening options: (1) a high-risk HPV (HR-HPV) test every five years, (2) a Pap test every three years, or (3) co-testing with both HR-HPV and Pap test every five years.
Summary of the updated Cervical Cancer Screening Guidelines:
- Women under age 21 should not be screened for cervical cancer.
- Women ages 21 to 29 should undergo a Pap test or cytology screening every three years. HPV testing is not recommended for women aged 21 to 29 because HPV infection is common in this group and is often cleared by the immune system.
- Women ages 30 to 65 have three options: the HR-HPV test every five years, a Pap test every three years, or co-testing with both HR-HPV and Pap tests every five years.
- Women over age 65 do not need to be screened for cervical cancer if they are up to date on their screening, their tests in the previous ten years were negative, and they don't have other risk factors for cervical cancer.
It is important to note that these guidelines do not apply to women who have symptoms of cervical cancer, regardless of their sexual history. Nor is it used for women who have previously been diagnosed with cervical cancer or a high-grade precancerous lesion or for women who have a condition that weakens their immune system, such as HIV.
