A shift toward more accessible screening options
Cervical cancer screening in the United States is expanding beyond traditional speculum exams. Updated guidelines released Thursday by the American Cancer Society now endorse self swab HPV testing, a change experts hope will make screening more accessible and increase participation among women who avoid pelvic exams due to discomfort.
HPV testing has become the preferred method for detecting cervical cancer risk, overtaking the Pap test. Because human papillomavirus is responsible for nearly all cases of cervical cancer, testing directly for high risk strains offers a more accurate and sensitive approach. Until recently, HPV testing required clinician collected samples. Since 2024, however, the FDA has authorized three self administered HPV tests, including one that allows patients to collect samples at home and mail them to a laboratory.
“HPV is such a strong indicator of cervical cancer, we know that screening for HPV is screening for cervical cancer,” said Jane Montealegre of MD Anderson Cancer Center, who noted that offering women additional testing options may help close long standing screening gaps.
How self collected HPV testing works
The newly endorsed approach allows patients to use a simple vaginal swab provided by a clinic. In approved cases, at home kits let women collect samples privately and send them for analysis. According to Robert Smith, senior vice president of early cancer detection science at the American Cancer Society, the method is straightforward: a patient receives a kit, steps into an exam room or restroom, and collects her own sample.
The guidelines reaffirm that HPV testing every five years is the recommended primary screening method for women in the approved age range. If results come back positive, clinicians follow up with additional tests or procedures. Pap tests remain an acceptable option every three years, and patients may also receive co testing (HPV plus cytology) every five years.
Despite decades of declining cervical cancer rates driven by screening and HPV vaccination, more than 20 percent of American women remain behind on screening schedules. Self sampling is expected to help address this gap by reducing barriers such as discomfort, embarrassment and logistical challenges.
Different recommendations on when screening should begin
The American Cancer Society recommends beginning HPV based screening at age 25, while the U.S. Preventive Services Task Force advises starting at age 30 and continuing Pap only screening every three years between ages 21 and 29. Montealegre does not expect the task force to adjust its start age but anticipates it will incorporate self administered testing into future updates.
Because cervical cancer screening is covered under the Affordable Care Act, self collected tests performed in clinical settings are expected to be reimbursed. Experts say the insurance rules already in place for primary HPV testing should apply regardless of who collects the sample.
Guidance on stopping screening and the future of cervical cancer testing
The updated guidelines also clarify when screening can end. Women may stop at age 65 only if they have a decade long history of consistent, negative test results. Many, according to Smith, do not meet this threshold and may mistakenly assume they can discontinue screening earlier than recommended.
Looking ahead, researchers expect even longer intervals between screenings for vaccinated populations. “We have data showing that in highly vaccinated groups, screening every ten years is possible,” said Dr. Diane Harper of the University of Michigan. She predicts U.S. guidelines will move in that direction as evidence accumulates.
Overall, the addition of self swab HPV testing marks a significant step toward improving access and reducing cervical cancer risk by making screening easier, more flexible and more patient centered.