New Cervical Cancer Screening Guidelines: HPV Testing & Self-Collection Options | ACS Recommendations 2024

The American Cancer Society (ACS) recently updated its recommendations for cervical cancer screening, placing a greater emphasis on testing for the human papillomavirus (HPV) and, notably, approving the use of self-collected samples. These updated guidelines apply to anyone with a cervix who is at average risk of developing cervical cancer and clarify the ages at which screening should begin, and end. The changes reach as the United States Preventative Services Task Force (USPSTF) is also in the process of revising its own cervical cancer screening guidelines, which significantly influence what health insurance plans will cover.

Understanding HPV and Cervical Cancer

Nearly all cases of cervical cancer are caused by long-lasting infections with certain types of HPV. HPV is a very common virus that is spread through skin-to-skin contact, most often during sexual activity. However, having HPV does not automatically mean someone will develop cancer. most HPV infections go away on their own. It’s the persistent infections with high-risk HPV types that can lead to cell changes that, over time, can develop into cancer. The American Cancer Society explains that HPV tests specifically look for these high-risk types of the virus.

Key Changes to ACS Screening Recommendations

The ACS recommendations offer several vital updates. One significant shift is the move towards “HPV primary” testing. This means that, when available, healthcare providers should use a test that directly looks for the presence of high-risk HPV types. If HPV primary testing isn’t accessible, the ACS recommends “co-testing,” which involves both an HPV test and a Pap test (also known as cytology) performed simultaneously. If neither of those options are available, a Pap test alone is still considered acceptable.

Starting Screening at Age 25

The ACS now recommends that individuals begin cervical cancer screening at age 25, regardless of the type of test used. This is a change from previous recommendations and reflects the fact that cervical cancer is relatively rare in younger people. This differs from current USPSTF recommendations, which suggest Pap tests can begin between ages 21 and 29, with a transition to HPV primary testing or co-testing at age 30.

The Option of Self-Collected Samples

Perhaps the most notable change is the acceptance of self-collected samples for HPV testing. Traditionally, samples for both HPV and Pap tests were collected by a healthcare provider during a pelvic exam. Although provider-collected samples remain the preferred method, the ACS acknowledges that this can be a barrier for some individuals, whether due to discomfort, lack of access to care, or other reasons. Self-collection, which can be done at home or under the supervision of a healthcare provider, offers a more accessible alternative.

Screening Frequency and When to Stop

The frequency of screening depends on the type of test(s) used and how the sample was collected. Those who receive HPV primary testing or co-testing with provider-collected samples and have normal results should be screened again in five years. Individuals who self-collect samples for HPV testing and have normal results should be screened every three years. Those who only receive a Pap test and have normal results should also be screened every three years. Abnormal results will likely necessitate more frequent screening.

The ACS also recommends that individuals can stop screening at age 65 if they have had 10 years of consistently normal results. This means either negative HPV tests at ages 60 and 65, or three consecutive negative Pap tests, with the most recent one at age 65.

The Impact of Screening on Cervical Cancer Rates

Cervical cancer is a preventable cancer, and widespread screening has been remarkably effective in reducing its incidence and mortality. In the United States, nearly 14,000 cases of cervical cancer are diagnosed each year, resulting in over 4,000 deaths annually. However, the disease typically develops slowly, allowing for detection and treatment before it progresses to cancer. Thanks to widespread screening, the number of cervical cancer cases has decreased by more than half since the mid-1970s.

Despite this progress, over half of cervical cancer diagnoses in the U.S. Today occur in individuals who have never been screened or who have been screened infrequently. This highlights the importance of ensuring access to screening for all who are eligible.

Expanding Access to Screening

The new ACS guidelines aim to address barriers to screening by offering more flexible options, including self-collection. Testing can now potentially be done at a primary care provider’s office, an urgent care clinic, a mobile clinic, or even some pharmacies. The availability of at-home self-collection kits is particularly beneficial for those who lack access to a gynecologist or who feel uncomfortable with traditional pelvic exams.

“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” explained Dr. Robert Smith, senior vice president, early cancer detection science at the American Cancer Society. He further emphasized that the development of self-collection tools will “broaden access to screening.”

What’s Next for Cervical Cancer Screening?

The USPSTF’s ongoing review of its cervical cancer screening guidelines will likely have a significant impact on insurance coverage and healthcare practices. The USPSTF’s recommendations are independent of the ACS, and their decisions can influence which screening methods are routinely covered by insurance plans. It’s important to stay informed about updates from both organizations to ensure you are receiving the most current and appropriate screening recommendations. Individuals should discuss their screening options with their healthcare provider to determine the best approach based on their individual risk factors and preferences.