Takeaways
- HPV self-collection is now an acceptable option for cervical cancer screening in average-risk individuals aged 25 to 65, though clinician-collected samples remain preferred.
- Negative self-collected HPV tests should be followed by repeat screening in 3 years, reflecting limited long-term US data on self-collection performance.
- Screening discontinuation now requires negative HPV-based tests at ages 60 and 65, or three consecutive negative cytology results, to ensure adequate screening before exit.
The American Cancer Society (ACS) has released updated cervical cancer screening guidelines for average-risk women and individuals with a cervix, incorporating self-collection of vaginal specimens for human papillomavirus (HPV) testing and new criteria for screening discontinuation. The revised recommendations, published in CA: A Cancer Journal for Clinicians, reflect expanded evidence on HPV test performance and the recent authorization of self-collection devices in the United States.1,2
“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” said Robert Smith, PhD, senior vice president of early cancer detection science at ACS and senior author of the report. “They are made possible as we continue to evolve our approach to screening for cervical cancer, primarily through research advancements, and the development of self-collection tools to broaden access to screening.”
Screening initiation and intervals
ACS continues to recommend initiating cervical cancer screening at age 25 and performing primary HPV testing every 5 years through age 65, with co-testing or cytology-alone testing acceptable when primary HPV testing is unavailable. This guidance remains consistent with prior ACS recommendations and is grounded in long-term data showing the high sensitivity of HPV testing for detecting cervical precancer.
Self-collection as an acceptable option
For the first time, the guideline designates self-collected vaginal specimens as an acceptable method for primary HPV screening among average-risk individuals aged 25 to 65 years. Clinician-collected cervical specimens remain the preferred method because they allow simultaneous cytology or dual-stain testing for triage of HPV-positive results. However, evidence reviewed by ACS and the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee supports the analytical performance of self-collected samples. Studies summarized in the guideline show that polymerase chain reaction–based HPV testing of self-collected specimens demonstrates sensitivity and specificity comparable to clinician-collected cervical samples.
The ACS report notes that self-collection may help overcome barriers to screening, particularly among individuals who are underscreened, live in rural areas, or face logistical or cultural barriers to clinic-based examinations. This aligns with comments from the American Cancer Society Cancer Action Network (ACS CAN). “Geographic disparities continue to exist in cervical cancer incidence and mortality, with individuals living in rural areas more likely to be diagnosed with later-stage cervical cancer,” said Lisa Lacasse, president of ACS CAN. “Self-collection options are a critical resource for these individuals and other underserved populations.”
For individuals who test HPV-negative on a self-collected vaginal specimen, ACS endorses repeating HPV testing in 3 years, rather than the 5-year interval used for clinician-collected primary HPV testing. Limited long-term US data on self-collection informed this more conservative interval.
Updated guidance for screening exit
The guideline clarifies the criteria for safely discontinuing cervical cancer screening after age 65. ACS now recommends that average-risk individuals have negative primary HPV tests or negative co-tests at both ages 60 and 65 before exiting screening. Alternatively, three consecutive negative cytology results, with the last at age 65, meet the criteria when HPV testing is not available.
The revised language is intended to simplify clinical implementation, as prior exit criteria requiring a 10-year retrospective evaluation have been difficult to apply in practice. The ACS notes that inadequate screening before age 65 contributes to persistent cervical cancer incidence and higher mortality in older women.
Patients with a history of cervical precancer, cervical cancer, immunosuppression, or in utero diethylstilbestrol exposure should continue screening beyond age 65.
Ongoing research and implementation needs
Self-collection options now approved by the US Food and Drug Administration include combinations of HPV assays and collection devices used in clinical settings, while at-home collection methods are emerging and remain under evaluation. The guideline highlights ongoing US-based trials, including the National Cancer Institute–sponsored SHIP study, which aims to assess accuracy and real-world implementation.
“In addition to funding research to help reduce the risk of cervical cancer, ACS established the National Roundtable on Cervical Cancer (ACS NRTCC) in late 2022,” Smith said. “The ACS NRTCC is a coordinated effort with the mission to accelerate the elimination of cervical cancer primarily by improving prevention and screening uptake and addressing health disparities.”
References
- American Cancer Society. American Cancer Society Updates Cervical Cancer Screening Guideline: Major Changes Include Self-Collection for HPV Testing and Guidance on Exiting Screening. Newswire. December 4, 2025. Accessed December 5, 2025. https://www.newswise.com/articles/american-cancer-society-updates-cervical-cancer-screening-guideline-major-changes-include-self-collection-for-hpv-testing-and-guidance-on-exiting-screening/?sc=mwhr&xy=10069075
- Wentzensen N, Baena A. Human papillomavirus self‐collection: The long road from scientific evaluation to implementation in screening programs. CA: A Cancer Journal for Clinicians. 2025;76(1). doi:https://doi.org/10.3322/caac.70047
