Barbara Levy, MD, on importance of public comments on new cervical cancer screening guidance

In another clip from an extended interview with Barbara Levy, MD, FACOG, FACS, clinical professor of obstetrics and gynecology at George Washington University School of Medicine and chief medical officer at Visana Health, Levy discussed some of the updated language in the new Health Resources and Services Administration (HRSA) cervical cancer screening guidelines.¹

In previous clips, Levy has discussed the updated guidance overall, including the largest changes and clinical implications, such as the patient-collected hrHPV testing, and much more.^2,3

In the video above, Levy noted that additional testing language that was updated in the January 2026 guidance to complete the cervical cancer screening process hasn’t changed much clinically.

“This really isn’t a change,” Levy said. “So if people tested previously positive with an abnormal cytology and a reflex test to high-risk HPV, they went to colposcopy and maybe biopsy, or maybe just a sooner repeat. But all of that cascade of testing really hasn’t changed that much.”

Levy noted that existing risk-based management tools already account for primary HPV testing. “ASCCP, which is the organization that does this incredibly wonderful app for all of us to make it simple for us to know what to do with these test results, have accounted for primary HPV testing for quite some time,” she said. “Those algorithms are already in existence.”

Instead, she said the greater hurdle is logistical. “The real challenge, I think… when we needed to see people every year and do the test every year, it was easy to keep track of it,” Levy said. “I think creating systems to track which patients need to be followed in a year, which patients need five-year follow-up.”

Patient understanding presents an additional barrier. “For patients, they mix up pelvic exam and Pap smear, or pelvic exam and cytology screening,” Levy said. “They feel like if they’ve had a pelvic exam, even in the ER for something, that they’ve had a Pap smear, and that’s not true. So we still have a lot of communication to do about what’s being accomplished at a visit.”

Levy framed evolving cervical cancer screening guidance as part of a broader shift toward patient-centered care. “I love the idea that we allow women to participate in the processes that affect us,” she said. “For decades, if not longer, we’ve been very authoritarian and hierarchical, telling women what they need to do without asking women what’s important to them.”

She emphasized that explaining the rationale behind screening intervals is essential. “It really is important for us to be able to explain to women the why,” Levy said. “Why are we doing this? Why is it every five years? Why is it not women who are younger than 30?”

According to Levy, HPV testing is not recommended for women aged 21 to 30 years because of high rates of transient infection. “That’s a time in life when people get exposed to a lot of human papillomavirus, and because it’s so transient, testing for HPV would result in a lot more of those downstream tests, when in fact, most people’s immune system is going to clear it,” she said. “So we don’t want to capture something that’s transient.”

The comments align with HRSA-supported Women’s Preventive Services Guidelines, designating high-risk HPV testing as the preferred screening method for most average-risk women aged 30 to 65 years, including the option of patient-collected testing. For Levy, these changes collectively underscore the importance of pairing evidence-based recommendations with systems that support follow-up and communication that patients can understand.

References:

1. New cervical cancer screening guidelines strengthen women’s preventive health. Health Resources & Services Administration. Press release. Published January 5, 2026. Accessed February 5, 2026. https://www.hrsa.gov/about/news/press-releases/new-cervical-cancer-screening-guidelines
2. Fitch, J. Barbara Levy, MD, reacts to HRSA's updated cervical cancer guidelines. Contemporary OB/GYN. Published January 20, 2026. Accessed February 5, 2026. https://www.contemporaryobgyn.net/view/barbara-levy-md-reacts-to-hrsa-s-updated-cervical-cancer-guidelines
3. Fitch J. Barbara Levy, MD: Patient-collected hrHPV testing is "huge" part of updated cervical cancer guideline. Contemporary OB/GYN. Published January 22, 2026. Accessed February 5, 2026. https://www.contemporaryobgyn.net/view/barbara-levy-md-patient-collected-hrhpv-testing-is-huge-part-of-updated-cervical-cancer-guideline