Barbara Levy, MD, reacts to HRSA's updated cervical cancer guidelines

Earlier this month, the Health Resources and Services Administration (HRSA) finalized updated cervical cancer screening guidelines that expand screening options and clarify insurance coverage requirements for follow-up testing, according to a recent agency announcement and a detailed notice published in the Federal Register. The updates designate high-risk human papillomavirus (hrHPV) testing as the preferred screening method for most average-risk women aged 30 to 65 years and formally introduce patient self-collection as an appropriate screening option.^1,2

The revised HRSA-supported Women’s Preventive Services Guidelines reflect a multiyear evidence review conducted through the Women’s Preventive Services Initiative, a HRSA-funded cooperative agreement that convenes expert clinicians and researchers to assess emerging data and recommend updates to preventive care guidance. Under the final recommendation, women aged 21 to 29 years should continue cervical cytology (Pap testing) every 3 years, while women aged 30 to 65 years should undergo primary hrHPV testing every 5 years as the preferred approach. Co-testing with cytology and hrHPV every 5 years remains an acceptable alternative, and cytology alone every 3 years is recommended only when hrHPV testing is unavailable.

Barbara Levy, MD, FACOG, FACS, clinical professor of obstetrics and gynecology at George Washington University School of Medicine and chief medical officer of Visana Health, said the guideline updates reflect decades of scientific understanding that have been slow to fully translate into practice.

“We have known that cervical cancer is caused by certain types of the human papillomavirus since the 1980s,” Levy said. “Testing for human papillomavirus and the high-risk types really is more sensitive and specific for what we’re trying to do.”

Levy explained that cytology-based screening identifies cellular changes without determining their cause, whereas hrHPV testing directly detects the virus responsible for cervical cancer. “Scraping the cells and looking at the way they look under the microscope gives us a way that the body’s responding to something, but we don’t know what,” she said. “This is a much, much more specific test.”

The updated guideline also supports longer screening intervals, recommending hrHPV testing every 5 years for average-risk women. According to Levy, this change reflects both the sensitivity of hrHPV testing and the slow progression of cervical cancer. “What we really want to capture is the ones that are persistent, because those are the ones that are at risk,” she said.

Still, Levy acknowledged that extending screening intervals may be uncomfortable for clinicians and patients long accustomed to annual Pap testing. “We trained the public really well to say that you’ve got to go in every year to prevent cervical cancer,” she said. “So we’ve got a lot of work to do to help people understand both the sensitivity of the virus test and the cadence of how often it really needs to be done.”

In addition to screening modality changes, the updated HRSA guideline clarifies that additional testing required to complete the screening process—including cytology, biopsy, colposcopy, extended genotyping, dual stain testing, and pathologic evaluation—must be covered without cost sharing by most non-grandfathered health plans. HRSA emphasized that this applies whether the initial sample is collected by a clinician or by the patient, with coverage requirements taking effect January 1, 2027.

References:

1. Update to the women’s preventive services guidelines. Health Resources & Services Administration. Federal Register. Published January 5, 2026. Accessed January 13, 2026. https://www.federalregister.gov/documents/2026/01/05/2025-24235/update-to-the-womens-preventive-services-guidelines
2. Fitch J. HRSA updates cervical cancer screening guidelines. Contemporary OB/GYN. Published January 13, 2026. Accessed January 20, 2026. https://www.contemporaryobgyn.net/view/hrsa-updates-cervical-cancer-screening-guidelines