Dual Biopsy, Primary HPV Testing, and Self-Collection: ACOG's Updated Screening Guidance

Updated clinical guidance from the American College of Obstetricians & Gynecologists (ACOG) on 2 high-priority topics—postmenopausal bleeding evaluation and cervical cancer screening—was among the practice-changing content featured at the organization's Annual Clinical & Scientific Meeting. In the final segment of this program, Maryam Siddiqui, MD, vice chair for clinical affairs and section chief for general obstetrics and gynecology at the University of Chicago Medicine, and Katrina Lee, MD, an assistant professor of obstetrics and gynecology at the University of Chicago Medicine, review the key components of this updated guidance and discuss its implications for both clinical practice and patient access.

On the topic of postmenopausal bleeding, Siddiqui described a significant shift in recommended evaluation strategy. The longstanding practice of using endometrial thickness on transvaginal ultrasound as a triage tool—whereby a threshold of less than 4 mm was considered sufficient to defer endometrial biopsy—has been replaced by guidance recommending both biopsy and imaging. This change reflects evidence that biopsy alone can miss focal lesions whereas ultrasound may not detect early-stage cancers, and is supported by data indicating that foundational studies underlying the prior guidance were more than 2 decades old and largely derived from non-US populations. The updated approach is particularly timely given a documented increase in the incidence and mortality of endometrial cancer.

Regarding cervical cancer screening, Siddiqui and Lee discussed ACOG's updated guidance supporting primary HPV testing and self-collection as a patient-facing option—particularly for individuals who face barriers to traditional pelvic examinations or who do not regularly access gynecologic care. Both physicians expressed enthusiasm for the expanded access that self-collection could enable, including through primary care settings where routine gynecologic screening has historically been inconsistent. Lee noted the alignment of this guidance with the World Health Organization's goal of eliminating cervical cancer by 2030, and Siddiqui emphasized that infrastructure changes in laboratory and pathology settings will be necessary to support broad adoption of primary HPV testing at the institutional level.