New HRSA guidelines strengthen cervical cancer prevention by adding self-collected hrHPV testing and clarifying no-cost coverage for additional diagnostic services.
Earlier this month, the Health Resources and Services Administration (HRSA) finalized updated cervical cancer screening guidelines that expand options and strengthen insurance coverage requirements for follow-up testing, according to a recent agency announcement and a detailed notice published in the Federal Register.1,2
The updated HRSA-supported Women’s Preventive Services Guidelines introduce patient self-collection as an option for cervical cancer screening and designate high-risk human papillomavirus (hrHPV) testing as the preferred screening method for most average-risk women aged 30 to 65 years. The changes follow a multiyear evidence review process conducted through the Women’s Preventive Services Initiative (WPSI), a HRSA-funded cooperative agreement that convenes expert clinicians and researchers to evaluate emerging data and recommend updates to preventive care guidance.
“The Women's Preventive Services Initiative recommends cervical cancer screening for average-risk women aged 21 to 65 years. For women aged 21 to 29 years, cervical cancer screening using cervical cytology (Pap test) every 3 years is recommended. Co-testing with cytology and human papillomavirus (hrHPV) testing is not recommended for women younger than 30 years. Women aged 30 to 65 years should be screened with primary hrHPV testing every 5 years (preferred) or cytology and hrHPV testing (co-testing) every 5 years. If hrHPV testing is not available, continue screening with cytology alone every 3 years. Women who are at average risk should not be screened more than once every 3 years. Patient-collected hrHPV testing is an appropriate method and should be offered as an option for cervical cancer screening in women aged 30 to 65 years at average risk. Additional testing may be required to complete the screening process and follow-up findings on the initial screening. If additional testing ( e.g., cytology, biopsy, colposcopy, extended genotyping, dual stain) and pathologic evaluation are indicated, these services also are recommended to complete the screening process for malignancies.”2
Under the updated guideline, average-risk women aged 30 to 65 years are now recommended to undergo primary hrHPV testing every five years as the preferred screening approach. Co-testing with cytology and hrHPV every 5 years remains an acceptable option, while cytology alone every 3 years is recommended only when hrHPV testing is not available. For women aged 21 to 29 years, the guideline continues to recommend cervical cytology (Pap testing) alone.1,2
A notable addition is the explicit inclusion of patient-collected hrHPV testing as an appropriate screening option for women aged 30 to 65 years at average risk. HRSA noted that this update reflects new evidence and recent regulatory developments supporting the effectiveness of self-collection, which has been shown to perform comparably to clinician-collected samples for detecting high-risk HPV.
“These updates represent a significant step forward in cervical cancer screening and will improve screening rates and save lives,” said HRSA Administrator Tom Engels. “By expanding screening options and removing cost barriers, we’re helping more women take an active role in protecting their health and their future.”1
According to a viewpoint article published in JAMA on January 5, 2026, authors Brian Christine, MD, Margaret Bush, MBA, BSN, RN, Anita Thurakal, MD, MPH, and Ann M. Sheehy, MD, MS concluded:
"Cervical cancer screening is highly effective at detecting precancerous and early-stage cancers for women who undergo recommended screening. Self-collection for hrHPV screening is an important and innovative breakthrough in the fight against cervical cancer and has the potential to increase screening rates and save lives. By reducing testing barriers, expanding choice, empowering women, and eliminating patient cost sharing, HRSA’s new Women’s Preventive Services guidelines for cervical cancer screening are a powerful step forward for women’s health across the US.”3
In addition to changes in screening modality, the updated guideline includes new language clarifying that additional testing needed to complete the cervical cancer screening process must also be covered by most insurance plans without cost sharing. This includes follow-up services such as cytology, biopsy, colposcopy, extended genotyping, dual stain testing, and related pathologic evaluation when clinically indicated.1,2
According to HRSA, this requirement applies regardless of whether the initial screening sample was collected by a clinician or by the patient. Non-grandfathered group health plans and health insurance issuers will be required to comply with the updated coverage provisions beginning January 1, 2027, under the preventive services requirements of the Affordable Care Act.
The guideline updates were proposed in October 2025 and underwent a public comment period, during which HRSA received 42 responses. After reviewing and considering these comments, the agency accepted the revised recommendations as detailed in the final notice. HRSA emphasized that the clinical recommendations are distinct from implementation considerations and research recommendations, which do not affect insurance coverage requirements.2
HRSA also highlighted that the updated guideline aligns with recent U.S. Food and Drug Administration approvals of self-collection tests in 2024 and 2025, as well as new cervical cancer screening guidance released by the American Cancer Society in December 2025.1
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