SearchNewsletter
All guidelines

Cervical cancer screening

4 recommendations USPSTF 2018 · ACS 2025 · ASCCP (multisociety consensus) 2020 · ASCCP (enduring guidelines) 2025 Updated Sept. 25, 2026

Recommendations

ACS2025

Start at 25. Preferred: primary HPV test on a clinician-collected sample every 5 years through 65. A self-collected vaginal HPV test is acceptable, repeated every 3 years after a negative result. Co-testing every 5 years or cytology every 3 years if primary HPV is unavailable. To stop at 65, need negative primary HPV tests (or co-tests) at 60 and 65, or 3 consecutive negative Paps with the last at 65.

Verify at ACS (opens in a new tab)

ASCCP (multisociety consensus)2020

Manage abnormal results by overall risk: if the immediate risk of CIN 3+ is 4% or higher, go to colposcopy or treatment; if lower, repeat testing in 1, 3, or 5 years based on 5-year risk (ASCCP risk tables). Expedited treatment without biopsy is preferred for nonpregnant patients 25+ with HPV 16-positive HSIL cytology. After treatment of CIN 2, CIN 3, or AIS: HPV-based test at 6 months, then yearly until 3 negatives, then every 3 years for at least 25 years, even past 65.

Verify at ASCCP (multisociety consensus) (opens in a new tab)

ASCCP (enduring guidelines)2025

Self-collected vaginal HPV samples are acceptable for primary screening of asymptomatic average-risk patients (clinician-collected preferred); after a negative self-collected test, repeat in 3 years. If positive for HPV 16 or 18, go to colposcopy; if positive only for other high-risk types, triage with clinician-collected cytology or dual stain; HPV 56/59/66 alone, repeat HPV in 1 year. Use clinician-collected samples for surveillance after abnormal results or treatment.

Verify at ASCCP (enduring guidelines) (opens in a new tab)

Who this applies to

  • Under 21: no screening. Ages 21 to 29: cytology every 3 years (USPSTF 2018, Grade A). The American Cancer Society starts at 25 with a primary HPV test.
  • Ages 30 to 65: primary high-risk HPV testing every 5 years, co-testing every 5 years, or cytology every 3 years (USPSTF). The ACS prefers primary HPV every 5 years.
  • Over 65: stop after adequate negative prior screening and no CIN2 or worse in the past 25 years. USPSTF: three consecutive negative cytology results or two consecutive negative co-tests within 10 years, the most recent within 5. ACS (2025): negative HPV tests or co-tests at 60 and 65, or three consecutive negative Paps with the last at 65.
  • After a total hysterectomy for benign disease with the cervix removed: stop.
  • Routine intervals do not apply to people with HIV, immunosuppression, in-utero DES exposure, or prior CIN2 or worse, who continue for 25 years after treatment.

How it is done in practice

  • Primary HPV screening requires an FDA-approved primary screening assay. Self-collected vaginal HPV sampling was FDA-approved in 2024 for health-care settings and in 2025 for home collection. The ACS and ASCCP accept it for average-risk patients, repeated every 3 years after a negative result (clinician-collected every 5). The USPSTF issued a draft in late 2024 adding self-collection for ages 30 to 65; its 2018 statement is still the final one, so check the link for its status.
  • Manage abnormal results with the ASCCP 2019 risk-based tables (the app), which combine the current result with history to choose colposcopy, a 1-year, 3-year or 5-year return.
  • HPV 16 or 18 positive goes straight to colposcopy; other high-risk types reflex to cytology.
  • HPV vaccination does not change the screening interval yet.

What changed recently

The ACS moved the start to 25 and to primary HPV testing in 2020, then added self-collection and clearer exit rules in 2025. The USPSTF 2018 statement remains the standard that insurers anchor to. Exiting screening correctly at 65 is where most practices still over-test.

Points that matter in clinic

  • A new partner, HPV vaccination or a patient request is not a reason to screen early. Annual Paps are obsolete.
  • A pelvic exam and cervical screening are separate decisions; a bimanual exam is not a screening test.
  • Prior CIN2, CIN3 or adenocarcinoma in situ means 25 years of surveillance, even past 65.

More quick references