Several prominent, professional organizations have issued specific guidelines on cervical cancer screening. Guidelines presented by the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), American Society for Clinical Pathology (ASCP), the U.S. Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists (ACOG) address the time to start screening, the screening methods and intervals, the time to stop screening, and the use of the HPV test. An excellent comparative summary of these guidelines can be found at the CDC’s web portal.
A copy of the comparative guidelines from the CDC website are provided on this page. However, it is important to periodically check for updates as these guidelines may change.
Here is a summary of the recommendations that are currently included in the guidelines including the updated 2018 USPSTF recommendations:
When to begin cervical cancer screening
Most guidelines recommend screening with Pap test once a woman becomes sexually active, however women under age 21 should not be screened for cervical cancer.
Intervals for screening with Pap smear or liquid-based cytology
Most recommendations are to screen women ages 21 to 29 every 3 years using a Pap test or liquid based cytology. No co-testing with HPV test is recommended for this age group because typically HPV infection is common and is often cleared by the immune system.
HPV co-test
All organizations agree that HPV co-testing should not be used for women aged <30 years. However, in women aged 30-65 years, recommendation among the organizations provide for co-testing using HPV and Pap tests every five years as an option.
Use of HPV Test (hrHPV) as a primary screening method
Prior to 2018, no professional organization had recommended the use of HPV testing alone. They did recommend against screening for cervical cancer with HPV (alone or in combination with cytology) in women aged <30 years. However, the USPSTF in 2018 led the way in recommending the HPV test (hrHPV) as an option as the primary cervical cancer screening test for women ages 30-65. The USPSTF guidelines for this age group recommended three screening options; (1) a high-risk HPV (hrHPV) test every five years, or (2) a Pap test every three years, or (3) co-testing with both hrHPV and Pap test every five years.
Summary of the updated Cervical Cancer Screening Guidelines:
- Women under age 21 should not be screened for cervical cancer.
- Women ages 21-29 should undergo a Pap test or cytology screening every three years. HPV testing is not recommended for women 21-29 because HPV infection is common in this group and is often cleared by the immune system.
- Women ages 30-65 have three options: the hrHPV test every five years or a Pap test every three years, or co-testing with both hrHPV test and Pap test every five years.
- Women over age 65 do not need to be screened for cervical cancer if they are up to date on their screening, their tests in the previous 10 years were negative and they don't have other risk factors for cervical cancer.
It is important to note that these guidelines do not apply to women who have symptoms of cervical cancer, regardless of their sexual history. Nor do they apply to women who have previously been diagnosed with cervical cancer or with a high-grade precancerous lesion, or to women who have a condition that weakens their immune system, such as HIV.
