Cervical Cancer Screening Guidelines
Primary Screening Recommendation
For women aged 30-65 years, primary HPV testing alone every 5 years is the preferred screening strategy, with cotesting every 5 years or cytology alone every 3 years as acceptable alternatives. 1, 2
Age-Specific Screening Algorithm
Women Under Age 21
- Do not screen, regardless of sexual history or other risk factors 2
- Screening this age group leads to unnecessary interventions for lesions that would likely regress spontaneously 2
Women Ages 21-29 Years
- Screen every 3 years with cervical cytology alone 2, 3
- Do not use HPV testing (primary or cotesting) in this age group 2
- Annual screening is not recommended and provides minimal additional benefit while substantially increasing harms from false positives 1, 2
Women Ages 30-65 Years
Preferred approach:
Acceptable alternatives:
The American Cancer Society notes that cotesting and cytology alone will not be included in future guidelines as the U.S. transitions to primary HPV testing, reflecting superior performance in vaccinated populations 1
Women Over Age 65
- Discontinue screening if adequate prior screening with negative results is documented and the woman is not otherwise at high risk 2, 3
- Continue screening if adequate prior screening has not been documented 2
- Failure to discontinue screening in adequately screened women exposes them to unnecessary procedures 2
Special Populations
Post-Hysterectomy
- Do not screen women who have had a hysterectomy with cervix removal and no history of CIN2+ in the past 25 years or cervical cancer ever 1, 2, 3
HPV-Vaccinated Women
- Follow the same age-specific screening recommendations as unvaccinated women 1, 2
- Vaccination does not eliminate screening need because vaccines do not cover all oncogenic HPV types 1
High-Risk Women
Women with the following conditions require continued screening beyond age 65:
Management of Abnormal Results
Immediate Colposcopy Indicated For:
- HSIL (high-grade squamous intraepithelial lesion) 1, 2
- HPV-positive HSIL 1, 2
- HPV-positive ASC-H (atypical squamous cells, cannot exclude HSIL) 1, 2
- Atypical glandular cells (AGC) 1, 2
Risk-Based Management
- All abnormal screening results should be managed according to the 2020 ASCCP Risk-Based Management Consensus Guidelines 1, 2
Critical Pitfalls to Avoid
Never Screen More Frequently Than Recommended Intervals
- Annual screening is not recommended for any age group 1, 2
- More frequent screening provides minimal additional benefit while substantially increasing harms from false positives and unnecessary procedures 1, 2
Do Not Screen Women Under Age 21
- This leads to overtreatment of lesions that would spontaneously regress 2
Do Not Continue Screening Beyond Age 65 in Adequately Screened Women
Ensure Adequate Screening Before Age 65
- A substantial proportion of women (18.4% of those aged 61-65) are not recently screened and approach the stopping age without adequate prior screening history 5
- Special attention is needed for recent immigrants, uninsured women, and women without a usual source of healthcare, who have lower odds of being up to date 6