From the Guidelines
The recommended age to start testing for HPV is 25 years old for individuals with a cervix, with testing continuing until age 65, as stated in the 2020 guideline update from the American Cancer Society 1. This is typically done through cervical cancer screening, which may include HPV testing alone or in combination with a Pap test (co-testing).
- The American Cancer Society recommends primary HPV testing every 5 years as the preferred screening strategy for all individuals being screened, replacing the recommendation for cytology testing alone 1.
- The later starting age (compared to previous guidelines that recommended beginning at 21) reflects our understanding that most HPV infections in younger women clear naturally without causing cancer, and that cervical cancer is rare before age 25 1.
- The body's immune system often eliminates HPV infections without treatment, particularly in younger individuals.
- If you have specific risk factors such as HIV infection, immunosuppression, or previous abnormal results, your healthcare provider may recommend a different screening schedule. The evidence suggests that starting screening at age 25 years with primary HPV testing applies to both vaccinated and unvaccinated women, based on the evidence of superior sensitivity and negative predictive value of HPV testing, the very low disease burden at young ages in unvaccinated and vaccinated women, and the overall balance of benefits and harms 1.
From the Research
HPV Testing Age Recommendations
- The ideal age to start testing for HPV is not explicitly stated in the provided studies, but they do offer insights into the performance of HPV testing in different age groups 2, 3, 4.
- A study from 2015 found that HPV testing with individual HPV-16/HPV-18 genotyping had similar accuracy to cytology for the detection of CIN2+ in women aged 25-55, with increased specificity in older women (≥30) compared to younger ones (25-29) 3.
- Another study from 2019 reported that HPV testing with 16,18, and 45 genotyping stratifies cancer risk for women with normal cytology, with the highest prevalence of HPV 16 found in women aged 30 or older 4.
- However, there is no clear consensus on the exact age to start testing for HPV, and more research may be needed to determine the optimal age for screening.
Age-Related HPV Prevalence and Risk
- A study from 2018 found that women with HPV-18 only were more likely to be aged at least 45 years than women with HPV-16 only, suggesting that the prevalence of different HPV types may vary with age 5.
- The same study reported that high-grade squamous intraepithelial lesions were detected more frequently in the HPV-16 only group, but this did not influence the rate of invasive cervical cancer when compared to women in the HPV-18 only group 5.
- A study from 2015 reported that the overall prevalence of HR-HPV was 12.7%, with HPV-16 and HPV-18 prevalence of 2.7% and 1.4%, respectively, in a population of Greek women aged 25-55 3.
Screening Recommendations
- The studies suggest that HPV testing, either alone or in combination with cytology, can be an effective method for primary cervical cancer screening in women aged 25-55 2, 3, 4.
- However, the optimal age to start testing for HPV and the frequency of screening are not clearly established and may depend on various factors, including individual risk factors and guidelines from health organizations.