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ACS Updates Cervical Cancer Screening Guidelines to Start Screening at Age 25

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The American Cancer Society (ACS) has updated its guidelines for cervical cancer screening. The new guidelines are for people with a cervix with an average risk of cervical cancer.

For people aged 25 to 65 years, the preferred screening recommendation is to get a primary human papillomavirus (HPV) test every 5 years. A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration (FDA) has approved certain tests to be primary tests.

Because these  HPV tests may not be widely available in the US yet, the guidelines include these two other acceptable screening methods and schedules.


  • A pap test alone every 3 years.

The most important thing to remember is to get screened regularly, no matter which test you get.

The 2020 guidelines also recommend that people older than age 65 with a cervix stop being screened as long as they’ve had 10 years of regular screening with normal results. Otherwise, they should continue to be screened until they do.

Those who have had their cervix removed, such as from a hysterectomy, don’t need screening as long as the surgery was done for reasons not related to cervical cancer or serious pre-cancer.

People who have gotten the HPV vaccine should still follow the screening guidelines as listed above.

The full, updated guideline was published online July 30, 2020 in CA: Cancer Journal for Clinicians. The journal also has a patient page.

How cervical cancer starts and how to find it early

The cervix connects the uterus to the vagina. It’s part of the path babies pass through during birth. Cancer that starts in the cells of the cervix is called cervical cancer.

Almost all cervical cancers are caused by an HPV infection. Most people will never know they have HPV because the body can usually fight the infection before any symptoms occur. But high-risk types of HPV (such as HPV 16 and HPV 18) can cause serious pre-cancers and cancers of the cervix.

The goal of cervical cancer screening is to find pre-cancers that are likely to progress to cancer and to remove or treat them before they do. Screening can also find cervical cancer at an early stage, when it is easier to treat.

Both types of screening tests, the HPV and Pap tests, require a small sample of cells from the cervix. A healthcare provider collects these by using a special, small tool to gently scrape or brush the cervix. The same set of cells is used for both tests.

  • The Pap test looks for changes in the cells that might be pre-cancer or cancer.
  • The HPV test looks in the cells for infection by high-risk types of HPV that are most likely to cause pre-cancer or cancer.

Although all the screening tests are good at finding cancer and pre-cancer, primary HPV testing is better at finding them than a Pap test done alone. Plus, primary HPV testing does not lead to more follow-up tests for abnormal areas that turn out to not to be pre-cancer.

In the US, the expectation is that over time fewer people will have a co-test or Pap test alone as the primary HPV test become more widely available.

“When we combine improved HPV vaccination rates with the screening and treatment of pre-cancers in the cervix, we have the potential to make history by eliminating cervical cancer," said Debbie Saslow, PhD, a co-author of the 2020 ACS updated guideline. 

How do you know if you’re at average risk for developing cervical cancer?

It’s a good idea to talk with your healthcare provider about your risk for cervical cancer and the screening guidelines that will protect you best. These updated screening guidelines are only for people at average risk.

You are at average risk if you don’t have any symptoms of cervical cancer and any of these is true.

  • It’s the first time you’re getting screened.
  • Your results have been normal every time you’ve been screened before.
  • You had an abnormal result checked and your healthcare provider told you that you could follow the screening schedule for people at average risk.   

You need to talk to your healthcare provider and follow different guidelines if either or both of these are true.

  • You’ve had pre-cancer or cancer of the cervix in the past.
  • You have a weakened immune system. This includes, for example, people who have human immunodeficiency virus (HIV) or had an organ transplant or stem cell transplant. It also includes people whose mothers took diethylstilbestrol (DES) when she was pregnant with them. 

If you have an abnormal cervical screening test result

Discuss your results carefully with your healthcare provider because there are many different follow-up schedules, tests, and treatment options depending on your specific risk of developing cervical cancer.

Don’t wait to see a doctor if you have problems between screenings. See a doctor right away if you have symptoms of cervical cancer—don’t wait to be screened. These symptoms include unusual bleeding or discharge from the vagina or pain during sex.

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