Cervical cancer screening can now include “self-swab” HPV testing, according to updated guidelines released Thursday by the American Cancer Society.
Experts hope the change will encourage more women to undergo regular cancer screenings, giving them an alternative to speculum examination.
The HPV test, or human papillomavirus, has supplanted the Pap test as the preferred method of cervical cancer screening. Pap tests (also called cytology) involve collecting cells from a patient’s cervix during a pelvic exam, a process that some women find uncomfortable and even painful.
“HPV is such a strong predictor of cervical cancer that we now know that screening for HPV is screening for cervical cancer. This gives women more options,” said Jane Montealegre, an associate professor of behavioral sciences at the University of Texas MD Anderson Cancer Center in Houston, who was not involved in the updated guidelines.
HPV testing typically uses a similar approach to the Pap test, using cells taken from the cervix. However, as of 2024, the Food and Drug Administration has approved three self-administered HPV tests, including one that can be done at home.
Cervical cancer rates have been steadily declining in the United States since the 1970s, largely due to better screening and widespread use of the HPV vaccine since its approval in 2006. There are 40 different types of HPV that can infect the genitals, 13 of which cause almost all cervical cancers. HPV testing focuses on high-risk strains.
Despite falling cervical cancer rates, more than 20% of American women are not up to date with screening, an open-label JAMA Network study found. Self-administered tests allow patients to collect their own sample using a vaginal swab in a doctor’s office. One of the FDA-approved tests allows women to use the swab at home and mail it to a lab for testing.
Self-administered tests allow patients to collect their own sample using a vaginal swab in a doctor’s office. One of the FDA-approved tests allows women to use the swab at home and mail it to a lab for testing.
“A woman was given a kit and could go somewhere, whether it was the exam room or the bathroom, and collect her own sample,” said Robert Smith, an oncologic epidemiologist and senior vice president of cancer early detection science at the American Cancer Society. Smith was the lead author of the update.
Both the American Cancer Society and the U.S. Preventive Services Task Force (a group of independent doctors, nurses, and public health experts who regularly review the latest scientific research and issue recommendations for everything from diabetes to cancer screening) recommend that women be screened for cervical cancer through HPV testing every five years. If the test is positive, a doctor will follow up with additional tests.
Both groups also say that patients can be screened with a Pap smear and a speculum exam every 3 years, or by using both methods every 5 years.
Where the two groups differ is when they should start screening: The American Cancer Society recommends that women begin this screening regimen at age 25 and not have screening before that age. The task force, whose recommendations influence which screening tests will be covered by insurance, recommends starting the HPV screening program at age 30 and screening with cytology alone every 3 years between ages 21 and 29.
Montealegre said he doesn’t expect the working group to change its position on the matter; however, it is expected to update its HPV screening guidelines to include self-administered testing.
Cervical cancer screening is covered by the Affordable Care Act, and Montealegre said self-administered tests, at least those performed at a health clinic, will likely be covered by insurance.
“The USPSTF already recommends primary HPV testing, so it’s already covered by insurance, and they don’t specify how it should be collected,” he said.
Both organizations recommending HPV testing as the primary way to screen for cervical cancer “indicates that there is growing agreement that it is the gold standard,” Smith said.
“We’ve known for years that primary HPV testing is much more efficient; now we’re doing self-sampling to allow better access,” said Dr. Diane Harper, professor of obstetrics, gynecology and family medicine at the University of Michigan.
The American Cancer Society update also included clarification about when a woman can stop getting screened for cervical cancer. Previously, both the group and the task force recommended screening up to age 65. The updated guidelines clarify that this should be the case only if a woman has undergone consistent screening, with negative results, for at least a decade.
“Despite clear recommendations about the importance of women being up to date with their screening until age 65, very few women are,” Smith said. “It’s important for women to understand that there is a registry that they will want to have when they turn 65 that will basically tell them that it is safe to stop getting screened for cervical cancer.”
Harper, who was not involved in writing the new guidelines, expects that in the coming years, cervical cancer screening will likely be performed at even longer intervals.
“We have data now showing that in a highly vaccinated population, screening can be done every 10 years, but in the United States we are lagging behind,” he said.
