Updated cervical cancer screening guidelines from the American Cancer Society (ACS) introduce several clinically meaningful changes aimed at improving screening uptake, refining risk stratification, and reducing cervical cancer incidence, particularly in older adults. Key updates include the integration of self-collected HPV testing, clearer guidance on screening initiation and cessation, and continued emphasis on HPV vaccination as a cornerstone of prevention.

“These updated ACS recommendations will improve patient care primarily by expanding access through self-collection options and clarifying screening exit criteria, which may help reduce cancers diagnosed in older patients,” says Ryan M. Kahn, M.D., gynecologic oncologist at Baptist Health Miami Cancer Institute.

Self-Collected HPV Testing: Expanding Screening Access

One of the most notable updates is the endorsement of self-collected vaginal specimens for primary HPV testing as an acceptable alternative to clinician-collected samples for average-risk individuals ages 25 to 65.

From a population health perspective, this change addresses persistent barriers to screening adherence. “Many individuals remain under-screened due to logistical barriers, discomfort with pelvic exams or limited access to care,” Dr. Kahn explains. “Self-collection—whether performed at home or in a clinical setting using FDA-approved devices—has the potential to close those gaps.”

While clinician-collected samples remain the preferred method, self-collection provides a pragmatic option for increasing screening coverage among historically underserved or reluctant populations.

Patient Selection and Screening Intervals

Self-collection is not appropriate for all patients. According to Dr. Kahn, appropriate candidates include individuals who:

• Have a cervix
• Are asymptomatic, without abnormal bleeding or other concerning signs
• Are undergoing routine screening and have a history of normal results

Importantly, screening intervals differ by collection method. “Self-collected HPV testing requires repeat screening every three years,” Dr. Kahn notes. “Clinician-collected samples allow for a five-year interval and remain the preferred approach when feasible.”

Understanding and communicating these distinctions will be essential for clinicians integrating self-collection into practice workflows.

Updated Age Parameters for Screening Initiation and Cessation

The ACS guidelines now recommend initiating screening at age 25 for average-risk individuals with a cervix. Thomas P. Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute at Boca Raton Regional Hospital, notes that this change is supported by evidence showing reduced harm without compromising cancer prevention.

“Delaying initiation until age 25 decreases false-positive results and unnecessary diagnostic procedures in younger patients,” Dr. Morrissey says.

Equally significant is the clarification around when screening may be safely discontinued. Historically, inconsistent application of exit criteria has contributed to a disproportionate burden of cervical cancer diagnoses in patients older than 65.

The revised guidelines specify that individuals must have documented negative HPV tests at both age 60 and age 65 before discontinuing screening. “This two-step confirmation addresses prior gaps in implementation and directly targets the elevated cancer rates we continue to see in older adults,” Dr. Morrissey explains.

HPV Vaccination Remains Central to Prevention

Despite advances in screening, both physicians emphasize that vaccination remains the most effective strategy for reducing cervical cancer incidence.

“The HPV vaccine saves lives,” Dr. Kahn says. “We’ve already observed substantial declines in HPV-associated cervical cancers in vaccinated populations.”

HPV remains the etiologic agent in the majority of cervical cancers. Current CDC recommendations call for routine vaccination at ages 11–12, with initiation as early as age 9 and catch-up vaccination through age 26 for those not previously immunized.

“Vaccination at ages 9 to 12 has the potential to prevent more than 90 percent of cervical precancers and cancers,” Dr. Kahn adds. “At a population level, this represents one of the most effective cancer prevention strategies we have.”

Aligning Prevention and Screening for Long-Term Impact

By pairing widespread HPV vaccination with more flexible, evidence-based screening strategies, the updated ACS guidelines offer clinicians a clearer framework for reducing cervical cancer morbidity and mortality.

For physicians, the challenge—and opportunity—lies in applying these recommendations consistently, educating patients appropriately, and leveraging new tools to reach those who remain unscreened.