Cervical cancer screening now includes a “self-swab” HPV test, according to updated guidelines released Thursday by the American Cancer Society.
Experts hope the change will provide an alternative to speculum exams and encourage more women to get regular cancer screenings.
HPV (human papillomavirus) testing has replaced the Pap test as the preferred method of cervical cancer screening. A Pap test (also known as a Pap test) collects cells from a patient’s cervix during a pelvic exam, but some women find the process uncomfortable and even painful.
“We know that HPV is a strong indicator of cervical cancer, and screening for HPV is screening for cervical cancer. This gives women more options,” says Jane Montealegre, associate professor of behavioral sciences at the University of Texas MD Anderson Cancer Center in Houston.
HPV testing has typically used an approach similar to the Pap test, using cells taken from the cervix. But starting in 2024, the Food and Drug Administration has approved three self-administered HPV tests, including one that can be performed at home.
Cervical cancer incidence has steadily declined in the United States since the 1970s, thanks in large part to improved screening and widespread use of the HPV vaccine since its approval in 2006. There are 40 types of HPV that infect the genitals, and 13 of these are the cause of almost all cervical cancers. HPV testing focuses on high-risk strains.
Despite declining cervical cancer rates, more than 20% of American women do not have up-to-date screening, a JAMA Network Open study found. Self-administered testing allows patients to collect their own sample using a vaginal swab in the clinic. One FDA-approved test allows women to use a swab at home and mail it to a lab for analysis.
Self-administered testing allows patients to collect their own sample using a vaginal swab in the clinic. One FDA-approved test allows women to use a swab at home and mail it to a lab for analysis.
“Women are given a kit and can go to either a doctor’s office or a restroom and collect their sample,” said Robert Smith, a cancer epidemiologist and senior vice president of early cancer detection science at the American Cancer Society. Smith was the senior author of this update.
The American Cancer Society and the U.S. Preventive Services Task Force, a group of independent physicians, nurses, and public health experts who regularly review the latest scientific research and issue recommendations on everything from diabetes to cancer screening, both recommend that women screen for cervical cancer every five years using an HPV test. If the test result is positive, your doctor will perform additional tests.
The groups also say patients can be screened using a Pap test and speculum every three years or using both methods every five years.
Where the two groups differ is when screening should begin. The American Cancer Society recommends that women begin this screening program at age 25 and not be screened earlier. The task force, which influences which tests are covered by insurance, recommends starting an HPV testing schedule at age 30, with cytology-only testing every three years from ages 21 to 29.
Montealegre said he does not expect the task force to change its position on the matter, but that it is expected that the HPV screening guidelines will be updated to include self-testing.
Cervical cancer screenings are covered by the Affordable Care Act, and Montealegre said it’s likely that insurance will cover at least the self-examination done in a doctor’s office.
“Primary HPV testing is already recommended by the USPSTF, so it is already covered by insurance, but it does not specify how the test is collected,” she said.
Both organizations’ recommendation of HPV testing as the primary method of cervical cancer screening “demonstrates growing agreement that HPV testing is the gold standard,” Smith said.
“We’ve known for years that primary testing for HPV is much more efficient, but now we’re doing self-sampling to allow for better access,” said Dr. Diane Harper, professor of obstetrics and gynecology and family medicine at the University of Michigan.
The American Cancer Society’s update also includes clarification on when women can stop cervical cancer screening. Previously, both the group and the task force recommended screening up to age 65. The latest guidelines clarify that women should only be screened if they have been screened consistently for at least 10 years and have received negative results.
“Despite clear recommendations about the importance of women getting up-to-date testing up until the age of 65, very few do so,” Smith said. “It’s important for women to understand that there is a record that it is safe to stop getting cervical cancer screenings by the age of 65.”
Harper, who was not involved in drafting the new guidelines, predicts that cervical cancer screenings will likely be performed at longer intervals in the coming years.
“We currently have data showing that testing is possible every 10 years in highly vaccinated populations, but the U.S. is lagging behind,” she said.
