Self-collected HPV testing enters mainstream in updated cervical screening guidance

Clinical takeaway: Transition eligible patients to primary high-risk HPV testing every 5 years (ages 30–65), consider self-collected samples to improve screening uptake, and reserve cytology-based strategies for limited scenarios.

The Women’s Preventive Services Initiative (WPSI) has updated its cervical cancer screening recommendations, emphasizing a shift toward primary high-risk human papillomavirus (hrHPV) testing as the cornerstone of screening for average-risk individuals. The guidance, published in Obstetrics & Gynecology and endorsed by ACOG, reflects evolving evidence on HPV testing performance, longer screening intervals, and strategies to improve access and adherence.

For individuals aged 21–29, screening remains unchanged: cervical cytology (Pap test) alone every 3 years.

For those aged 30–65, the preferred approach is clinician-collected primary hrHPV testing every 5 years using FDA-approved assays. Co-testing (hrHPV plus cytology every 5 years) or cytology alone every 3 years are now considered secondary options, reserved for settings where primary hrHPV testing is not available or based on patient preference after counseling.

A notable addition is the option for patient-collected vaginal samples for hrHPV testing every 3 years, provided appropriate systems are in place for follow-up and result management—an effort to reduce barriers and improve equity in screening participation.

Screening cessation criteria continue to apply to individuals older than 65 with adequate prior screening and no high-risk factors, while those with higher risk (eg, immunosuppression, prior high-grade lesions) require individualized management.

What’s changed

• Primary hrHPV testing now clearly preferred over cytology or co-testing for ages 30–65
• Cytology-only and co-testing strategies downgraded to alternative (not routine) options
• Self-collected hrHPV testing introduced to expand access and improve adherence
• Greater emphasis on risk-based, age-stratified screening pathways

The updated recommendations reflect a broader shift toward HPV-driven screening, leveraging its higher sensitivity and enabling longer intervals between tests. They also aim to reduce unnecessary procedures and improve adherence by incorporating more flexible, patient-centered approaches.

For clinicians, the key action is to align practice workflows with hrHPV-first screening, ensure access to validated testing platforms (including self-collection where feasible), and counsel patients on the rationale for longer screening intervals.

ACOG President Steven J. Fleischman, MD, MBA, FACOG, said self-collected hrHPV testing “has the potential to expand access to screening for those who face barriers to in-office screening,” while emphasizing the need for systems that connect patients to follow-up care.

Source: Vosooney A, et al; Women's Preventive Services Initiative. (2026 July 1) Obstet Gynecol. Screening for Cervical Cancer: A Recommendation From the Women's Preventive Services Initiative