The American Cancer Society released revised cervical cancer screening guidelines December 4, 2025, introducing self-collection of vaginal samples for HPV testing as an approved option and providing clearer criteria for when average-risk individuals can safely stop routine screening.
The changes, published in CA: A Cancer Journal for Clinicians, apply to women and people with a cervix who are at average risk. Primary HPV testing remains the preferred method starting at age 25 and continuing every five years through age 65.
When primary HPV testing is unavailable, the ACS recommends co-testing (HPV test plus Pap cytology) every five years or Pap cytology alone every three years for the same age group.
The most significant update allows self-collected vaginal samples for primary HPV testing in a health care setting. Samples that test negative for HPV require repeat testing in three years rather than five, aligning with follow-up protocols for clinician-collected specimens.
For exiting screening, individuals at average risk may discontinue after age 65 if they have two consecutive negative primary HPV tests or negative co-tests at ages 60 and 65. When only cytology has been performed, three consecutive negative Pap tests with the most recent at age 65 meet exit criteria.
“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” said Dr. Robert Smith, ACS senior vice president for early cancer detection science and senior author of the report. “They are made possible as we continue to evolve our approach to screening for cervical cancer, primarily through research advancements, and the development of self-collection tools to broaden access to screening.”
Cervical cancer incidence has fallen more than 50 percent since widespread screening began in the mid-1970s, yet an estimated 13,360 new cases and 4,320 deaths are projected nationwide in 2025. Disparities persist along racial, ethnic, and socioeconomic lines, with rural residents facing higher rates of late-stage diagnosis.
The Food and Drug Administration approved HPV self-collection kits earlier this year, paving the way for the guideline change. Self-collection must occur in a health care facility under clinical oversight; mail-in home kits are not currently part of the recommendation.
Screening is not recommended for individuals younger than 25, those older than 65 with adequate prior negative tests and no high-risk history, or anyone who has undergone hysterectomy with cervical removal absent a history of high-grade precancerous lesions.
Southern Maryland health providers note that self-collection could benefit patients in Calvert, Charles, and St. Mary’s counties where travel distance to obstetric-gynecologic care remains a barrier for some residents. MedStar St. Mary’s Hospital in Leonardtown and CalvertHealth Medical Center in Prince Frederick already offer primary HPV testing, with staff preparing to implement self-collection protocols once commercially available kits reach local laboratories.
The ACS National Roundtable on Cervical Cancer, launched in 2022, coordinates efforts to boost vaccination rates, screening uptake, and follow-up care while addressing equity gaps.
“Geographic disparities continue to exist in cervical cancer incidence and mortality, with individuals living in rural areas more likely to be diagnosed with later-stage cervical cancer,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network. “Self-collection options are a critical resource for these individuals and other underserved populations.”
The advocacy arm, ACS CAN, supports legislation to eliminate out-of-pocket costs for screening and diagnostic follow-up under the Affordable Care Act framework.
Maryland’s statewide cervical cancer screening program through the Department of Health continues to provide free or low-cost services for uninsured and underinsured residents, including those in the tri-county area.
