Cervical Cancer Screening for Individuals at Average Risk

Publication Date: July 30, 2020
Last Updated: March 14, 2022


The ACS recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary HPV testing every 5 years through age 65 years (preferred). If primary HPV testing is not available, individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation)

Cotesting or cytology‐alone testing are acceptable options for cervical cancer screening because access to an FDA‐approved primary HPV test may be limited in some settings. As the United States makes the transition to primary HPV testing, the use of both cotesting and cytology for cervical cancer screening will not be included in future guidelines.


When to Stop Cervical Cancer Screening

The ACS recommends that individuals with a cervix who are older than age 65 years, who have no history of CIN2+ within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years discontinue cervical cancer screening with any modality (qualified recommendation).
  • Adequate negative prior screening is currently defined as 2 consecutive negative HPV tests, or 2 consecutive negative cotests, or 3 consecutive negative cytology tests within the past 10 years, with the most recent test occurring within the recommended interval for the test used. These criteria do not apply to individuals who are currently under surveillance for abnormal screening results.
  • Individuals aged >65 years without conditions limiting life expectancy for whom sufficient documentation of prior screening is not available should be screened until cessation criteria are met.
  • Cervical cancer screening may be discontinued in individuals of any age with limited life expectancy.

Recommendation Grading




Cervical Cancer Screening for Individuals at Average Risk

Authoring Organization

Publication Month/Year

July 30, 2020

Last Updated Month/Year

July 10, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Social worker, physician, nurse, nurse practitioner, physician assistant


Assessment and screening

Diseases/Conditions (MeSH)

D002583 - Uterine Cervical Neoplasms, D008403 - Mass Screening


guideline, Cervical cancer screening, cervical neoplasms, cervix neoplasms, mass screening, prevention and control

Source Citation

Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 Sep;70(5):321-346. doi: 10.3322/caac.21628. Epub 2020 Jul 30. PMID: 32729638.

Supplemental Methodology Resources

Data Supplement