January is Cervical Cancer Awareness Month, providing a valuable opportunity to increase awareness of cervical cancer and the importance of vaccination against human papillomavirus (HPV), the primary cause of cervical cancer. This year, the focus of Cervical Cancer Awareness Month is on emphasizing the significance of expanding access to HPV vaccines, regular screening, and cutting-edge treatment for early-stage cervical cancer. The ultimate goal is to significantly reduce the incidence of cervical cancer by 2030 and eradicate it as a public health concern by 2120.
The number of deaths from cervical cancer in the United States (US) has seen a significant decrease since the widespread implementation of cervical cancer screening, dropping from 2.8 per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015. The majority of cervical cancer cases occur in women who have not undergone adequate screening. Strategies aimed at ensuring all women receive appropriate screening and follow-up care are most likely to succeed in further reducing cervical cancer rates and mortality in the US.
This article, Guidelines Side-By-Side, presents a comprehensive comparison of the current clinical practice guidelines established by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS). By examining these recommendations, the goal of this article is to provide healthcare professionals with valuable insights and best practices for evaluating cervical cancer prevention. This evidence-based approach is intended to enhance health outcomes for individuals affected by this condition.
Titles of Comparison:
| Titles | Cervical Cancer: Screening -- Women aged 21 to 65 years | Cervical Cancer Screening for Individuals at Average Risk |
|---|---|---|
| Society | United States Preventive Services Task Force (USPSTF) | American Cancer Society (ACS) |
| Publication Date | August 21, 2018 | July 30, 2020 |
| Objective | To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer. | ACS recommends that individuals with a cervix follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from starting. |
| Target Population | This recommendation statement applies to all asymptomatic individuals with a cervix, regardless of their sexual history. This recommendation statement does not apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who have a compromised immune system (eg, women living with HIV). | The recommendations apply to all asymptomatic individuals with a cervix, regardless of their sexual history or human papillomavirus (HPV) vaccination status, includ-ing those who have undergone supracervical hysterectomy and transgender men who retain their cervix. |
| Methodology | The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. | American Cancer Society screening guidelines are created by the Guideline Development Group (GDG), 11 clinicians and population health care professionals and 1 patient advocate appointed by the ACS Board of Directors to create all of its cancer screening guidelines. To avoid professional conflicts of interest, the GDG considers content specific input and the opinions of expert clinical specialists but is responsible for supervising the review of the evidence and transforming the evidence into writing the guidelines. |
| Graded Strength of Recommendations | Yes | Yes |
| Graded Level of Evidence | Yes | Yes |
| Systematic Review Conducted | Yes | Yes |
| Literature Review Conducted | Yes | Yes |
| COIs & Funding Source(s) Disclosed | Yes | Yes |
| Full-text | Screening for Cervical Cancer | Cervical Cancer Screening for Individuals at Average Risk |
| Summary | Cervical Cancer: Screening – Women aged 21 to 65 years | ACS Cervical Cancer Screening for Individuals at Average Risk |
Comparison of Key Points
USPSTF Guidelines:
- Age range: 21 to 65 years.
- Preferred test:
- Women aged 21 to 29: Cytology (Pap test) every 3 years.
- Screening with cytology is recommended in this age group
- Screening with hrHPV testing is not recommended because of the transient nature of infection and natural clearance of HPV
- Women aged 30 to 65:
- Primary HPV testing every 5 years, or
- Primary hrHPV testing has adequate sensitivity
- Cotesting (HPV test and Pap test) every 5 years, or
- Cotesting may detect slightly more cases of CIN than screening with hrHPV testing alone but with a significant increase in the number of tests and procedures
- Cytology (Pap test) alone every 3 years.
- Cytology has lower sensitivity than primary hrHPV testing or cotesting and a lower false-positive rate and rate of additional testing
- Primary HPV testing every 5 years, or
- Women aged 21 to 29: Cytology (Pap test) every 3 years.
- Recommends against screening in those:
- 21 years old and younger: The USPSTF recommends against screening for cervical cancer in women younger than 21 years.
- Women who have had a hysterectomy: USPSTF advises against screening for cervical cancer in women who have undergone a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions (such as cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. This recommendation is based on the evidence that suggests screening in this population does not provide significant benefits in terms of detecting or preventing cervical cancer. It is important for healthcare providers to consider individual patient histories and risk factors when determining the appropriate screening guidelines for cervical cancer.
- Women older than 65 years: USPSTF advises against screening for cervical cancer in women who have undergone a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions (such as cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. This recommendation is based on the evidence that suggests screening in this population does not provide significant benefits in terms of detecting or preventing cervical cancer. It is important for healthcare providers to consider individual patient histories and risk factors when determining the appropriate screening guidelines for cervical cancer.
ACS Guidelines:
- Age Range: 25 to 65 years.
- Preferred Test:
- Women age 25 to 65:
- Primary HPV testing every 5 years.
- If primary HPV testing is not available:
- Cotesting (HPV test and Pap test) every 5 years, or
- Cytology (Pap test) alone every 3 years.
- Recommends against screening in those:
- People who have had a hysterectomy: Individuals who have undergone a total hysterectomy, which involves the removal of the uterus and cervix, are generally advised to discontinue screening tests such as Pap tests and HPV tests. However, this recommendation does not apply to those who had a hysterectomy as a treatment for cervical cancer or serious pre-cancer. On the other hand, individuals who have had a hysterectomy without removal of the cervix, known as a supra-cervical hysterectomy, should adhere to cervical cancer screening guidelines as outlined above.
- Women older than 65 years: Cervical cancer screening may be discontinued after the age of 65 for individuals who have undergone regular screenings with normal results over the past decade, and have no history of high-grade precancerous lesions or cervical cancer.
Key Differences:
- Screening Starting Age: USPSTF recommends starting at age 21, while ACS recommends starting at age 25.
- Preferred Test and Frequency: Both recommend primary HPV testing, but the starting age and frequency vary slightly.
- Discontinuation Criteria: Both recommend discontinuation after age 65 with adequate prior screening and normal results, but the exact criteria for "adequate screening" might differ slightly.
Both guidelines emphasize the importance of regular screening and the use of HPV testing as the primary method for detecting cervical cancer. The main differences lie in the starting age for screening and the flexibility in testing methods if HPV testing is not available.
In conclusion, although the guidelines may vary slightly, they share the common primary objective of cervical cancer screening: to identify treatable abnormalities, precancers, and adenocarcinoma in situ that have the potential to develop into invasive cancer. By doing so, the incidence, mortality, and treatment-related morbidity of cervical cancer can be reduced significantly.
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