The number of women affected by cervical cancer has been steadily decreasing thanks to expanding access to HPV vaccinations and widespread screening. That being said, this year the American Cancer Society (ACS) estimates that as many as 13,490 women will be diagnosed with invasive cervical cancer. Most cervical cancer cases occur in women who have not been adequately screened. In an effort to make screening available to more women, newer FDA approved home testing kits allow patients to obtain self-collected specimens. With appropriate notification and follow-up this could be a viable option for some women.
In this guidelines side-by-side comparison, we look at the latest clinical practice guidelines from the ACS, Cancer Care Ontario (CCO) and the American College of Obstetricians & Gynecologists (ACOG) on cervical cancer screening. Recommendations that were compared in this article are for patients of average-risk for cervical cancer. We encourage you to review the full guidelines which can be found at the links below for more information on this topic.
Guidelines for Comparison
| Item | Cervical Cancer Screening for Individuals at Average Risk: 2020 Guideline Update from the American Cancer Society | Self-Collected Vaginal Specimens for Human Papillomavirus Testing and Guidance on Screening Exit: An Update to the American Cancer Society Cervical Cancer Screening Guideline | Ontario Cervical Screening Program Recommendations for Cervical Screening and Colposcopy with Human Papillomavirus Testing in Ontario | Screening for Cervical Cancer |
|---|---|---|---|---|
| Authoring Organization | American Cancer Society | American Cancer Society | Cancer Care Ontario | American College of Obstetricians & Gynecologists |
| Publication Date | July 2020 | December 2025 | March 2025 | April 2026 |
| Graded Recommendations | Yes | No | Yes | No |
| Links | Summary / Full Text | Full Text | Summary / Full Text | Summary / Full Text |
Key Takeaways
The following information pertains to women of average-risk for cervical cancer.
Age to Initiate Screening
- Both the ACS and CCO recommend starting screening for cervical cancer at the age of 25 years.
- ACOG offers a bit more flexibility recommending screening begin between the ages of 21 and 29 years.
Preferred Screening Test
- Primary HPV testing is preferred for most patients in the guidelines that were reviewed. The exception to this is ACOG, which prefers cytology testing alone for younger patients aged 21 to 29 years.
- The ACS and ACOG also find co-testing and cervical cytology alone to be acceptable screening methods.
Screening Interval
- Screening interval depends on which test is performed and is the same throughout all 4 guidelines.
- If primary hrHPV testing or Co-testing are used they should be repeated every 5 years.
- If cervical cytology is used alone it should be repeated every 3 years.
Provider Collected versus Patient Collected Samples
- Only two societies made recommendations regarding self-collected samples.
- Both the ACS and ACOG prefer clinician collected samples for cervical cancer screening, but agree that self-collected samples are acceptable. Self-collected screening needs to be repeated more frequently, every 3 years.
- It’s important that appropriate notification and follow-up procedures are in place for patients providing self-collected samples.
Discontinuation of Screening
- CCO discontinues screening in patients with a negative HPV test between the ages of 65 and 69 years and otherwise discontinues routine screening at the age of 75 years.
- All of the guidelines reviewed begin discontinuing screening after the age of 65 years.
- ACS and ACOG both discontinue routine screening after the age of 65 years in patients with adequate negative prior screenings. Their definition of adequate negative prior screening differs slightly.
- ACS requires 2 consecutive negative HPV tests, or 2 consecutive negative co-tests, or 3 consecutive negative cytology tests within the past 10 years
- ACOG requires 2 consecutive negative co-tests or 3 consecutive negative cytology results within the past 10 years.
- ACS also recommends discontinuing routine screening in patients of any age with limited life expectancy.
Comparison of Selected Recommendation Components
| Type | ACS | ACS update | CCO | ACOG |
|---|---|---|---|---|
| Initiation Age | 25 years | Not addressed. | 25 years. | 21-29 years. |
| Primary hrHPV Testing | Preferred test, repeat every 5 years. | Not addressed. | Every five years. | Preferred for age 30 to 65 years, repeat every 5 years. |
| Co-Testing | Acceptable, repeat every 5 years. | Not addressed. | Not addressed. | Acceptable for age 30 to 65 years, repeat every 5 years. |
| Cervical Cytology Alone | Acceptable, repeat every 3 years. | Not addressed. | Not addressed. | Preferred for age 21-29 years, repeat every 3 years. For ages 30-65 years use only if hrHPV and co-testing are not available. |
| Provider Collected Specimen | Addressed in update. | Preferred | Recommended. | Preferred. |
| Patient Collected Specimen | Addressed in update. | Acceptable, repeat every 3 years | Not addressed. | Acceptable, repeat every 3 years. |
| Discontinuation of Screening | Over age 65 years of average risk with adequate negative screening over the past 10 years. Any age with limited life expectancy. | Not addressed. | Age 65 to 69 years who are average-risk with one negative HPV test between the ages of 65 and 69 75 years of age or older without visible cervical abnormalities or abnormal symptoms. | Older than 65 years of average-risk and with adequate negative screenings over the past 10 years. |
Comparison of Recommendations
| Type | ACS | ACS update | CCO | ACOG |
|---|---|---|---|---|
| Initiation of Screening | 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). | Not Addressed | Cervical screening for people with a cervix who have ever been sexually active should start at age 25. Note: Cervical screening under age 25 is not recommended for people who had an early age of first sexual activity. In addition, cervical screening is also not recommended for those over age 25 who have never been sexually active. Human papillomavirus (HPV) testing is the recommended cervical screening test in the Ontario Cervical Screening Program (OCSP). Reflex cytology will be performed automatically on specimens that are HPV positive (i.e., the health care provider does not need to order a second test). | Individuals aged 21–29 years should be screened for cervical cancer every 3 years with cervical cytology alone. |
| Screening Intervals | Primary HPV testing every 5 years through age 65 years 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). | Not addressed. | People with a cervix who are at average risk of developing pre-cancer and cervical cancer should screen every five years. | Individuals aged 30–65 years should undergo clinician-collected primary high-risk human papillomavirus (hrHPV) screening every 5 years, using U.S. Food and Drug Administration–approved tests for primary screening. Co-testing with hrHPV and cervical cytology every 5 years for individuals aged 30–65 years is acceptable when primary hrHPV testing is not available or, after counseling, the patient chooses co-testing. Cervical cytology alone for individuals aged 30–65 years should be used only in settings in which primary hrHPV testing or co-testing is not available or if, after counseling, the patient chooses cervical cytology alone. |
| Specimen Collection | Addressed in update. | Clinician-collected cervical specimens are preferred, and self-collected vaginal specimens are acceptable for cervical cancer screening. When self-collected vaginal specimens are HPV-negative in the screening setting, repeat testing in 3 years is recommended. | Only referred to specimens collected by the clinician. | Patient-collected primary hrHPV screening every 3 years, using U.S. Food and Drug Administration approved testing kits, may be considered when systems are in place for appropriate notification and follow-up. |
| Discontinuation of 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. Cervical cancer screening may be discontinued in individuals of any age with limited life expectancy. 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. | Not addressed. | People can stop cervical screening if they have had one negative HPV test result from age 65 to 69 with the following exceptions:•People who were not screened from age 65 to 69 should be screened until age 74•Immunocompromised populations should be screened until age 74•People who are age 65 to 69, have been discharged from colposcopy and have been advised to screen in 2 years because they have not yet met the criteria to return to average risk screening in five years or immunocompromised screening in 3 years should be screened until age 74The following immunocompromised populations are at higher risk of pre-cancer and cervical cancer: •People who are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), regardless of CD4 cell count;•People with congenital (primary) immunodeficiency;•Transplant recipients (solid organ or allogeneic stem cell transplants);•People requiring treatment (either continuously or at frequent intervals) with medications that cause immune suppression for three years or more;•People who are living with systemic lupus erythematosus (SLE), regardless of whether they are receiving immunosuppressant treatment; and•People who are living with renal failure and require dialysis. The OCSP does not recommend cervical screening for people ages 75 and older. Note: People ages 75 and older with any visible cervical abnormalities or abnormal symptoms must be investigated, regardless of age. | Routine screening is not clinically indicated in patients older than age 65 years if they have received adequate prior screening, defined as three consecutive negative cytology results or two consecutive negative co-testing results within 10 years before stopping screening, with the most recent test occurring within 3 years for cytology alone or 5 years if co-testing is used. For patients older than age 65 years who have not received adequate prior screening according to the criteria described or who are at high-risk for cervical cancer, screening should continue. Routine cervical cancer screening is not recommended for patients who have undergone hysterectomy with removal of the cervix and who do not have a history of cervical cancer or another high-grade precancerous lesion. |
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