Cervical Cancer Screening: What to Know from ReproHH

ReproHH StaffDecember 29, 2025

Say you have a 32-year-old patient who avoided Pap tests for 6 years due to discomfort and a prior traumatic pelvic exam. She recently saw an advertisement about “at-home HPV self-swab kits” and asks whether she can do that instead of a speculum exam in clinic. She wants to know if self-collected HPV testing is accurate, whether it would replace a Pap test, and if it is an appropriate option for someone with no prior abnormal results.

The short answer - YES! There are new and exciting ways to screen for cervical cancer. Let’s review!

HPV and Cervical Cancer

In the United States, 1 in 4 people are not up to date on cervical cancer screening, and nearly half of those diagnosed with cervical cancer have either never been screened or are overdue for screening,₁ and 90% of cervical cancers are attributable to HPV. Despite numerous initiatives aimed at increasing screening, significant and persistent racial disparities in cervical cancer incidence and mortality remain, underscoring the critical role of both cervical cancer screening and HPV vaccination in reducing disease burden. We have work to do!

HPV Vaccination Recommendations (U.S.):

Age Group	Recommendation	Dosing Schedule
Ages 9–14	Routine vaccination recommended (can start at age 9)	2 doses, given 6–12 months apart
Ages 15–26	Catch‑up vaccination recommended	3 doses over 6 months
Ages 27–45	Shared clinical decision‑making	3 doses if vaccinated
Immunocompromised (any age)	Vaccination recommended	3 doses

HPV vaccination rates, and consequently cervical cancer, vary dramatically by state. For example Mississippi’s vaccination rate is 40% but North Dakota’s is over 80%! Successful HPV vaccination programs can eradicate HPV related cancer₈. Are you in a state with low vaccine rates₃? You can help change that!

KFF infographic on HPV Vaccination Rates of Adolescents by State

Cervical Cancer Screening Guidelines

The options for cervical cancer screening include:

Primary cytology alone
Primary cytology w/reflex HPV
Co-testing: cytology + HPV
Primary HPV testing w/reflex cytology
Self-collected HPV testing

Screening guidelines vary by organization and will continue to evolve. The ACS recommends starting screening at age 25, with primary HPV testing every 5 years. Acceptable alternatives include cotesting every 5 years or cytology alone every 3 years. In December 2025, the ACS updated its guidelines to include self-collected HPV testing every 3 years as an additional option. The USPSTF and ACOG recommendations are more nuanced, but we anticipate updated guidelines are coming soon! Guidelines for screening along with management are summarized in this table:₅

HPV Screening Guidelines by Organization

Organization	Starting Age	Preferred Method	Acceptable Alternatives	Self-Collection
ACS	25	Primary HPV every 5 years	Cotesting every 5 years or cytology every 3 years	Yes — HPV self-collection every 3 years (added Dec 2025)
USPSTF / ACOG	21	Cytology every 3 years (ages 21–29)	Ages 30–64: primary HPV every 5 years, cotesting every 5 years, or cytology every 3 years	Not formally included
ASCCP	Follows USPSTF / ACS	Risk-based management using current screening results	Uses prior screening history and current test results to guide follow-up	Not addressed (management-focused, not screening)

Self-Collected HPV Testing

Because HPV-based testing does not require the same degree of sampling precision as cytology, many organizations are advocating for HPV self-collection as a way to expand screening options. This approach may be preferred for patients who have a history of trauma, limited transportation or healthcare access, gender and sexual minorities, or anyone with limitations that make pelvic exams done by another person challenging. Evidence shows that self-collected HPV samples perform similarly to clinician-collected samples, whether collected in a health care setting or at home, supporting self-collection as a reliable and patient-centered option.₇ Emerging evidence has also shown urine HPV testing may be comparable to swabs. More to come!

In recognition of these benefits, the Health Resources and Services Administration (HRSA) issued guidance on January 5, 2026, supporting the use of HPV self-collection for cervical cancer screening.₄ Beginning in January 2027, insurance coverage will be required, reducing financial barriers that have historically limited access to preventive care. Framed as a harm-reduction strategy, self-swabbing prioritizes bodily autonomy, informed choice, and dignity, and should be offered alongside clinician-collected screening rather than as a replacement.

Currently, there are three FDA-approved HPV self-collection devices for use in health care settings (cobas, Onclarity, and Simpli-Collect) and one FDA-approved option for at-home collection (Teal Wand). These tests are available through major laboratories, including Quest and Labcorp, allowing clinicians to integrate self-collection into existing workflows while offering patients multiple screening pathways.

You get the Screening Results Back, What Next?

The American Society for Colposcopy and Cervical Pathology (ASCCP) management guidelines provide detailed, clear management for cervical cancer screening results. Plug your patient’s information in, and it will tell you what to do next! Don’t forget to include the screening context, patient’s age, and previous results. You can use their web or mobile-based app.

When To Stop Cervical Cancer Screening

Joint guidelines from ACS, ASCCP, and the American Society of Clinical Pathology recommend that a patient can stop screening if all of the following criteria are met:

The most recent screening is performed at age 65 or older
The penultimate screening was no more than 5 years ago
No abnormal results in the past 10 years
At least 2 consecutive negative HPV or 3 consecutive normal cytology (no LSIL or higher)
No history of HIV or immunosuppression
No history of cervical cancer at any time
No history of CIN2 or higher in the last 25 years

With AI and the EMR calculating care gaps, remember to double-check screening guidelines. Ask yourself, is it really ok to stop screening?

Other General Tips and Tricks:

Remember to use patient-centered, trauma-informed steps when conducting pelvic exams, including for cervical cancer screening. Check out this comprehensive guide from the National Coalition for Sexual Health.
Bimanual exams are not recommended for asymptomatic individuals undergoing cervical cancer screening.₆ Limiting invasive exams is patient-centered.
Make sure your health facility is using a lubricant that won’t interfere with lab testing. Check the recommended lubricants for PAP and STI testing.

TLDR:

When in doubt, screen.
When possible, take a harm reduction approach. This includes encouraging HPV vaccination and offering self-collection HPV based testing!
Still have questions? We get it. It’s complicated! Call us at 1-844-ReproHH!

References:

Have a clinical question related to sexual and reproductive health (SRH)? Call us at the Reproductive Health Hotline, call 1-844-ReproHH (844-737-7644) after reading our Terms of Service.

Updates from ReproHH