Cervical Cancer Screening Guidelines

Age-Specific Recommendations

The American Cancer Society recommends no cervical cancer screening for women under 21 years, regardless of method 1, 3
For women aged 21-24 years, cytology alone every 3 years is recommended, while HPV testing or co-testing is not recommended for this age group 2, 3, 4
The American Cancer Society guidelines indicate that primary HPV testing every 5 years is preferred starting at age 25, with cytology alone every 3 years as an acceptable transitional option 1, 6
For women aged 30-65 years, primary HPV testing alone every 5 years is the preferred screening method, with co-testing every 5 years as an acceptable option 1, 2, 6
The American Cancer Society recommends discontinuing screening for women over 65 years if adequate negative prior screening has been documented, defined as 2 consecutive negative primary HPV tests, or 2 negative co-tests, or 3 negative cytology tests within the past 10 years 1

Co-testing has increased detection of precancerous lesions and adenocarcinoma compared to cytology alone, with a lower risk conferred by a negative screening result 6
Co-testing may allow for longer screening intervals, but has higher rates of false positives and unnecessary colposcopies, especially in younger women 2, 3, 5

No screening is recommended for women without a cervix and without a history of CIN2+ in the past 25 years or cervical cancer, according to the American Cancer Society guidelines 1
HPV-vaccinated women should follow the same age-specific screening recommendations as unvaccinated individuals, with cytology-based screening being less efficient in vaccinated populations 1

The American Cancer Society guidelines indicate a transition toward primary HPV testing as the preferred method, with co-testing considered an acceptable but transitional option 1
The use of co-testing or cytology alone for cervical cancer screening will likely not be included in future guidelines as the US transitions to primary HPV testing, according to the American Cancer Society 1