Cervical Cancer Screening Guidelines

Screening Recommendations

The American Cancer Society recommends that all women should begin cervical cancer screening at age 21 years, regardless of sexual activity history or HPV vaccination status 1, 2
For women aged 21-29 years, the preferred screening method is a Pap test alone every 3 years 1, 2, 3
For women aged 30-65 years, the preferred approach is co-testing (Pap test plus HPV DNA test) every 5 years 1, 2, 3
The American College of Obstetricians and Gynecologists (ACOG) and the US Preventive Services Task Force (USPSTF) support the 2019 American Cancer Society guidelines, which represent the most current consensus recommendations 1, 2, 3, 5

Women aged 30-65 years can also use Pap test alone every 3 years or primary HPV testing alone every 5 years as acceptable alternatives 1, 3
Co-testing maximizes cancer prevention while reducing false-positives compared to younger age groups 3
Primary HPV testing shows 51% higher detection of high-grade lesions at enrollment and 42-47% reduction in subsequent detection compared to cytology alone, but the benefit-to-harm ratio only becomes favorable at age 30 and above 3

Women can discontinue screening at age 65 if they meet all of the following criteria: three consecutive negative Pap tests or two consecutive negative co-tests within the last 10 years, most recent test occurred within the past 5 years, and no history of CIN2+ or cervical cancer 1, 2, 5
Once screening is discontinued, it should not resume for any reason, even if a woman reports having a new sexual partner 5

Women who have had a total hysterectomy (cervix removed) for benign reasons should stop all cervical cancer screening 1, 5
HPV-vaccinated women should screen using the same recommendations as unvaccinated women 2, 4
Pregnant women should follow the same screening recommendations as non-pregnant women 2

For women ≥21 years with ASC-US, three management options exist: HPV triage testing, repeat Pap tests at 6 and 12 months, or prompt colposcopy 4
Women with ASC-H, LSIL, or HSIL should be referred to colposcopy for evaluation 4
HPV-negative ASC-US in women ≥65 years is not sufficiently reassuring to stop screening at age 65, and retesting in 3 years is recommended 6