Cervical Cancer: Screening

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms to improve the health of people nationwide. 

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. 

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. 

The USPSTF is committed to mitigating the health inequities that prevent many people from fully benefiting from preventive services. Systemic or structural racism results in policies and practices, including healthcare delivery, that can lead to inequities in health. The USPSTF recognizes that race, ethnicity, and gender are all social rather than biological constructs. However, they are also often important predictors of health risk. The USPSTF is committed to helping reverse the negative impacts of systemic and structural racism, gender-based discrimination, bias, and other sources of health inequities, and their effects on health, throughout its work.

The number of deaths from cervical cancer in the United States has decreased dramatically since the implementation of widespread cervical cancer screening. Most cases of cervical cancer occur among women who have not been adequately screened, diagnosed, or treated.¹ Increasing human papillomavirus (HPV) vaccination rates and strategies that aim to ensure that all eligible women are appropriately screened and receive appropriate followup and treatment are most likely to succeed in further reducing cervical cancer incidence and mortality in the United States.

The age-adjusted incidence of cervical cancer in 2021 was 7.6 cases per 100,000 women per year. In 2024, there will be an estimated 13,820 new cases of cervical cancer and 4,360 deaths.² The mortality rate has declined an average of 0.7% each year during 2011 to 2020.¹ However, disparities in the incidence of morbidity and mortality persist. The age-adjusted mortality rate from cervical cancer among Black women is about 1.5 times the rate among White women (3.2 cases and 2.1 cases per 100,000 persons, respectively).² However, data from the Surveillance, Epidemiology, and End Results (SEER) Program reveal that the disparity is even greater, when adjusted for hysterectomy rates: White women had a hysterectomy-corrected cervical cancer mortality rate of 4.7 deaths per 100,000 persons whereas Black women had a mortality rate of 10.1 deaths per 100,000 persons, resulting in a mortality rate ratio of 2.2.³ Several studies have found that Black women are screened for cervical cancer at rates similar to those for White women and that inadequate followup after screening and differences in treatment are important contributing factors to the disparities.^4-6 Native American/Alaska Native women also have higher rates of cervical cancer mortality (3.0 deaths per 100,000 women) compared with the national average.² Factors driving this higher rate may include lower screening rates and inadequate followup.^1,4 Hispanic women have a significantly higher incidence rate of cervical cancer and slightly higher mortality rate (2.5 deaths per 100,000 women) compared with White women.² Although White women overall have the lowest mortality rate from cervical cancer, White women living in geographically isolated and medically underserved areas have much higher mortality rates than the U.S. average.^6-9 Asian women, especially those who have recently immigrated to the United States, also have lower screening rates that may be due to language barriers in patient-provider communication on recommended screening or cultural barriers to screening and appropriate followup.^2,3 Certain geographic locations in the United States have low screening rates and higher incidence and mortality rates, including Appalachia, the southeastern Atlantic states, and the lower Mississippi Valley. Additionally, locations along the Texas-Mexico border have higher cervical cancer incidence and mortality rates.^10,11

In addition to race, ethnicity, and geography, insurance coverage plays an important role in access to cervical cancer screening; one study reported that 23.1% of women without health insurance and 25.5% of women with no regular healthcare clinician reported not receiving a Papanicolaou (Pap) test in the past 5 years, compared with 11.4% of the general population.¹⁰ Insurance status may interact with other demographic factors, such as race, ethnicity, and age, to increase disparities. In addition, limited data  among individuals with disabilities and those identifying as LGBTQ+ suggest likely disparities in their screening rates.⁴ In one U.S.-based study, 64.3% of transgender men were up-to-date with cervical cancer screening compared with 73.5% of cisgender women.^12,13

The USPSTF concludes with high certainty that cervical cancer screening in women ages 21 to 65 years has a substantial net benefit.

The USPSTF concludes with moderate certainty that the benefits do not outweigh the potential harms of screening in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

The USPSTF concludes with moderate certainty that the harms outweigh the benefits of screening in women younger than age 21 years.

The USPSTF concludes with high certainty that the harms outweigh the benefits of screening in women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer.

See Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.¹⁴

Patient Population Under Consideration

These recommendations apply to cisgender women and all other persons who were assigned female sex at birth (including transgender men and nonbinary persons). In this recommendation statement, the text uses “women,” although the net benefit estimates are driven by sex as assigned at birth rather than gender identity. In describing the evidence, sex terms are reported as used by study authors, which is typically “women.” Transgender men, nonbinary individuals, and others who were assigned female sex at birth have the same risks as cisgender women and should be screened as recommended, based on their age and the presence of a cervix.

Definitions

Invasive cervical cancer (ICC) develops over time and is preceded by premalignant (precancerous) changes to the cervix. Cervical intraepithelial neoplasia (CIN) categorizes abnormal histological changes in the cells of the cervix into varying levels of severity: CIN1, CIN2, and CIN3. CIN2 and CIN3 are considered premalignant (precancerous) lesions. The term CIN2+ indicates CIN2 or worse (CIN2, CIN3, or cancer) and CIN3+ indicates CIN3 or worse (CIN3 or cancer).

Throughout this statement, we use “human papillomavirus” or “HPV” to refer to high-risk HPV. The 12 most common high-risk HPV genotypes associated with cervical cancer include: 16, 18, 58, 33, 45, 31, 52, 35, 59, 39, 51, and 56; HPV types 16 and 18 account for approximately 70% of cervical cancers.¹

Assessment of Risk

It is well established that infection with high-risk types of HPV is associated with nearly all cases of cervical cancer, and that people are exposed to HPV through sexual intercourse. Although a large proportion of HPV infections resolve spontaneously, the high likelihood of exposure to HPV means that sexually active women are at risk for precancerous lesions and cervical cancer. Immunization with high-risk HPV vaccines is effective at reducing the risk of infection with HPV, cervical dysplasia, and cervical cancer.

Certain factors increase risk for cervical cancer, including HIV infection, a compromised immune system, in utero exposure to diethylstilbestrol, and previous treatment of a high-grade precancerous lesion or cervical cancer. Women with these risk factors are not included in this recommendation and should receive condition-specific management. Women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer are not at risk for cervical cancer and should not be screened. As part of their evaluation, clinicians should confirm through a combination of patient history, physical examination, and review of surgical records, if available, that the cervix was removed.

Notable disparities in cervical cancer mortality rates across populations exist. Although several studies have found similar screening rates for cervical cancer between Black women and White women, differences in followup after screening and treatment are important contributing factors to the higher mortality rate in Black women. Lower screening rates impact inequities in Native American/Alaska Native women and women living in geographically isolated and medically underserved areas. Other important factors associated with higher incidence and mortality rates include financial, geographic, and language/cultural barriers to screening; barriers to followup; unequal treatment; and differences in cancer types, all of which vary across specific populations.

Screening Tests

Women who are ages 21 to 29 years should be screened with cytology alone every 3 years. Starting at age 30 years and until age 65 years, self-collected or clinician-collected HPV testing alone (primary HPV screening) every 5 years provides the optimal balance of benefits and harms. For women ages 30 to 65 years, the strategies of screening with cytology alone every 3 years or HPV screening in combination with cytology (cotesting) every 5 years offers an acceptable balance between benefits and harms. Self-collection of HPV test for screening has similar accuracy to clinician-collected tests and is associated with increased screening in underscreened individuals and in historically underscreened populations. The accuracy does not appear to show a difference between home or clinic setting for self-collection. However, most of the evidence for increased rates of screening was for home self-collection of HPV.

Maintaining comparable benefits and harms of screening with cytology alone or HPV testing alone requires that patients, clinicians, and healthcare organizations adhere to evidence-based guidelines for repeat testing, diagnostic colposcopy, and treatment.

Screening Intervals and Timing

Screening more frequently than every 3 years with cytology alone confers little additional benefit, with a large increase in harms, including additional tests, colposcopies, procedures, and evaluation and treatment of transient lesions. Treatment of lesions that would otherwise resolve on their own is harmful because it can lead to procedures with unwanted adverse effects, including the potential for cervical insufficiency and preterm labor during pregnancy. For women older than age 30 years, evidence from randomized, controlled trials (RCTs), observational studies, and modeling studies suggest that primary HPV testing alone every 5 years offers the optimal balance of benefits and harms. Screening more frequently than every 5 years with primary HPV testing alone (or cotesting) does not substantially improve benefit but substantially increases the number of screening tests and colposcopies.

Women Younger Than Age 21 Years

Cervical cancer is rare before the age of 21 years and will likely become rarer due to increasing rates of vaccination in this age group through herd immunity and even lower in vaccinated individuals. Because of the slow progression of disease and the high likelihood of regression of HPV-associated lesions in this age group, evidence suggests that screening earlier than age 21 years, regardless of sexual history, leads to more harm than benefit. 

Women Older Than Age 65 Years

Recommendations from expert organizations define adequate prior screening as three consecutive negative cytology results or two consecutive negative cotesting results within 10 years before stopping screening, with the most recent test occurring within 3 to 5 years. They further recommend that routine screening should continue for at least 25 years after spontaneous regression or appropriate management of a precancerous lesion, even if this extends screening past the age of 65 years.^15-17 

Screening is clinically indicated in older (≥65 years) women with inadequate prior screening. In one large U.S. study, approximately two-thirds of women ages 64 to 66 years failed to qualify for exiting screening or did not have adequate data to determine adequacy of prior screening, and another study reported that three-quarters of patients who developed cervical cancer after age 65 years had not been adequately screened prior to diagnosis.¹ Specifically, women with limited access to care, women from certain racial and ethnic groups, and women previously living in countries where screening is not available may be less likely to meet criteria for adequate prior screening. Certain considerations may also support screening in women older than age 65 years who are otherwise at high risk (i.e., women with a history of high-grade precancerous lesions or cervical cancer, in utero exposure to diethylstilbestrol, or a compromised immune system).

Treatment

Screening aims to identify high-grade precancerous cervical lesions to prevent progression to cervical cancer. High-grade cervical lesions may be treated with excisional and ablative therapies. Early-stage cervical cancer may be treated with surgery (hysterectomy), radiation, or chemotherapy. Treatment of precancerous lesions is much less invasive than treatment of cancer.

Implementation

A significant amount of evidence shows that self-collection of primary HPV screening can increase screening, especially in populations who are underscreened. Most of this evidence comes from home settings for self-collection. However, HPV self-collection is approved by the U.S. Food and Drug Administration currently in a clinical setting.

We recognize that a shift to HPV primary screening and to the feasibility of self-collection at home may take some time. We encourage health professionals to provide screening, including consideration for home self-collection, that is consistent with established FDA approvals or other regulatory pathways for laboratory-developed testing and that is linked to healthcare settings. 

Additional Tools and Resources

HPV vaccination substantially reduces the risk of cervical cancer and should be provided as recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.¹⁸

The Enduring Consensus Cervical Cancer Screening and Management Guidelines provide guidance on management of abnormal screening tests (https://dceg.cancer.gov/research/cancer-types/cervix/enduring-guidelines).

When finalized, this recommendation will update the 2018 USPSTF recommendation on screening for cervical cancer. This draft is consistent with the 2018 recommendation except that this draft includes a recommendation that HPV primary screening every 5 years is the preferred screening strategy starting at the age of 30 years and now includes patient-collected HPV screening.

Scope of Review

The USPSTF commissioned a systematic review of the evidence on screening for cervical cancer and a collaborative decision analysis modeling report to update its 2018 recommendation. The systematic evidence report reviewed the evidence on the benefits and harms associated with cervical cancer screening from comparative effectiveness studies of different cervical cancer screening strategies. In addition, the review synthesized the evidence on the test accuracy and uptake of self-collected HPV samples.¹ The decision analysis modeling report analyzed how the benefits and harms of screening might vary by screening test, age to start screening, age to switch from cytology to HPV primary screening or cotesting, screening interval, and age to stop screening.¹⁹

Accuracy of Screening Tests

The accuracy of cytology and clinician-collected cervical HPV testing is well established and was not reviewed again for this update. For this recommendation, the USPSTF reviewed the evidence on the agreement and test accuracy of self-collected HPV screening specimens compared with clinically collected specimens to detect precancer. The USPSTF reviewed 14 studies that reported on the agreement between self-collected vaginal and clinician-collected HPV samples and six studies that reported the absolute or relative test accuracy of self-collected vaginal HPV samples to detect CIN2+ or CIN3+ lesions. Agreement between self-collected vaginal and clinician-collected cervical samples was high, with similar proportions screening positive.¹ The pooled absolute sensitivity of self-collected samples to detect CIN2+ was 0.86 (95% confidence interval [CI], 0.78 to 0.93) and the pooled absolute specificity was 0.81 (95% CI, 0.71 to 0.91). The relative accuracy of self-collected vaginal samples to detect CIN2+ compared with the accuracy of clinician-collected samples was high (relative sensitivity, 0.94 to 0.99; relative specificity, 0.98 to 1.02).¹ There was limited information on variation in test agreement or accuracy by population characteristics. One study indicated that, for women age 30 years or older, specificity was higher for CIN1 and CIN2/3+ when compared with women ages 20 to 29 years.²⁰

Uptake of Self-Collected HPV Screening

The USPSTF reviewed 42 RCTs that compared the uptake of self-collected vaginal HPV testing with usual care (i.e., clinician-collected cervical sample for HPV, cytology, or both). In nearly all studies (40 of 42 trials), offering self-collected vaginal HPV tests increased cervical cancer screening rates.¹ Although possibly confounded by study design and co-interventions, completion rates of screening due to HPV self-sampling appeared to be larger in traditionally underscreened groups. There were no consistent differences in uptake by other population characteristics (age, race or ethnicity, socioeconomic status, or screening history).

Benefits of Early Detection

The benefits of screening for cervical cancer are well established. The reduction of mortality and morbidity associated with the introduction of cytology-based screening is consistent across populations.^1,21 A cluster RCT conducted in India found a nearly 50% reduction in cervical cancer mortality after a single round of HPV testing compared with a nonscreened control group after 8 years of followup.²² The current evidence review and decision analysis assessed the evidence on the comparative benefits and harms of HPV-based screening strategies compared with cytologic screening, when to start screening, when to switch from cytology to HPV-based screening, and when to stop screening.^1,19

The USPSTF reviewed 14 studies that evaluated HPV primary screening or cotesting vs. cytology alone and found consistent evidence that HPV screening strategies (primary or cotesting) detected more precancerous lesions (CIN3+) than cytology alone.¹ Most of the studies the USPSTF considered evaluated the impact of one round of screening. One trial reported ICC detection after two rounds of screening and found a statistically significant reduction of ICC with cotesting compared with cytology at a second round of screening (n=39,310 at round 2). No studies directly compared primary HPV screening vs. cotesting. Most of the studies reported the comparative detection of precancerous lesions or ICC outcomes.

Eight studies (six RCTs and two nonrandomized studies of interventions [NRSIs]; n=637,241) of women ages 25 to 64 years evaluating primary HPV screening strategies demonstrated that primary HPV screening can detect more CIN3+ lesions in one round of screening compared with cytologic testing (relative risk [RR], 1.80 [95% CI, 1.38 to 2.36]).¹ Two RCTs (n=67,298) reported a decreased detection of CIN3+ after two rounds of screening (RR, 0.42 [95% CI, 0.25 to 0.70] and 0.22 [95% CI, 0.08 to 0.58]). One additional NRSI (n=44,579) in participants ages 65 to 69 years who were not up to date on screening reported that a single primary HPV screening detected additional CIN3+ compared with usual care (RR, 11.1 [95% CI, 4.81 to 25.5]). One additional trial (n=13,925) compared self-collected to clinician-collected primary HPV screening and found no differences in the detection of CIN3+ or CIN2+.

Four RCTs (n=122,316) reported that cotesting in study participants ages 20 to 64 years detects more CIN2+ and CIN3+ lesions in one round of screening compared with cytology; results were not statistically significant for CIN3+ (pooled RR, 1.13 [95% CI, 0.98 to 1.30]) but were statistically significant for CIN2+.¹ These same four RCTs demonstrated a reduction in precancer at the second round (pooled RR, 0.67 [95% CI, 0.53 to 0.83]).

Vaccinated Women

Emerging evidence shows that HPV vaccination lowers the risk of precancer and cervical cancer among those directly vaccinated and in populations with high coverage of HPV vaccination (due to herd immunity),¹ thereby likely reducing the benefits of cervical cancer screening in these populations. No comparative screening studies have reported results by vaccination status. Decision modeling for the USPSTF explored the effect of vaccination status and reported substantial reductions in the lifetime benefit of screening in vaccinated vs. unvaccinated women. For example, the decision modeling analysis reported that the benefit of screening over not screening with the recommended strategy of cytology every 3 years from ages 21 to 29 years followed by HPV primary screening every 5 years from ages 30 to 65 years in a population of 1,000 vaccinated instead of 1,000 unvaccinated women would lower median cervical cancer cases detected from 2.33 to 0.25, lower median deaths from 0.99 to 0.10, and lower median life-years gained from 170 to 18.¹⁹

It is conceivable that screening recommendations may start at later ages, occur at extended intervals, or evolve to focus primarily on HPV screening, given the increasing rates of vaccination in younger persons. However, at this time, the USPSTF cannot make specific recommendations by vaccination status.

Harms of Screening and Treatment

Screening with cervical cytology and HPV testing can lead to harms, including more frequent followup testing and invasive diagnostic procedures (e.g., colposcopy and cervical biopsy), as well as unnecessary treatment in women with false-positive results. Evidence from RCTs and observational studies indicates that harms from diagnostic procedures include vaginal bleeding, pain, infection, and failure to diagnose (due to inadequate sampling).²³

The USPSTF reviewed 12 fair- to good-quality studies that compared HPV screening strategies with cytologic screening and reported burden of testing or harms of screening, and one fair-quality NRSI comparing catch-up screening in women ages 65 to 69 years using primary HPV screening vs. usual care.¹ The USPSTF found no new studies that reported downstream harms of testing or treatment of cervical lesions. When reported, studies (k=7) evaluating primary HPV screening strategies reported an increased likelihood of positive tests compared with the cytology arm (RR, 1.10 [95% CI, 1.02 to 1.19] to 2.99 [95% CI, 2.74 to 3.26]).¹ Cotesting was also associated with an increase in positive tests. In six studies, primary HPV screening was associated with a statistically significant increase in colposcopy rates compared with cytology-based screening (RR, 1.23 [95% CI, 1.16 to 1.31] to 3.05 [95% CI, 2.75 to 3.38]).¹ One observational followup study of a trial of primary HPV screening reported that colposcopy referral rates decreased after initial rounds of primary HPV screening. The NRSI (n=44,579) that evaluated catch-up screening in older women reported no significant difference in the rate of colposcopies with primary HPV screening vs. usual care.²⁴ In two trials (n=69,684), cotesting increased colposcopy rates compared with cytology-based screening alone (absolute difference in colposcopies between arms was 1.6% and 7.6%).¹

In seven studies (n=616,796), the absolute increase in false-positive rate for primary HPV vs. cytology ranged from 0.4% to 5.6%.¹ Two trials (n=161,228) of primary HPV screening that used a higher-grade cytology threshold for referral to colposcopy reported lower test positivity, a lower rate of colposcopies, or lower false-positive rate. In three trials (n=107,560) of cotesting vs. cytology, the absolute increase in false-positive rate for cotesting ranged from 3.3% to 9.0%.¹ One RCT (n=13,925) that evaluated primary HPV screening in self-collected vs. clinician-collected HPV samples found no difference in false-positive rates between the strategies.^1,25

The USPSTF found two studies (n=3,481) that reported distress, anxiety, or depression outcomes, with both studies finding no difference in distress, anxiety, or depression between HPV-based screening and cytology-based screening at 2 weeks or 4 to 24 months.¹

HPV screening strategies in the comparative trials resulted in higher test positivity, colposcopies, and false-positive rates in younger (age <30 or 35 years) compared with older women (age >30 or 35 years).¹

The harms of treatment include risks from the treatment procedure itself and the potential subsequent consequences of treatment. Evidence from observational studies indicates that certain treatments for precancerous lesions (e.g., cold-knife conization and loop excision) are associated with subsequent adverse pregnancy outcomes, such as preterm delivery and related complications.²³ Evidence suggests that many HPV infections and precancerous cervical lesions will regress, so that identifying and treating such lesions would constitute overdiagnosis.¹ Estimating the precise magnitude of overdiagnosis associated with any screening or treatment strategy remains challenging but is concerning because diagnosis and treatment confers no benefit and leads to unnecessary surveillance, diagnostic tests, and treatments, with associated harms.

Balance of Benefits and Harms of Various Screening Strategies

The USPSTF commissioned a collaborative decision analysis report involving four models to provide estimates of the benefits, harms, and the balance of benefits and harms for various screening strategies; that is, ages to start and stop screening, screening test strategies (primary HPV, cytology alone, or cotesting), and screening intervals.¹⁹ Modeling confirmed that all screening strategies result in overall benefits by reducing cervical cancer cases and deaths compared with no screening. Although observational data suggest lower cervical disease risk in high-coverage HPV vaccinated populations,¹ given the variability in HPV vaccination implementation, the lack of a vaccine registry to confirm vaccination history in the United States, and the lack of comparative effectiveness trials of primary HPV screening in vaccinated persons, the USPSTF focused its deliberation on modeling-based results of an unvaccinated cohort. The preferred strategy of cytology every 3 years from ages 21 to 29 years followed by HPV primary screening every 5 years among those ages 30 to 65 years resulted in 152 to 193 life-years gained and a total of 449 to 1,209 lifetime colposcopies per 1,000 women. The alternative strategy of cytology-based screening every 3 years from ages 21 to 29 years followed by cotesting every 5 years from ages 30 to 65 years resulted in 153 to 195 life-years gained and 765 to 1,480 lifetime colposcopies per 1,000 women across the four models. The second alternative strategy of cytology every 3 years from ages 21 to 65 years resulted in 140 to 187 life-years gained and 562 to 806 lifetime colposcopies per 1,000 women. Based on the decision modeling analysis comparing various strategies and using numbers of colposcopies per life-year gained, the USPSTF concluded that the strategy of cytology-based testing every 3 years from ages 21 to 29 years and HPV primary screening every 5 years from ages 30 to 65 years optimized the balance of benefits and harms and is, therefore, the preferred recommended strategy for screening.

Women Older Than Age 65 Years

Regarding the age at which to stop screening, the USPSTF considered the incidence of cervical cancer in older women and whether that incidence differs in screened vs. unscreened women. Importantly, the incidence and prevalence of CIN peak in the 25 to 35 age group. The rate of CIN2+ diagnosed by cytology is low in older women who have had adequate prior screening.²⁶

Although screening women older than age 65 years who have adequate prior screening is not recommended, data suggest that screening rates begin to decline before that age. As a result, approximately 13% of 60- to 65-year-old women have not been adequately screened, and this percent increases to 37.1% in the absence of a regular healthcare provider.¹⁰ A Kaiser Permanente registry study found that most cases of ICC among women older than age 65 years occurred among those who had not met criteria for stopping screening.^27,28 This suggests that the decision to stop screening at age 65 years should only be made after determining that the patient has received prior adequate screening. Current expert recommendations define adequate screening as three consecutive negative cytology results or two consecutive negative HPV results within 10 years before stopping screening, with the most recent test performed within 3 to 5 years.^15-17

Women Who Have Had a Hysterectomy With Removal of the Cervix

Two large studies have documented the low risk for cytologic abnormalities after hysterectomy. A cross-sectional study of more than 5,000 cytology tests among women older than age 50 years found that identification of low- and high-grade intraepithelial lesions and cancer after hysterectomy was rare in this age group.²⁹ In a second study of more than 10,000 Pap tests over 2 years in 6,265 women who had a hysterectomy with removal of the cervix, screening yielded 104 abnormal Pap test results and no cases of cervical cancer; although, six cases of high-grade vaginal lesions were detected, it is not known whether that detection improved clinical outcomes.³⁰

See Table 2 for the research needs and gaps related to screening for cervical cancer.

The American Cancer Society recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and continue testing every 5 years through age 65 years. If primary HPV testing is not available, it recommends testing every 5 years with cotesting or every 3 years with cytology alone.  It also recommends that individuals older than age 65 years with no history of CIN2+ and adequate prior screening discontinue screening.¹⁵

The American College of Obstetricians and Gynecologists, the American Society for Colposcopy and Cervical Pathology, and the American Academy of Family Physicians endorse the 2018 USPSTF recommendations on screening for cervical cancer.^16,31,32 The American Society for Colposcopy and Cervical Pathology acknowledges benefits to primary HPV screening but also risk of harms, including widespread barriers to adoption.

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2. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Cervical Cancer. Accessed November 25, 2024. https://seer.cancer.gov/statfacts/html/cervix.html
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24. Tranberg M, Petersen LK, Hammer A, et al. Value of a catch-up HPV test in women aged 65 and above: a Danish population-based nonrandomized intervention study. PLoS Med. 2023;20(7):e1004253.
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Abbreviations: HPV=human papillomavirus; USPSTF=U.S. Preventive Services Task Force.

To fulfill its mission to improve health by making evidence-based recommendations for preventive services, the USPSTF routinely highlights the most critical evidence gaps for making actionable preventive services recommendations. We often need additional evidence to create the strongest recommendations for everyone and especially for persons with the greatest burden of disease.

In this table, we summarize key bodies of evidence needed for the USPSTF to make recommendations for cervical cancer screening. For each of the evidence gaps listed below, research must be inclusive of populations with a high prevalence of HPV, cervical cancer, or cervical cancer mortality, including Hispanic/Latino, Native American/Alaska Native, non-Hispanic Black, and Asian American women, and women living in rural or other underserved geographic areas.

Abbreviation: HPV=human papillomavirus; USPSTF=U.S. Preventive Services Task Force.