The American Cancer Society published updated cervical cancer screening guidelines Dec. 4, including recommendations for self-collection and providing clearer guidance on when to safely discontinue screening.
The update comes one year after the U.S. Preventive Services Task Force published cervical cancer screening recommendations that included self-collection.
Thirteen leaders in oncology and gynecology shared with Becker’s their reactions to the American Cancer Society’s guidelines, including how they will influence screening rates.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How do you see these changes impacting your organization’s cervical cancer screening strategy? Are you hopeful these guideline updates will help increase screening rates across the U.S.?
Amy Armstrong, MD. Division Chief of Gynecologic Oncology at University Hospitals Seidman Cancer Center (Columbus, Ohio): While in-person visits with pelvic exam will remain the gold standard, we definitely plan to implement self-collection for cervical cancer screening for patients that desire this approach. This initiative will drastically increase the number of patients screened and decrease cases of cervical cancer.
Adding the option [of self-collection] for patients will increase the number of patients that will be screened. Many patients are unable to come to an office for an in-person visit. For other patients, a pelvic exam can be a traumatic experience. Having the freedom to self-collect in their own home will allow patients to be comfortable and in control of their own health.
Peter Dottino, MD. Gynecologic Oncologist at Yale Medicine’s Smilow Cancer Hospital, and Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine (New Haven, Conn.): There have been some significant changes made in the 2025 guidelines for cervical cancer screening of average-risk women. The changes include the use of standalone HPV testing as the preferred method of screening, the age that HPV screening should commence and the addition of HPV self-collection to the screening armamentarium.
These guidelines would increase the age for HPV testing to 25 years, limiting the anxiety that occurred with abnormal pap smears in the age group 21-25 years as per earlier guidelines. The acceptability of self-collected HPV offers many positive aspects to screening, including increasing accuracy, as samples no longer need to be taken by a health professional.
Self-collection would undoubtedly increase screening coverage for patients unable to keep appointments due to conflicting working demands or for those unable to afford a clinical visit. Given that cervical cancer is the fourth-most common cancer among women, increasing screening coverage is a positive move towards attaining the goals of eliminating cervical cancer by 2050.
Megan Huchko, MD. Hollier Family Associate Professor of Global Health, Associate Professor of Obstetrics and Gynecology and Associate Research Professor of Global Health at Duke Cancer Institute (Durham, N.C.): Duke Health providers are advancing efforts to expand patient-centered options to screen for cervical cancer. We have recently completed internal validation of our testing process for self-collection and are now working on developing and disseminating protocols and counseling materials for shared decision-making around self-collection of HPV. The ACS guidelines are very helpful to defining patient eligibility for self-collection and guiding the discussion of the benefits and drawbacks.
Self-collection has transformed screening in lower-resource settings globally, and we anticipate similar benefits in the U.S. The hope is that more primary care providers will feel comfortable offering screening through self-collection, and, by offering an alternative to pelvic exams, self-collection may encourage more women to participate in screening. It’s important for people to understand the key differences with self-collection: Women need to screen more frequently and may require follow-up exams, and it’s not recommended for women at higher risk of cervical cancer.
Amer Karam, MD. Clinical Professor, Obstetrics and Gynecology, Director of Robotic Surgery and Director of Outreach for Stanford Gynecologic Oncology at Stanford (Calif.) Medicine: Allowing patients another method for screening for cervical cancer is a meaningful strategy and broadens our reach. The self collection will help increase our screening rates and will help patients avoid costly trips for their annual exams and the costs associated, it will also allow primary care physicians who may not be familiar with pelvic exams to order the screening allowing more physicians to conduct the screening. This screening likely applies to patients at average risk and doesn’t apply to higher-risk patients, who will need to be followed more closely.
Increasing accessibility should help increase screening rates across the U.S., just like mailed fecal occult blood testing did for colon cancer screening.
Diane Harper, MD. Professor of Family Medicine, Obstetrics and Gynecology, Fulbright Cervical Cancer Specialist, University of Michigan (Ann Arbor): The American Cancer Society has affirmed the USPSTF draft guidelines of a year ago, supporting the move to self-sampling for average-risk women for cervical cancer screening. Women want this. Many health systems and practices are now offering self-sampling with a five-year screening interval for those who test negative, including the University of Michigan.
The least screened women are those 50 and older. Half of the cervical cancers occur in women older than 50 years and 20% occur in women over 65 years. The self-screening option allows women between 50 and 65 years to choose a comfortable, private and quick screen to detect any cancerous changes. We ask women to have two negative HPV tests five years apart as they approach 65 years to allow women to exit the screening program safely.
Ann Lutich, MD. Associate Professor of Obstetrics and Gynecology and Medical Director for the Lowe Foundation Center for Women’s Preventative Health Care at UT Southwestern Medical Center (Dallas): The vast majority of practitioners in the Dallas-Fort Worth area are still performing yearly pap and pelvic examinations, and this is the expectation for most of our patients. Our challenge at UT Southwestern is not under-screening but over-screening, and educating women about evidence-based guidelines.
However, there are some groups of women who have difficulty with pelvic examinations, including those with mobility issues, neuromuscular disorders, intellectual disabilities and history of trauma that may be under-screened for cervical cancer. These women would benefit from self-collection for primary HPV screening with appropriate follow-up for any abnormal test results.
It is also important to understand that cervical cancer screening is not prevention of disease, but simply prevention of progression of disease to cancer. The only preventative for cervical cancer is HPV vaccination. It is my hope that access to screening as well as vaccination can be improved throughout the United States.
Alex Mastroyannis, MD. Assistant Professor and OB-GYN Residency Associate Program Director at University of Colorado Anschutz Cancer Center (Aurora): Here at the University of Colorado Anschutz, we care for patients in a very geographically diverse region, where some patients take the bus from a mile away, others drive across hundreds of miles of farmland and others have to traverse several, sometimes snowy, mountain passes. Giving patients the choice of completing their cervical cancer screening from home will not only increase uptake and compliance with screening guidelines but will also significantly decrease the financial and time burdens of completing care. We have seen the effect that Cologuard has had on increased compliance with colorectal cancer screening, and I am optimistic we will see similar gains in cervical cancer screening.
I am very optimistic that these updated guidelines will allow patients in under-resourced settings to access standard of care screening for cervical cancer. While annual exams are an important component of health maintenance, I also believe that increased convenience will allow patients to stay up to date on their health screenings from the comfort of home. Additionally, having the option to collect in the comfort of one’s own home is a thoughtful, patient-centered approach for patients who have had trauma and for whom a pelvic exam in a clinic is potentially a deterring factor.
Sharon Robertson, MD. Gynecologic Oncologist at IU Health Simon Cancer Center (Indianapolis): The introduction of self-screening for cervical cancer is an exciting and promising development. I am hopeful that offering a self-screening option will help patients feel more comfortable and engaged in staying up to date with their screenings, while also reducing hesitation in accessing care.
As providers, we will adapt our practices to incorporate this option, educate patients, and manage results as they become available. I am optimistic that these guideline updates will lead to increased cervical cancer screening rates in Indiana and across the United States.
Ritu Salani, MD. Director of Gynecologic Oncology at the UCLA Health Jonsson Comprehensive Cancer Center: Self-testing for HPV is a great option for patients. At this time, it must be ordered by a healthcare provider and there should be a clear follow-up plan in the event of abnormal results.
These guidelines will be helpful for increasing screening, but we must recognize there will still be barriers in regard to ordering the test and following up on the results. Along with screening, HPV vaccination is also a key method to prevent cervical cancer.
Katherine Sampene, MD. Obstetrician and Gynecologist at UW Health, and Clinical Professor of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health (Madison): UW Health is offering clinician-collected primary HPV screening beginning in January 2026. Self-collection of primary HPV screening will be the next roll-out as an important strategy to reach unscreened or under-screened populations. Both clinic-located self-collection and home self-collection are now FDA-approved, a revolutionary change that expands options for individuals to engage in cervical cancer screening in ways that align with their needs and preferences. The additional clarity on guidance regarding existing cervical cancer screening will help clinicians and patients understand when it is safe to discontinue screening, and equally as importantly, which individuals over age 65 will continue to warrant screening.
George Sawaya, MD. UCSF Professor of Obstetrics, Gynecology and Reproductive Sciences; Epidemiology & Biostatistics and Director, UCSF Center for Healthcare Value (San Francisco): We are exploring ways to provide self-collected HPV tests to patients who otherwise would not be screened at all.
Most people who develop cervical cancer in the U.S. have not been well engaged in the screening process. Self-collected HPV tests hold promise by providing an alternative way to be screened that may be more acceptable and accessible to some patients.
Editor’s note: A study recently published by Dr. Sawaya and his colleagues found that more than 7 in 10 women in the U.S. who are ages 21-49 were open to HPV self-collection for cervical cancer screening.
Isabel Scarinci, PhD. Senior Adviser for Global Cancer at the O’Neal Cancer Center at the University of Alabama at Birmingham O’Neal Cancer Center, and Warner Huh, MD. Chair of the UAB Department of Obstetrics and Gynecology: The new ACS guidelines can be instrumental in accelerating our cervical cancer elimination efforts in Alabama and beyond.
Self-collection for HPV testing could be a game changer allowing people to collect their own HPV sampling at home, which our group and others have shown to be safe, effective, and preferred by many women, particularly the ones reluctant or unable to go to a clinic due to intrapersonal and structural barriers.
As we increase screening coverage by providing individuals with a self-collection option, we will likely detect more precancers, which has great implications for reducing incidence and mortality, and consequently accelerating cervical cancer elimination as a public health problem. However, our work and others have shown that when self-collection for HPV testing is performed at home, particularly among un- or under-screened women, it requires major efforts for them to adhere to follow-up in the event of an abnormal screening.
Although longer intervals between screenings is not new, it is important that it is being reinforced as it will reduce unnecessary procedures, clinical burden and cost while safeguarding safety and effective detection.
Providing clear recommendations on when stop screening is also a great contribution as it will prevent unnecessary procedures among older adults and reduce anxiety. All three recommendations will be instrumental in providing clear messages to community members.
However, we will still face some challenges. Cervical cancer is a disease of poverty, and if these recommendations are not adequately implemented, disparities can be exacerbated. Clear guidelines and protocols as well as education of providers and patients will be critical for effective implementation and adoption of these recommendations.
The major impact to our organization will be the need for a greater emphasis on population-based prevention while maintaining the high clinical care standard, workforce development and retooling, adaptation of quality metrics, and new opportunities for the implementation of science research.
Leave a Reply