August 2025
INTRODUCTION —
Cervical cancer is common among females worldwide. Most cases occur in resource-limited countries [1]. In resource-abundant countries, lower cervical cancer incidence and mortality rates are related to the availability of primary prevention (with human papillomavirus [HPV] vaccination) and secondary prevention (with screening to detect precancerous lesions and timely treatment, if needed).
Available methods for cervical cancer screening include primary HPV testing, cytology, and co-testing (with both HPV and cytology).
This topic will discuss screening of average-risk patients in resource-abundant settings, including appropriate ages to initiate and discontinue screening, and frequency of screening.
Other related issues, including the types of screening methods, techniques for performing such testing, screening in high-risk patients (those with HIV, on long-term immunosuppressive therapy, or with a history of diethylstilbestrol [DES] exposure in utero), and information about invasive cervical cancer are discussed in detail separately.
●(See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups".)
●(See "Screening for cervical cancer in resource-limited settings".)
●(See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing".)
●(See "Cervical cancer screening: The cytology and human papillomavirus report".)
●(See "Cervical cancer screening: Risk assessment, evaluation, and management after screening".)
●(See "Screening for cervical cancer in patients with HIV infection and other immunocompromised states".)
●(See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis".)
DEFINING AVERAGE RISK —
Cervical cancer screening recommendations differ for patients at average and high risk of developing cervical cancer (see "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Patient groups'). Definitions for average and high-risk may differ based on country/guideline.
In the United States, average risk is defined as those with a cervix who have all the following:
●Asymptomatic (ie, no signs or symptoms of cervical disease such as abnormal bleeding).
●Immunocompetent.
●Have had all normal cervical cancer screening results in the past. The only situations in which patients with prior abnormal results are at sufficiently low risk to return to age-based routine screening are the following [2]:
•Patients <25 years with HPV-negative atypical squamous cells of undetermined significance (ASC-US )
•Patients <25 years with low-grade squamous intraepithelial lesions (LSIL) or ASC-US, followed by two consecutive negative cytology results.
•Patients ≥25 years with ASCUS or LSIL followed by colposcopy in which CIN 2 or worse was not found and followed by three consecutive negative HPV testing or co-testing results.
•Patients ≥25 years with HPV-negative ASCUS followed by a negative HPV test or co-test.
By contrast, patients with symptoms (eg, abnormal bleeding or discharge) need diagnostic evaluation, and those with HIV [3], immunosuppression, or a history of diethylstilbestrol (DES) exposure in utero, have a higher risk of cervical cancer and need more frequent screening. If patient-specific factors raise concern that a patient may be at higher risk for cervical cancer, but their risk factors do not conform exactly to these set criteria, it is reasonable for the clinician to manage the patient with a more conservative approach. (See 'Symptomatic patients' below and "Screening for cervical cancer in patients with HIV infection and other immunocompromised states" and "Outcome and follow-up of diethylstilbestrol (DES) exposed individuals".)
Similarly, patients with an abnormal cytology or HPV test result or a history of cervical precancer or cancer need active surveillance (not screening). This is discussed in more detail separately. (See "Cervical cancer screening: Risk assessment, evaluation, and management after screening" and "Cervical intraepithelial neoplasia: Management" and "Invasive cervical cancer: Patterns of recurrence and post-treatment surveillance", section on 'Surveillance strategies'.)
HOW TO SCREEN
Age to initiate screening
First screening between 21 and 25 years — Most screening guidelines in resource-abundant countries recommend initiating screening in average-risk patients between the ages of 21 and 25 years (table 1). However, consensus guidelines may offer different strategies to account for the variance in local incidence of cervical cancer, HPV vaccination rates, as well as other social and systemic factors (eg, cost, availability of tests or services). The starting age is chosen to balance the benefits of cervical cancer screening (decreasing the incidence, morbidity, and mortality of cervical cancer) with the risks of screening (false-positive screening results and subsequent unnecessary procedures). This is described in detail separately. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Benefits of screening' and "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Potential harms'.)
In the United States, guidance from the United States Preventative Task Force (USPSTF) and American Cancer Society (ACS) is as follows (table 1):
●The USPSTF recommends initiating screening at the age of 21 years [4]. Rationale for these recommendations include the following:
•Prior to the age of 21, cervical cancer is rare (0.1 percent of incident cancers are diagnosed in this age group) [4]. Starting at the age of 21, the benefits of cervical cancer screening outweigh the potential harms (ie, increased number of colposcopies and treatment procedures).
•HPV vaccination rates were not used to adjust screening recommendations given the uneven rates of vaccination in the United States [5]. Vaccination rates vary substantially by state, rurality, and data source, ranging from 30 to 90 percent [6]. In addition, most studies show limited effectiveness when vaccines are administered at age 18 and older, therefore, ascertaining both the vaccination status and age at administration would be needed if using HPV vaccination status to determine screening needs.
●The ACS recommends initiating screening at the age of 25 years [7]. Rationale for these recommendations includes the following:
•Between the ages of 20 and 24, the incidence of cervical cancer in the United States is low (0.8 percent of incident cancers are diagnosed in this age group) [7]. Therefore, the age at which cervical cancer screening is initiated is raised from 21 to 25 years by the ACS recommendations; observational studies show patients ages 20 to 24 typically spontaneously clear HPV infection and its associated abnormalities, and screening these patients does not substantially reduce their risk of cervical cancer [8-11].
•The ACS used HPV vaccination as a factor for raising the age of initial screening, citing an increased uptake of HPV vaccination rates; in one 2024 study, 77 percent of female adolescents (ages 13 to 17) in the United States received at least one dose of the vaccine [12]. However, these guidelines do not incorporate vaccination history into their screening recommendations.
•Following the availability of the HPV vaccine in 2006, rates of cervical cancer and precancer have significantly decreased among females <25 years [13]. (See "Human papillomavirus vaccination", section on 'Cervical, vaginal, and vulvar disease'.)
As primary HPV testing becomes more widely available, and as the rate of HPV vaccination increases, the age of initiation (and testing method) may change. (See 'Recipients of HPV vaccine' below.)
Not screening prior to 21 years — Almost all guidelines recommend not screening prior to age 21 years, regardless of the age of initiation of sexual activity [7].
Observational studies suggest that the potential harms (ie, increased number of colposcopies and treatment procedures) outweigh the potential benefits in this age group, due to the low incidence of cervical cancer in this age group [4,7,8]. In the United States, the age-adjusted incidence of cervical cancer in patients ages 15 to <20 years is 0.1 per 100,000 (figure 1) [14]. Adolescents are also more likely to spontaneously clear HPV infection and associated abnormalities. While rates of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) are consistently higher in adolescent patients than in adults, 90 to 95 percent of low-grade lesions in adolescent patients, as well as many high-grade lesions, regress spontaneously [15-19].
Testing method and frequency
Choice of test — Expert guidance regarding the choice of test (ie, primary HPV testing, co-testing, cervical cytology) and the frequency of such testing also varies (table 1).
In the United States, guidance from the USPSTF and ACS is as follows [4,7]:
●The USPSTF recommends cytology every three years for patients ages 21 through 29. This recommendation is based on a meta-analysis of randomized trials and observational studies that demonstrated higher false-positive rates (defined as a positive screening test result in which further follow-up with repeat screening, colposcopy, and/or biopsy was negative for a precancerous lesions or cervical cancer) with HPV testing because of the higher rates of transient infection in this age group [20].
For patients ages 30 to 65, the USPSTF recommends a strategy of primary HPV testing every five years, cervical cytology every three years, or co-testing (HPV plus cervical cytology) every five years.
●The ACS recommends primary HPV testing every five years for patients ages 25 through 65. Primary HPV testing, rather than cytology, is preferred based on randomized trials which demonstrate HPV-based testing is more sensitive and specific than cervical cytology alone [21,22]. This may be particularly important in HPV-vaccinated patients, as described below. (See 'Recipients of HPV vaccine' below.)
As an alternative, the ACS states that patients can be screened with co-testing every 5 years or cytology alone every three years. It is important to note that the added value of co-testing over primary HPV testing alone is limited and co-testing is more costly [7,23].
Each of these screening strategies is the same irrespective of HPV vaccination status. (See 'Recipients of HPV vaccine' below.)
Details regarding the various screening methods (ie, primary HPV testing, co-testing, cervical cytology) are provided separately. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Types of screening and frequency'.)
Increased utilization of HPV-based testing — Many guidelines have adopted primary HPV as the preferred screening method (table 1).
Infection with oncogenic types of HPV (ie, high-risk HPV [hrHPV]) (table 2) and persistence of hrHPV infection are the most important determinants of progression to cervical cancer [24]. While females <25 years have the highest incidence and prevalence of hrHPV infection [25-27], they also experience low rates of HPV persistence and progression and high rates of regression of precursor lesions within two years [17,21,22]. Thus, some guidelines use the age of 30 to begin HPV testing to balance the potential burdens and harms (eg, colposcopy, biopsy, excision) of testing younger individuals who have a high chance of clearance of HPV and regression of precursor lesions.
This is discussed in more detail separately. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Relative risks and benefits of each method'.)
Role of HPV self-collection — Self-collection is a form of primary HPV testing. Self-collection may be used in some countries to expand screening access, particularly for individuals with barriers to screening. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Types of screening and frequency'.)
While self-collection allows the patient to avoid a speculum examination (which may be of particular importance in those with a history of sexual trauma), a disadvantage of self-collection is that the cervix is not visualized, and cervical cells are not obtained. Thus, if additional testing (eg, cytology, dual stain testing) is needed, the patient needs to return for these tests at a later date.
In the United States, only certain HPV tests have been approved by the US Food and Drug Administration (FDA) for self-collection; these are shown in the table (table 3). The Enduring Guidelines Cervical Cancer Screening and Management Guidelines Committee, a consensus of 19 national organizations, developed guidelines for self-collection in asymptomatic, average-risk individuals ages 25 to 65 [28]. Depending on the test used, self-collection can occur in an office-based setting or at home. This is discussed separately. (See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing", section on 'Self-collection'.)
When an HPV test using self-collection is negative, repeat testing is performed in three years [28]. When an HPV test using self-collection is positive, a repeat clinic visit to collect a sample for cytology or dual staining (cytology with p16/Ki-67) is often needed to determine next steps. Colposcopy is also needed for those in whom HPV 16 or 18 was detected. (See "Cervical cancer screening: Risk assessment, evaluation, and management after screening", section on 'HPV positive, genotyping performed'.)
Self-collected samples appear to perform similarly at detecting high-grade CIN as provider-collected screening methods. This is discussed separately. (See "Cervical cancer screening tests: Techniques for cervical cytology and human papillomavirus testing", section on 'Self-collection' and "Screening for cervical cancer in resource-limited settings", section on 'Self-collected samples'.)
Discontinuing screening
Risk of cervical cancer in older individuals — Approximately 20 percent of cervical cancers in the United States occur in patients >65 years (figure 1) [29-32]. In a study that corrected for the estimated prevalence of hysterectomy, cervical cancer incidence in the United States peaked at ages 65 to 69 years (corrected rate of 27.4 cervical cancer cases per 100,000 women versus uncorrected rate of 14.8 per 100,000 women) [30]. In another study, invasive cervical cancer incidence did not decline with increasing age until at least age 85 years [33].
Older individuals are also more likely to have higher-stage disease and higher mortality rates compared with younger individuals [34,35]. For example, in the United States from 2011 to 2015, mortality rates in females ages ≥85 and 70 to 74 years compared with 40 to 44 years were 6.5, 5.3, and 3.2 per 100,000, respectively [36]. Similarly, in a Danish cohort of females ≥60 years, the proportion of individuals with advanced-stage disease was lowest in those ages 60 to 64 years and highest in those ages 75 to 79 years [35].
Many of these cervical cancers occur in those with inadequate prior screening. In a retrospective analysis of United States survey data, 18 percent of patients aged 61 to 65 years had not had a Pap test within the preceding five years (including those who had never had a Pap test) [33].
Age to discontinue screening — As with the age at which to initiate screening, recommendations regarding the age at which to discontinue screening vary. The decision to discontinue screening in average-risk patients depends on many factors, including the patient's prior results, life expectancy, and preferences in a shared decision-making discussion.
In the United States, guideline recommendations are as follows [4,7]:
●For those who have an adequate and all normal screening history, screening is often discontinued after age 65 years if the following criteria are met:
•No history of cervical intraepithelial neoplasia (CIN) grade 2+ for the past 25 years, and
•A history of adequate prior screening, as defined by:
-Two consecutive negative primary HPV tests within the past 10 years, with the most recent test within the previous five years, or
-Two consecutive negative co-tests (Pap and HPV testing) within the past 10 years, with the most recent test within the previous five years, or
-Three consecutive negative Pap tests within the past 10 years, with the most recent test within the previous three years.
If the results of screening within the prior 10 years are not known, then prior screening is not considered adequate.
Absent a nationwide integrated medical record or decades of care in one health system, it can be very difficult to know if a person has had adequate prior screening, and data from several sources indicate that less than half of patients fulfill exit criteria, the majority due to insufficient screening [37].
The development of high-grade cervical dysplasia or cervical cancer in this patient population is rare.
●For those without adequate prior screening or an unknown screening history, screening should continue beyond age 65 years.
However, the frequency and duration of this screening is unclear. Some experts test such patients more frequently (eg, annually for two to three years for a baseline), others follow screening frequency for younger patients (see 'Testing method and frequency' above), and some screen up to approximately age 80 years. The decision about how long to continue screening should be predicated on a life expectancy of at least 10 years and an informed decision-making discussion with the patient.
●For patients with adequate and all normal screening history but without serious health issues or a limited life expectancy, continued screening may also be a reasonable option [2,38].
Other regions/guidelines have different approaches to discontinuing screening (table 1). For example, in Australia, which has the lowest cervical cancer mortality rate in the world, guidelines advise continuing screening until age 74 years [39].
Data regarding the age at which to discontinue screening are limited and are discussed below. (See 'Benefits of continued screening' below.)
Benefits of continued screening — Continued screening may help prevent new cervical cancer cases and deaths. However, data about the stopping age for cervical cancer screening are limited. A meta-analysis of 23 cohort and case-control studies and one randomized trial found no conclusive evidence to support a specific age to stop cervical cancer screening, as none of the reviewed studies looked specifically at this question [40]. Furthermore, observational studies suggest that continued screening in older patients may be efficacious [30,31,33,41-43]. One of the primary limitations of these studies is that it is unclear whether the patients who developed cervical cancer at an older age had been adequately screened through age 65 years; thus, the studies' implications are not necessarily applicable to patients over age 65 years whose prior screening was adequate and negative.
The benefit of screening older individuals may also be underestimated. Most cancer registries do not exclude females who have had a hysterectomy and are therefore not at risk for cervical cancer nor require screening (if the indication for hysterectomy was not due to cervical dysplasia or cancer) [30,44,45]. In one modeling study, not excluding females with prior hysterectomy underestimated the incidence of cervical cancer by 71 percent [46]. The same modeling study suggests that while most of the prevention of cervical cancer in later life is due to screening before age 55 years, continued screening up to age 75 years results in incremental decreases in cancer risk later in life.
However, it is important to note that with the transition from cervical cytology to primary screening with HPV testing, the risk of cervical cancer after a negative exit HPV test is unclear since data supporting HPV testing is mostly among younger patients and does not account for other factors (eg, aging populations in resource-abundant countries with longer life expectancies, cdes0omorbidities, sexual behaviors).
SPECIAL CONSIDERATIONS
Prior hysterectomy for benign disease
●History of CIN – Patients who have had a hysterectomy and have a history of cervical intraepithelial neoplasia (CIN) grade 2 or higher require surveillance even after hysterectomy. (See "Cervical intraepithelial neoplasia: Choosing excision versus ablation, and prognosis and follow-up after treatment", section on 'Follow-up after treatment'.)
When vaginal cytology is performed, a spatula is used to collect cells from the vaginal apex; the sample is labeled as a vaginal sample because pathology evaluation cannot typically differentiate between vaginal and cervical squamous cells. (See "Cervical cancer screening: The cytology and human papillomavirus report", section on 'Vaginal cytology'.)
As a history of HPV and/or cervical dysplasia also increases the risk of dysplasia at other anatomic sites (eg, vagina, vulva, anus) other screening may also be warranted in some patients. This is especially true for patients with a history of HPV 16 or high-grade cervical dysplasia. (See "Vaginal intraepithelial neoplasia" and "Vulvar squamous intraepithelial lesions (vulvar intraepithelial neoplasia)" and "Anal squamous intraepithelial lesions: Epidemiology, clinical presentation, diagnosis, screening, prevention, and treatment".)
●No history of CIN – For patients who have had a hysterectomy and have no history of cervical cancer or CIN, our recommendations are based on the type of hysterectomy:
•Total hysterectomy (with cervix removed) – We recommend that patients who have undergone total hysterectomy and have no history of cervical cancer, CIN, or high-risk HPV not undergo screening for cervical cancer or screening for vaginal cancer. This is consistent with consensus guidelines [4].
Patients who have undergone a hysterectomy in which the cervix was removed and have never had any screening abnormality have no risk of cervical cancer [47]. Although it was once believed that patients without a uterus were at increased risk for vaginal cancer [48-52], studies show no association between total hysterectomy for benign disease and subsequent vaginal carcinoma [52-57]. In addition, there is no role for screening for vaginal cancer in patients with a history of hysterectomy for benign disease. (See "The gynecologic history and pelvic examination", section on 'Examination after hysterectomy'.)
•Subtotal hysterectomy (cervix intact) – Patients who have undergone subtotal hysterectomy and have no history of CIN likely share the same risk of cervical cancer as patients with an intact uterus and cervix, and screening recommendations should follow the guidelines for average-risk patients described above. (See 'How to screen' above.)
Patients who are uncertain if their cervix was removed at the time of a benign hysterectomy should undergo a pelvic examination to determine if the cervix is present.
●Unknown screening history – For patients who have had a total hysterectomy but do not know their screening history, management is unclear. The decision to continue versus discontinue screening is determined on a case-by-case basis, after a discussion of the risks and benefits. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Benefits of screening' and "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Potential harms'.)
Recipients of HPV vaccine — The optimal approach to cervical cancer screening in patients who have received the HPV vaccine remains uncertain [58]. Until data from clinical trials are available, standard cervical cancer screening recommendations should be observed for patients who have received the HPV vaccine. This is discussed in detail separately. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Recipients of HPV vaccine'.)
Sexually abstinent patients — Patients should be screened even if they report sexual abstinence. New detection of HPV infections in sexually abstinent patients may be due to the reactivation of a prior infection. In addition, patients may be at risk due to a variety of reasons for not disclosing prior sexual activity, including social, religious, or cultural norms; expectations regarding modesty, maintaining sexual abstinence, and shame; as well as reluctance to acknowledge prior sexual violence [59]. Furthermore, HPV can be transmitted through skin-to-skin genital touching, which patients may not consider as sexual activity.
Symptomatic patients — Patients of any age, including those ages <21 years, who have signs or symptoms of cervical disease (eg, abnormality on visualization or palpation of the cervix, abnormal or postmenopausal bleeding, abnormal discharge, pelvic pain) should undergo appropriate diagnostic evaluation regardless of prior screening history. This evaluation often includes cervical cytology, cervical biopsy, and/or endometrial biopsy; by definition, this evaluation is diagnostic, not "screening," and may require additional follow-up. (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis", section on 'Clinical manifestations'.)
FOLLOW-UP OF ABNORMAL RESULTS —
Patients with positive HPV results, or those with abnormal, unsatisfactory, or satisfactory but limited cytology results need appropriate follow-up.
Result categories — The following abnormal result categories are discussed in detail elsewhere (table 4):
●Pap test satisfactory for evaluation but limited (see "Cervical cancer screening: The cytology and human papillomavirus report", section on 'Satisfactory for evaluation')
●Pap test unsatisfactory (see "Cervical cancer screening: The cytology and human papillomavirus report", section on 'Unsatisfactory for evaluation')
●Abnormal HPV and/or Pap testing (see "Cervical cancer screening: Risk assessment, evaluation, and management after screening")
●Atypical and malignant glandular cells (see "Cervical cytology: Evaluation of atypical and malignant glandular cells")
●Cervical cancer (see "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis", section on 'Diagnosis')
After the evaluation of the abnormal screening result is complete, most patients will require long-term surveillance. Only a minority of patients will return to age-based cervical cancer screening (see 'Defining average risk' above).
Impact of inadequate follow-up — Inadequate follow-up of abnormal cervical cancer screening results performed months or years before the diagnosis of cancer is, unfortunately, a common issue [60-64]. In one study, the median time from the date of the "failed" follow-up for an abnormal Pap test to the cancer diagnosis was 22 months [65]. Patient characteristics associated with a greater likelihood of failed follow-up include older and younger age, poverty, and those with Medicaid (compared with commercial) insurance [64,65]. By contrast, those with a primary care clinician may be more likely to have timely testing [64]. This is also discussed separately. (See "Cervical cancer screening: Benefits, harms, screening methods, and patient risk groups", section on 'Improving screening rates'.)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Basics topic (see "Patient education: Cervical cancer screening tests (The Basics)")
●Beyond the Basics topics (see "Patient education: Cervical cancer screening (Beyond the Basics)" and "Patient education: Management of a cervical biopsy with precancerous cells (Beyond the Basics)" and "Patient education: Follow-up of low-grade abnormal Pap tests (Beyond the Basics)" and "Patient education: Follow-up of high-grade or glandular cell abnormal Pap tests (Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
●Defining average risk – For cervical cancer screening, average risk is defined as individuals with a cervix who are asymptomatic (ie, no signs or symptoms of cervical disease such as abnormal bleeding), immunocompetent, and have had all normal cervical cancer screening results in the past, with a few exceptions, as noted above. (See 'Defining average risk' above.)
●Age to initiate screening – For most average-risk individuals, we suggest initiating screening between the ages of 21 and 25 years rather than earlier initiation (Grade 2C). This approach is consistent with most screening guidelines in resource-abundant countries (table 1). For example, screening starts at age 21 years according to the United States Preventative Task Force (USPSTF) and at age 25 years according to American Cancer Society (ACS) guidelines. Almost all guidelines advise against screening prior to age 21 years, regardless of the age of initiation of sexual activity. (See 'First screening between 21 and 25 years' above and 'Not screening prior to 21 years' above.)
●Testing method and frequency – Many guidelines have adopted primary HPV as the preferred screening method; however, the preferred testing method (ie, primary HPV testing, co-testing, cervical cytology) varies in available guidelines, and local availability, as summarized in the table (table 1). (See 'Choice of test' above and 'Increased utilization of HPV-based testing' above.)
•In the United States, the USPSTF recommends cytology every three years for patients ages 21 through 29 and primary HPV testing every five years, cervical cytology every three years, or co-testing (HPV plus cervical cytology) every five years for those ages 30 through 65. The ACS recommends primary HPV testing every five years for patients ages 25 through 65. Other options for patients ages 30 to 65 include screening with cervical cytology every three years or co-testing every five years. (See 'Choice of test' above.)
•HPV self-collection may be used in some countries to expand screening access, particularly in those individuals with barriers to screening. In the United States, only certain HPV tests (eg, Onclarity HPV, Cobas HPV) have been approved by the US Food and Drug Administration (FDA) for self-collection (table 3). (See 'Role of HPV self-collection' above.)
●Discontinuing screening – The decision to discontinue screening depends on whether the patient has had adequate prior screening, their life expectancy, and preferences in a shared decision-making discussion. (See 'Age to discontinue screening' above.)
•In the United States, for patients who have an adequate and all normal screening history, screening is often discontinued after age 65 years.
•By contrast, for those without adequate prior screening or an unknown screening history, screening should continue beyond age 65 years. However, the frequency and duration of this screening are unclear.
●Special considerations
•Prior hysterectomy – Patients who have had a total hysterectomy (removal of the cervix) and have no history of cervical cancer, cervical intraepithelial neoplasia (CIN), or high-risk HPV do not need to undergo screening for cervical cancer. By contrast, patients who have had a subtotal hysterectomy (cervix intact) and have no history of CIN likely should be screened similarly to patients with a cervix who have not undergone hysterectomy. For patients who have had a total hysterectomy but do not know their screening history, management is unclear. The decision to continue versus discontinue screening is determined on a case-by-case basis, after a discussion of the risks and benefits. (See 'Prior hysterectomy for benign disease' above.)
•Symptomatic patients – Patients with signs or symptoms of cervical disease (eg, abnormality on visualization or palpation of the cervix, abnormal bleeding, abnormal discharge) should undergo appropriate diagnostic evaluation (with cervical cytology, biopsy, and/or endometrial biopsy); this evaluation is diagnostic, and not "screening." (See 'Symptomatic patients' above.)
●Abnormal results – Patients with positive HPV results, or those with abnormal, unsatisfactory, or satisfactory but limited cytology results need appropriate follow-up. This is described in related UpToDate topics. (See 'Follow-up of abnormal results' above.)
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