The American Cancer Society has updated its cervical cancer screening guidance to permit self-collected vaginal specimens for HPV testing in average-risk people aged 25–65. This change aims to expand access and reduce barriers to screening for underserved groups.
What changed
– Average-risk people 25–65 may now use FDA-cleared self-collection kits for PCR-based HPV testing, typically under clinician supervision in a healthcare setting. One at-home option, the Teal Wand used with the Roche cobas HPV test, is FDA-cleared but currently available only through a specific telehealth service.
– The recommendation rests on multiple studies and meta-analyses showing that PCR-based assays on self-collected vaginal samples have sensitivity and specificity comparable to clinician-collected cervical samples, especially for detecting the high-risk HPV types associated with cervical precancer.
– After a negative self-collected HPV result, the ACS recommends repeating screening in three years. This is shorter than the five-year interval recommended after a negative clinician-collected primary HPV test and provides a conservative margin while more long-term U.S. data are gathered.
Approved test and collection pairings cited by the ACS include:
– Roche cobas HPV test with FLOQSwab or Evalyn Brush
– BD Onclarity HPV test with FLOQSwab
– Abbott Alinity m with Evalyn Brush or Qvintip swab
– Teal Wand for at-home collection paired with Roche cobas HPV via a specific telehealth pathway
Who should not self-collect
Self-collection is not appropriate for higher-risk individuals who also require cytology (Pap) testing, because cytology needs clinician-collected cervical samples. Excluded groups include people with HIV, those who are immunocompromised, anyone with a history of cervical cancer or cervical precancer, and people who were exposed in utero to diethylstilbestrol (DES).
Changes to stopping screening
To address cancers that occur after age 65, the ACS revised exit criteria. Average-risk people should have negative primary HPV tests (preferred) or negative co-tests at both ages 60 and 65 before stopping screening. If those records are unavailable, three consecutive negative Pap tests at recommended intervals—with the last at age 65—are acceptable. For those using self-collected HPV testing, the three-year interval applies. Screening should continue past 65 for anyone with risk factors such as HIV, immunosuppression, recent abnormal results, prior cervical precancer within 25 years, or any history of cervical cancer.
Practical implications
– Clinician-collected cervical specimens remain the preferred approach, but self-collection is an evidence-based alternative to improve uptake among people facing barriers to in-person sampling, including those in rural areas, people with trauma histories, and those uncomfortable with speculum exams.
– Screening frequency will depend on the test: three-year intervals for self-collected approaches and up to five years for clinician-collected primary HPV testing.
– The ACS stresses that clear follow-up protocols and risk-based decision-making are essential to maintain safety while expanding options.
Expert perspectives
ACS authors and outside clinicians view the update as progress toward reducing screening barriers. Expanding validated self-collection options may increase participation and help address higher cervical cancer burdens in older and underserved populations by meeting people where they are.
