The American Cancer Society (ACS) has updated its cervical cancer screening guidance to allow self-collected vaginal specimens for human papillomavirus (HPV) testing for average-risk people aged 25–65. This marks a major change in U.S. practice intended to improve access and reduce screening barriers for underserved populations.
What changed
– Average-risk individuals ages 25–65 may collect their own vaginal samples for HPV testing using FDA-cleared kits, typically under the supervision of a clinician in a healthcare setting. One at-home option, the Teal Wand paired with the Roche cobas HPV test, is FDA-cleared but currently available only through a proprietary telehealth service.
– The ACS based the change on multiple studies and meta-analyses showing that PCR-based HPV assays on self-collected vaginal specimens have sensitivity and specificity comparable to clinician-collected cervical samples, particularly for detecting high-risk HPV types linked to cervical precancer.
– If a self-collected HPV test is negative, the ACS recommends repeating screening in three years. This interval is shorter than the five years recommended after a negative clinician-collected primary HPV test; the shorter interval provides a “margin of safety” while more long-term U.S. data are collected.
Approved test and collection combinations 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 used with the Roche cobas HPV test (via a specific telehealth pathway)
Who should not use self-collection
Self-collection is not appropriate for higher-risk groups who need both HPV testing and cytology (Pap) because cytology requires clinician-collected cervical specimens. These excluded groups include people with HIV, those who are immunocompromised, anyone with a history of cervical cancer or cervical precancer, and people exposed in utero to diethylstilbestrol (DES).
Changes to stopping screening
The ACS also revised exit criteria to address cancers occurring after age 65. Roughly one-quarter of U.S. cervical cancers occur in people over 65, with higher mortality linked to inadequate screening before stopping.
Under the new guidance, average-risk individuals should have negative primary HPV tests (preferred) or negative co-tests at both ages 60 and 65 before ceasing screening. If those records are unavailable, three consecutive negative Pap tests at recommended intervals—with the last test at age 65—are acceptable. For those using self-collected HPV testing, the three-year screening interval applies. Screening should continue past age 65 for anyone with risk factors such as HIV, immunosuppression, abnormal results within the past 10 years, prior cervical precancer within 25 years, or any history of cervical cancer.
Practical implications
– After establishing appropriate results, ongoing screening frequency will depend on the test: every three years for some approaches and up to every five years for clinician-collected primary HPV testing.
– Clinician-collected cervical specimens remain the preferred approach, but self-collection offers an evidence-based alternative to increase screening uptake among people who face barriers to in-person clinician sampling, including those in rural areas, people with trauma histories, and those uncomfortable with speculum exams.
– The ACS emphasizes clear follow-up protocols and risk-based decision making to maintain safety while expanding options.
Expert perspectives
ACS authors and outside clinicians note the updates as progress toward reducing barriers: many people are overdue for screening, often citing discomfort as a reason. Self-collection and multiple testing options may increase screening participation by meeting people where they are and could help reduce the higher cervical cancer burden observed in older and rural populations.
