HPV cervical screening
Cervical Cancer Screening Options
Recommended options for screening aged 30–65 years:
Primary hrHPV testing every 5 years
Cervical cytology alone every 3 years
Co-testing (cytology + hrHPV testing) every 5 years
All strategies are effective with a balance of benefits (disease detection) and potential harms (more frequent follow-ups, invasive procedures, false positives).
Primary hrHPV testing and co-testing detect more high-grade cervical intraepithelial neoplasia than cytology alone; however, hrHPV tests lead to more colposcopies and false positives.
Two hrHPV tests are FDA-approved for individuals aged 25 and older.
Cytology remains the recommended screening method for ages 21–29 years, but hrHPV testing can be considered for average-risk 25–29 year-olds.
Future Directions
In 2020, the American Cancer Society (ACS) made primary hrHPV testing the preferred screening option for ages 25–65 years.
Slow uptake due to limited availability of tests and necessary lab infrastructure changes, with concerns about access in rural and disadvantaged communities.
ACS proposes phasing out cytology options as hrHPV testing access improves, while cytology remains an option until then.
HPV self-sampling could improve access but is still investigational.
Age to Initiate Screening
HPV vaccines advance primary prevention; increasing vaccination may lead to raising the screening age to 25 years.
Current HPV vaccination rates are below targets with disparities among different demographics.
Cervical cancer screening initiation is still recommended at age 21 years due to health equity concerns.
Conclusion
Screening options (cytology, primary hrHPV testing, co-testing) are effective, but adherence to guidelines is crucial.
Inadequate screening and health inequities persist in the U.S.
HPV vaccination remains a vital prevention method and should be strongly recommended by healthcare professionals.
Cervical cancer prevention, screening, and treatment are essential for comprehensive reproductive health care.