Updated Cervical Cancer Prevention and Early Detection–Screening Guideline!
Cervical cancer is one of the few cancers that can be prevented by vaccination and detected through screening before cancer develops. Nevertheless, according to current GLOBOCAN 2024 estimates, among women worldwide it is the fifth most commonly diagnosed cancer: in 2024 there were approximately 604 thousand new cases and 280 thousand deaths .
The fundamental change in recent years is this: the focus of screening is increasingly shifting from the Pap smear to high-risk HPV testing . In December 2025, the American Cancer Society (ACS) added self-collected vaginal samples to its guideline as an acceptable screening option. In January 2026, HRSA also recommended offering self-collection to average-risk women aged 30–65. However, these developments do not mean “Pap smears are no longer necessary” or “a positive home HPV test is a cancer diagnosis” .
A cervical sample collected by a clinician is preferred and, if negative, is repeated every 5 years according to ACS. A self-collected vaginal sample using an appropriate FDA-authorized system is an acceptable alternative; if negative, ACS recommends repeating it every 3 years. If a Pap smear alone is used, the interval is 3 years.
| Topic | Previous approach | Current approach in 2025–2026 |
|---|---|---|
| Main screening test | The Pap smear was central to most explanations. | Primary high-risk HPV testing has become the preferred method for average-risk individuals. |
| Who collects the sample? | The sample used to be collected only by a healthcare professional. | A clinician-collected cervical sample remains preferred; with appropriate FDA-authorized systems, a self-collected vaginal sample is also acceptable. |
| Starting screening | Guidelines often emphasized age 21. | ACS: age 25. HRSA/WPSI: Pap at ages 21–29; HPV-based screening at ages 30–65. Türkiye: ages 30–65. |
| Stopping screening | The statement “screening can stop at age 65 with normal results” was insufficiently detailed. | Stopping at age 65 requires a defined number of timely negative results according to the test used, and no high-risk history. |
| HPV-positive result | HPV positivity was often treated as a single category. | HPV16/18 and other high-risk types carry different risks; genotyping and triage determine the next steps. |
- HPV vaccination
- Avoiding tobacco use
- Reducing HPV transmission risk through barrier methods
- Appropriate management of diseases affecting the immune system
- Primary high-risk HPV testing
- Combined HPV testing and Pap smear
- Pap smear
- Triage, colposcopy and, when necessary, biopsy after a positive result
Nearly all cervical cancers arise from a high-risk HPV type causing a persistent infection in the cervix. HPV infection is very common, and most infections are cleared spontaneously by the immune system. What matters for cancer is not a single encounter with the virus, but oncogenic HPV persisting for years and causing cellular changes.
A positive result indicates that high-risk HPV has been detected. The next step depends on HPV type, previous tests, age and any cytology result. For some people, repeat testing at short intervals is sufficient, whereas others need cervical sampling, dual staining, colposcopy or biopsy.
| Test | What does it look for? | ACS 2025 – average risk, ages 25–65 | Important detail |
|---|---|---|---|
| Clinician-collected primary HPV test | High-risk HPV types associated with cancer | Preferred Every 5 years |
The sample is collected from the cervix; an important advantage is the ability to perform additional triage using the same sample after a positive result. |
| Self-collected HPV sample | High-risk HPV in a vaginal sample | Acceptable Every 3 years if negative |
It is not a Pap smear. A positive result usually requires a clinician to collect a cervical sample. |
| HPV + Pap cotesting | Both high-risk HPV and cellular changes | Alternative Every 5 years |
An effective option if primary HPV testing is unavailable. |
| Pap smear | Abnormal cells in the cervix | Alternative Every 3 years |
A valid method when HPV testing is inaccessible; it does not directly detect HPV infection. |
Pap smear is not merely a “stain”; it is a cytology test named after Dr. George Papanicolaou, in which cells shed from or collected from the cervix are examined under a microscope. Colposcopy is not scraping the cervix, but examining it in detail under magnification; if a suspicious area is seen, a separate biopsy may be taken. VIA is visual inspection after dilute acetic acid application and is a resource-sensitive option mainly used in programs with limited access to validated HPV testing.
ACS recommends starting screening at age 25 for average-risk individuals.
Clinician-collected HPV every 5 years; self-collected HPV every 3 years; cotesting every 5 years; Pap every 3 years.
Screening is not automatically stopped without sufficient, timely negative results.
These are two separate United States guidelines. ACS emphasizes HPV-based screening between ages 25–65 for average-risk individuals who have a cervix. HRSA/WPSI recommends a Pap smear at ages 21–29 every 3 years and primary high-risk HPV testing at ages 30–65 every 5 years as the preferred method. HRSA also calls for self-collection to be offered at ages 30–65. This difference does not mean one is “right” and the other “wrong”; the guidelines have different objectives and ways of applying the evidence.
The person collects their own sample by inserting the brush or swab from a prescription kit validated with the relevant laboratory system into the vagina. The specimen is sent to the laboratory and tested for high-risk HPV. The procedure does not require a speculum; it may increase screening participation among people facing barriers related to privacy, vaginismus, limited mobility, a history of trauma, time or access to healthcare.
- It makes the first screening step possible without a pelvic examination.
- It may improve access to unreached or underscreened groups.
- With appropriate PCR-based tests, its performance approaches that of clinician-collected samples.
- It can be performed in a private area at a clinic or, with an appropriate system, at home.
- The sample comes from the vagina, not the cervix.
- It does not replace a Pap smear or gynecological examination.
- A positive result does not diagnose cancer and requires clinical follow-up.
- Not every kit can be used with every HPV test.
- 2024: Self-collection at a healthcare facility was authorized for certain HPV tests.
- 9 May 2025: Teal Wand received the first FDA marketing authorization in the United States for home sample collection in the average-risk 25–65 age group.
- 2 April 2026: The BD Onclarity Self-Collection Kit received 510(k) clearance for collecting a sample at home or in a private setting and sending it to a laboratory.
These authorizations apply specifically to the United States. FDA authorization of a product does not mean it is licensed, sold, reimbursed or included in the national screening program in Türkiye.
- People with symptoms such as abnormal vaginal bleeding, bleeding after intercourse, or foul-smelling or bloody discharge
- People with previous abnormal HPV/Pap results, colposcopy or treatment for CIN2+
- People with a history of cervical cancer
- People living with HIV or who are immunosuppressed
- People exposed to diethylstilbestrol (DES) in the womb
For these groups, the issue is personalized follow-up or diagnostic assessment rather than “routine screening.”
The high-risk type detected, particularly HPV16 and HPV18, determines the risk.
In most cases, clinician-collected Pap testing, dual staining or direct colposcopy is needed.
Repeat testing, colposcopy, biopsy or treatment of a precancerous lesion is planned.
The new guideline published by WHO in May 2026 addresses the role of limited and extended genotyping in risk classification using HPV-DNA tests. In practice, this means that not all high-risk HPV-positive results are managed in the same way. However, the pathway is determined not by type alone, but together with age, cytology, previous results, immune status and local algorithms.
The new ACS update makes the statement “screening may stop if previous tests are normal” more specific. In an average-risk person, screening can stop around age 65 only if the following conditions are met:
- If primary HPV testing or HPV + Pap cotesting was used, the last two tests must be negative and performed at the recommended intervals; ACS gives testing at ages 60 and 65 as an example.
- If only Pap smears were used, the last three tests must be negative and performed at the recommended intervals, with the last test around age 65.
- There must be no high-risk history such as CIN2, CIN3, adenocarcinoma in situ or cervical cancer.
Assessment continues if the screening history is unknown or incomplete or there have been previous abnormalities. In people previously treated for high-grade precancerous lesions, follow-up may continue for many years regardless of the age limit.
For women aged 30–65, an HPV-DNA test every 5 years is provided. Community-based screening is performed free of charge at Family Health Centers, Healthy Life Centers and KETEM centers. Positive or suspicious results are referred to diagnostic centers for further evaluation.
Therefore, the United States recommendations to “start at age 25” and use “home self-collection” should not be regarded as directly equivalent to Türkiye’s national program. For an average-risk person living in Türkiye, the practical public-program recommendation is HPV-DNA screening between ages 30–65, every 5 years. However, symptoms warrant gynecological assessment without waiting for a particular age or screening interval.
HPV-DNA testing or a Pap smear is only one part of an overall women’s health assessment. New bleeding, discharge, pain or other complaints should not wait until the next screening date. The frequency of routine health consultations is planned separately according to individual needs.
According to WHO/UNICEF data published in July 2026 reflecting the situation through the end of 2025, Türkiye remains among countries that have not yet included HPV vaccination in their national routine immunization schedule. HPV vaccination is also absent from the Ministry of Health’s published routine schedule. Although the vaccine can be obtained individually in Türkiye, the greatest population-level impact can be achieved through a national program providing widespread and equitable access to the appropriate age group.
Yes. HPV vaccines provide strong protection against most of the major high-risk types causing cervical cancer, but they do not cover every oncogenic HPV type or treat infections acquired before vaccination. Vaccinated people should therefore continue screening according to national recommendations.
Protection is greatest before exposure to HPV. WHO identifies girls aged 9–14 as the priority target group. Many countries also include boys in their vaccination programs.
Catch-up vaccination benefits previously unvaccinated young adults. At older adult ages, the decision is individualized according to previous exposure, the likelihood of new infection, licensing and national recommendations.
This target does not mean cervical cancer disappearing entirely from the world, but reducing its incidence to a level no longer considered a public health problem. Success requires not only testing, but completion of diagnosis and treatment after a positive result.
- HIV infection or another form of immunosuppression
- Organ transplantation or long-term immunosuppressive treatment
- Previous CIN2+, adenocarcinoma in situ or cervical cancer
- DES exposure in the womb
- An abnormal screening result or incomplete follow-up
- Hysterectomy without removal of the cervix
- Bleeding after intercourse, irregular bleeding, bloody/foul-smelling discharge or pelvic pain
Routine cervical screening is generally unnecessary if the cervix was completely removed by total hysterectomy and there is no history of CIN2+ or cervical cancer. However, screening should not stop without confirming the type of operation and pathology history.
Cervical cancer is one of the few cancers whose biology we understand, for which an effective vaccine exists, and whose precursors can be detected through screening. Continued deaths therefore point more to gaps in access and the follow-up pathway than to a lack of scientific tools.
Self-collection may be an important milestone in reaching people who have never been screened or are underscreened. Performance approaching clinician-collected samples with appropriate PCR-based systems creates an opportunity to reduce privacy and access barriers.
A home HPV test is not a “cancer test,” a Pap smear or a gynecological examination. A self-collection program that does not link positive results to clinical assessment cannot complete cancer prevention, even if it increases the number of screening tests.
Participation in existing free HPV-DNA screening should increase, and follow-up should establish whether HPV-positive individuals reach colposcopy and treatment. In parallel, including HPV vaccination in the national program is the most important structural step toward a lasting reduction in the burden of cervical cancer.
Screening is moving toward a more personalized model comprising clinician-collected or self-collected HPV testing, extended genotyping, molecular triage and risk-based follow-up. The goal is not more tests, but accurately identifying high risk, reducing unnecessary procedures and preventing loss to follow-up.
- World Health Organization. Cervical cancer fact sheet. 3 July 2026.
- Perkins RB, et al. Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: An update to the American Cancer Society cervical cancer screening guideline. CA Cancer J Clin. 2026. doi:10.3322/caac.70041.
- American Cancer Society. Updated Cervical Cancer Screening Guidelines. 4 December 2025.
- Health Resources and Services Administration. New Cervical Cancer Screening Guidelines Strengthen Women’s Preventive Health. 5 January 2026.
- World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions: use of HPV DNA genotyping. 8 May 2026.
- ASCCP. Practice Advisory: Self Collection for Cervical Cancer Screening. October 2025.
- U.S. Food and Drug Administration. Teal Wand De Novo decision summary (DEN240045); BD Onclarity Self-Collection Kit 510(k) decision summary (K260184).
- Republic of Türkiye Ministry of Health, General Directorate of Public Health. National Cancer Screening Program.
- WHO/UNICEF. HPV vaccination coverage estimates—2026 revision.
- IARC Global Cancer Observatory. GLOBOCAN 2024 Türkiye country fact sheet.
- Related drozdogan.com content: Home HPV screening for cervical cancer · The 20th anniversary of HPV vaccination · What are CIN1, CIN2 and CIN3?
Editor’s note: This content provides general information, not personalized screening or treatment recommendations. Screening starting ages and intervals may vary by country, the test used and individual risk. The ACS and HRSA recommendations presented here are United States guidelines; Türkiye’s community-based national program uses HPV-DNA testing between ages 30–65 every 5 years. Symptoms, previous abnormal results, immunosuppression or a history of high-grade lesions require individualized assessment instead of the routine schedule.
Sources
Primary Prevention of Cervical Cancer Resource-Stratified Guideline.
March 2017, JGO
Jose Jeronimo, Philip E. Castle, Sarah Temin et al.
Secondary Prevention of Cervical Cancer Resource-Stratified Guideline.
October 2016, JGO
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