New federal guidelines reshape cervical cancer prevention by expanding self-collection, eliminating cost sharing, and aiming to reach millions of women who have been left out of routine screening.
Study: New Cervical Cancer Screening Guidelines From the US Department of Health and Human Services. Image credit: Peakstock/Shutterstock.com
A viewpoint published in JAMA reports that decades of cervical cancer screening have cut US incidence and mortality by more than half, while outlining new federal guidelines that expand HPV testing and allow self-collection to improve early detection.
A wide-spread implementation of cervical cancer screening has reduced its incidence and mortality rates by more than 50 % over the last 50 years in the United States. Since early-stage cervical cancer mostly remains asymptomatic, regular screening is vital for detecting the disease. With early detection, the 5-year survival rate of this cancer is higher than 90 %.
Despite well-established benefits of early detection, about 37 % and 15 % of cervical cancer cases are diagnosed after regional (lymph nodes) and distant metastases, respectively. For women diagnosed with distant metastatic disease, the 5-year survival is only 20 %.
Cervical cytology and High-Risk Human Papillomavirus (hrHPV) tests are highly recommended screening modalities for the early detection of cervical cancer. However, about 50 % of women with diagnosed cervical cancer have never been screened or are not up-to-date on screening. The screening rate is particularly lower among women with lower educational background, those living in poverty, or underprivileged women.
Given that early screening significantly improves 5-year survival, the U.S. Food and Drug Administration (FDA) has approved self-collection options to improve screening rates among women in the United States, addressing long-standing barriers to participation in preventive care.
New cervical cancer screening guidelines
The Health Resources and Services Administration (HRSA), an agency within the US Department of Health and Human Services, has been authorized by Section 2713 of the Public Health Service Act to develop disease preventive guidelines for women, including screening guidelines for cervical cancer.
Under the Public Health Service Act, most private health insurers are required to cover the HRSA-recommended preventive services without beneficiary cost sharing. In this scenario, HRSA-recommended screening services can have a tremendous effect on affordability and care access, particularly for women who face financial and logistical barriers to screening.
HRSA has recently announced updated cervical cancer screening guidelines, released in late 2025 and published in early 2026, based on a systematic review of the scientific evidence and alignment with U.S. Preventive Services Task Force (USPSTF) recommendations. These guidelines provide a new option for average-risk women to collect hrHPV samples on their own, either in a clinical setting or at home, depending on the FDA-approved test used.
Furthermore, these guidelines recommend hrHPV testing, either by the patient or by the clinician, as the preferred screening modality for average-risk women aged 30 to 65 years.
Under the updated HRSA guidelines, insurance companies are required to cover the healthcare costs for any additional testing that may be needed to complete the screening process for malignancies, thereby closing a previous coverage gap for follow-up care. The companies will begin coverage under these guidelines starting from January 1, 2027.
Recommendations made in the updated guidelines
The updated guidelines recommend cervical cancer screening for average-risk women aged 21 to 65 years. For women aged 21 to 29 years, cervical cytology-based screening is recommended every three years. Co-screening with cytology and hrHPV testing is not recommended for women aged below 30 years.
For women aged 30 to 65 years, primary hrHPV screening every five years, using either self-collected or clinician-collected samples, co-screening every five years, or cervical cytology alone every three years is recommended. Cancer screening more than once every three years is not recommended for average-risk women, reflecting evidence-based intervals that balance benefit and harm.
Notably, the new guidelines emphasize hrHPV testing as the preferred screening modality, including the option of self-collected hrHPV testing for cervical cancer screening for average-risk women aged 30 to 65 years, while retaining the provision for additional testing to complete the screening process and follow-up findings on the initial screening.
Benefits of the updated HRSA guidelines
The inclusion of self-collected hrHPV testing as a screening modality is a major benefit of the updated guidelines, as it is as effective as clinician collection. Existing evidence indicates that self-collection has the potential to increase screening rates, especially in historically hard-to-reach populations, when combined with insurance coverage and patient support services.
Self-collection can also increase screening rates by making the process less uncomfortable and easily accessible, especially for women who live in rural areas or face transportation or scheduling challenges.
Self-collection in cervical cancer screening is similar to stool collection in colorectal cancer screening, wherein a woman with a prescribed test can collect a vaginal swab either at home or in a healthcare setting and send it to the processing company through mail when home-based collection is used. The updated guidelines recommend that self-collection should be performed only with FDA-approved hrHPV tests, several of which received FDA approval in 2024 and 2025.
The updated HRSA guidelines further strengthen cervical cancer screening by retaining the option for additional tests to complete the screening process. Women can get these tests without beneficiary cost sharing, reducing the risk of delayed diagnosis due to out-of-pocket costs.
Notably, on January 1, 2026, the guidelines expanded coverage to include evidence-based patient navigation services for cervical cancer screening and follow-up. This step is vital for advancing women’s health and preventing chronic diseases, including cancer, by helping patients overcome administrative, cultural, and logistical barriers.
Clinical considerations and future directions
Regarding clinical implementation, it is important to note that these guidelines are recommended only for average-risk women. These guidelines are not applicable to women who are at higher risk of cervical cancer, including women infected with human immunodeficiency virus (HIV), immunocompromised women, women exposed to diethylstilbestrol in utero, or women treated for cervical intraepithelial neoplasia grade 2 or higher within the past 20 years.
As advised by experts, long-term surveillance is important to assess the practical utility and effectiveness of these guidelines. Ongoing research should focus on determining the optimal age to begin screening with hrHPV self-collection and the screening interval for hrHPV self-collection, particularly as real-world implementation data emerge.
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