ACS Updates Guidelines for Cervical Cancer Screening

The new guidelines suggest the need to phase out cotesting and cytology, shifting towards primary HPV testing starting at age 25 years.

The American Cancer Society (ACS) recently released updated guidelines for cervical cancer screening, recommending that screening begin at age 25 years rather than 21 years.

The updated guidelines also recommend that, when available, primary human papillomavirus (HPV) testing should start at age 25 years rather than 30 years. Even further, it was advised that cotesting and cytology should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers.

“It is expected that the availability and use of primary HPV testing for cervical cancer screening will increase in all health care settings in the United States; but, in the meantime, screening utilization and adherence are prioritized, thus continuing the use of cytology and cotesting is acceptable if primary HPV testing is not available,” the ACS wrote in update.

Additional updates to the guidelines included that individuals older than age 65 with a cervix stop being screened as long as they have had 10 years of regular screening with normal results. Otherwise, they should continue to be screened until they do.

With regard to those who have had their cervix removed, ACS suggests there is no need for screening as long as the cervix was removed for reasons not related to cervical cancer or serious precancer.

However, the new recommendations have been viewed as controversial, with some gynecologists expressing concerns that phasing out cotesting and cytology could result in missed cancers.

In an interview with CancerNetwork®, Michael D. Randell, MD, FACOG, an obstetrics and gynecology specialist with OGBYN Atlanta (an affiliate of Emory Saint Joseph’s Hospital), spoke about his apprehension towards the new guidelines and what he recommends for his patients.

This segment comes from the CancerNetwork® portion of the MJH Life Sciences Medical World News, airing daily on all MJH Life Sciences channels.


Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21628.