cervical cancer

The incidence and mortality of cervical cancer have fallen since the adoption of widespread screening, but it still disproportionately affects underserved populations in the US. Expanding access to screening, especially in primary care settings, may reduce these disparities and improve women’s health. This Clinical Insights article summarizes cervical cancer screening recommendations for patients with average and higher than average risk, including recommendations for self-collected human papillomavirus (HPV) testing. It highlights statements by the US National Cancer Institute–sponsored Enduring Guidelines Committee, which was established to continuously evaluate new technologies for cervical cancer screening, management, and surveillance.

Author/s:

Hunter K. Holt, MD, MAS, Yasaswi Kislovskiy, MSc, George F Sawaya

New Cervical Cancer Screening Guidelines From the US Department of Health and Human Services: Strengthening Women’s Preventive Health

Megan George — Tue, 06 Jan 2026 14:29:39 +0000

Date Added:

January 6, 2026

Journal/Publication:

JAMA

Publication Date:

January 5, 2026

URL:

New Cervical Cancer Screening Guidelines From the US Department of Health and Human Services: Strengthening Women’s Preventive Health

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26456

Keywords

cervical cancer

Cancer Screeing

PMID (1):

41489823

MeSH

uterine cervical neoplasms

Papanicolaou Test

early detection of cancer

Uterine Cervical Dysplasia

Human Papillomavirus Viruses

Updated HRSA (2026) guidelines for cervical cancer screening. James W. Mold, MD, MPH

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Cervical cancer screening is one of the most significant public health accomplishments of the 20th century. Over the last 50 years, incidence and mortality rates from cervical cancer in the US have decreased by more than 50%1 because of widespread use of the Papanicolaou test and later adoption of high-risk human papillomavirus (hrHPV) testing.

Regular screening is critical in detecting disease because women with precancerous cervical intraepithelial neoplasia or early-stage cervical cancer are often asymptomatic. When detected early, 5-year cervical cancer survival is higher than 90%.1 Yet more than half of all cervical cancer diagnoses are made beyond an early stage; 37% when cancer has spread regionally to local lymph nodes and 15% when there are distant cancer metastases. Five-year survival is just 20% for women diagnosed with metastatic disease.1

Cervical cytology (Papanicolaou test) and hrHPV tests are highly effective in detecting early, more treatable disease; however, these modalities are only beneficial for women who undergo recommended screening. Unfortunately, about half of all women diagnosed with cervical cancer have never been screened or are not up-to-date on screening,2 and these women are more likely to present with regional or distant metastatic disease. Overall, approximately 1 in 4 women in the US are not up-to-date on cervical cancer screening.3 Women living in poverty or having fewer years of formal education have even lower screening rates. The direct link between screening and survival illustrates a clear and urgent need to improve cervical cancer screening rates in the US; new self-collection options approved by the US Food and Drug Administration (FDA) provide an opportunity to do so.

Author/s:

Brian Christine, Margaret Bush, Anita Thurakal, Ann M Sheehy

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Megan George — Thu, 04 Sep 2025 19:41:24 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 6, 2025

URL:

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2971

Keywords

PMID (1):

40478588

MeSH

Uterine Cervical Neoplasms* / diagnosis

Single-Blind Method

Safety-net Providers*

Early Detection of Cancer* / methods

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Design, Setting, and Participants This pragmatic, parallel, single-blinded, randomized clinical trial within a publicly funded safety-net health system in Houston, Texas, compared (1) telephone reminder (TR) for clinic-based screening, (2) TR with mailed self-collection (SC), and (3) TR with mailed SC and patient navigation among a random sample of CCS-eligible patients not up to date with CCS, including those with no CCS on record. The trial was conducted from February 20, 2020, to August 31, 2023.

Interventions All groups received a TR by a patient navigator to attend clinic-based CCS. In the SC and SC with patient navigation groups, participants were additionally mailed a self-collection kit to their home as an alternative to clinic-based CCS. In the SC with patient navigation group, the mailed kit was followed by a patient navigation telephone call.

Main Outcomes and Measures CCS participation was defined as attendance for clinic-based screening or return of a mailed self-collection kit within 6 months of randomization and determined through electronic health record review.

Results Of the 2474 participants in the intent-to-screen analyses (median [IQR] age, 49 [39-57] years), 2325 (94.0%) were from racial or ethnic minoritized populations (1655 [66.9%] identifying as Hispanic or Latino, 82 [3.3%] as non-Hispanic Asian, 535 [21.6%] as non-Hispanic Black or African American, and 53 [2.1%] as other or unknown race, including American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander), and 1388 (56.1%) were covered by the county’s publicly funded financial assistance program. At 6 months, 144 of 828 participants (17.4%) in the TR group, 340 of 828 (41.1%) in the SC group, and 381 of 818 (46.6%) in the SC with patient navigation group had participated in CCS. Compared to TR, relative participation was 2.36 (95% CI, 1.99-2.80) times higher for SC and 2.68 (95% CI, 2.27-3.16) times higher for SC with patient navigation; screening difference was 23.7% (95% CI, 19.4%-27.9%) for SC and 29.2% (95% CI, 24.9%-33.5%) for SC with patient navigation.

Conclusions and Relevance In this randomized clinical trial in a safety-net health system, SC was effective for increasing CCS participation among underscreened patients; there were modest additional gains from SC with patient navigation. The large increase in CCS participation using SC compared to TR suggest that SC should be considered in safety-net settings with suboptimal CCS coverage.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Megan George — Thu, 04 Sep 2025 19:41:13 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 6, 2025

URL:

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2971

Keywords

PMID (1):

40478588

MeSH

Uterine Cervical Neoplasms* / diagnosis

Single-Blind Method

Safety-net Providers*

Early Detection of Cancer* / methods

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Cervical Cancer

Alex Haga — Wed, 08 Jan 2025 14:37:18 +0000

Date Added:

January 8, 2025

Journal/Publication:

New England Journal of Medicine

Publication Date:

January 1, 2025

Issue:

Volume:

392

Pages:

56-71

URL:

Cervical Cancer

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2404457

Keywords

cervical cancer

PMID (1):

39752299

MeSH

uterine cervical neoplasms

A review of current knowledge regarding cervical cancer. James W. Mold, MD, MPH

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Cervical cancer is preventable through vaccination and treatment of dysplasia identified on screening (cytologic screening, DNA testing for high-risk human papillomavirus subtypes, or both).
Early-stage cervical cancer is treated with open radical hysterectomy and pelvic lymphadenectomy; small lesions can be treated with extrafascial hysterectomy or more conservative fertility-preserving operations.
Locally advanced cervical cancer is treated with chemoradiation therapy plus brachytherapy; incorporation of immunotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage III through IVA disease is associated with a survival benefit.
Isolated, centrally recurrent cervical cancer may be managed by means of pelvic exenteration with urinary diversion; however, owing to an increased incidence of distant or concomitant pelvic and extrapelvic relapse after widespread adoption of chemoradiation for locally advanced disease, fewer patients are candidates for this operation than in previous years.
Patients with newly diagnosed recurrent or metastatic disease may benefit from chemotherapy plus immunotherapy, with or without bevacizumab.
Antibody–drug conjugates may be an option for patients with disease progression after treatment with chemotherapy plus immunotherapy.

Author/s:

Krishnansu S Tewari

Cervical Cancer Screening

Erin Blanchette — Mon, 13 Nov 2023 16:19:48 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 27, 2023

URL:

Cervical Cancer Screening

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.21987

Keywords

Human Papillomavirus Viruses

PMID (1):

37889510

MeSH

Human Papillomavirus Viruses

Cervix Uteri

uterine cervical neoplasms

early detection of cancer

Papanicolaou Test

Patient education regarding cervical cancer screening. James W. Mold, MD, MPH

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This JAMA Patient Page discusses screening for cervical cancer, including who should be screened, recommendations for handling positive results, and the prevention of cervical cancer.

Author/s:

Rebecca A. Voelker

Managing Minimally Abnormal Cervical Cancer Screening Test Results

Brian Desmarais — Tue, 29 Sep 2020 14:27:23 +0000

Date Added:

September 29, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

September 25, 2020

URL:

Managing Minimally Abnormal Cervical Cancer Screening Test Results

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.12488

Keywords

cancer screening

cancer prevention

oncology

Pathology and Laboratory Medicine

cervical cancer

gynecological cancer

A concise summary of the recommended management of patients with abnormal pap smears. James W. Mold, MD

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Author/s:

Sawaya, George F., Lamar, Robyn, Perkins, Rebecca B.

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Tracy Ashby — Tue, 04 Sep 2018 05:00:00 +0000

Date Added:

November 1, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

August 6, 2018

Issue:

Volume:

320

Pages:

674-686

URL:

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Type:

Clinical Research Results, Public Health Announcements

Format:

Article

DOI (1):

10.1001/jama.2018.10897

Keywords

cervical cancer

screening

PMID (1):

30140884

MeSH

uterine cervical neoplasms

early detection of cancer

cohort studies

This new recommendation from the USPSTF suggests that it is not necessary to include HPV testing when doing pap tests, but if you do, the screening interval can be a little longer.

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IMPORTANCE:

The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

OBJECTIVE:

To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

FINDINGS:

Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer. (D recommendation).

Author/s:

US Preventive Services Task Force