Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society
A newer version of this guideline has been published: Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: An update to the American Cancer Society cervical cancer screening guideline (2026)
- Study type
- Clinical guideline
- Study name
- ACS Cervical Cancer Screening 2020
- Design
- Clinical guideline (update of the 2012 American Cancer Society guideline) for cervical cancer screening
- Sample size
- Not applicable (clinical guideline)
- Source
- CA A Cancer J Clinicians · 2020
In plain words
The American Cancer Society recommends that cervical cancer screening start at age 25, preferably with an HPV test every 5 years until age 65. If this test is not available, co-testing (an HPV test together with a Pap smear) every 5 years or a Pap smear alone every 3 years is acceptable. People over 65 who have had no significant precancerous changes and have had enough negative screening tests in the past 10 years can stop screening. These recommendations are for people at average risk, and your own screening plan should be set by your doctor.
Key points
Key guideline recommendations
- Strong recommendation
People with a cervix should start cervical cancer screening at age 25 and have primary HPV testing every 5 years until age 65 (preferred).
- Strong recommendation
If primary HPV testing is not available, people aged 25 to 65 should be screened with co-testing (HPV with cytology) every 5 years or cytology alone every 3 years (acceptable).
- Qualified recommendation
People over 65 who have had no history of cervical intraepithelial neoplasia grade 2 or a more severe lesion in the past 25 years and who have documented adequate negative prior screening in the past 10 years should stop all cervical cancer screening.
- Level of recommendation not stated in the abstract
Follow-up of people with a positive HPV test and/or cytology should follow the 2019 risk-based management consensus guidelines of the American Society for Colposcopy and Cervical Pathology (ASCCP).
Study population
People with a cervix who are at average risk of cervical cancer.
Endpoints
This is a clinical guideline and has no trial endpoint. The abstract gives recommendations on the age to start screening, the screening method and interval, and the age to stop. Details of the methodology and evidence review are in the full text of the paper.
Safety and side effects
No data on the adverse effects or harms of screening are reported in the abstract. Details are in the full text of the paper.
Clinical significance and place in guidelines
This guideline changed the age to start screening from 21 to 25 and introduced primary HPV testing every 5 years as the preferred strategy. Co-testing and cytology alone are acceptable options only when primary HPV testing is not available, and should be phased out once full access to primary HPV testing is achieved. Follow-up of abnormal results should follow the 2019 ASCCP guideline. For use in any country, the status of national guidelines should be checked.
Limitations
This card is based on the abstract only. The abstract does not describe the quality of evidence, the methodology or the harms of screening. The recommendations are for people at average risk. The guideline is transitional and its implementation depends on access to FDA-approved primary HPV testing. Further details are in the full text of the paper.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.