Self-collection of vaginal samples for human papillomavirus (HPV) testing is now being considered an acceptable, recommended option for cervical cancer screening, per recent updates to the American Cancer Society's (ACS) guidelines published in CA: A Cancer Journal for Clinicians CA: A Cancer Journal for Clinicians.
Another significant update to the ACS guidelines is the age at which individuals can cease screening for cervical cancer.
“These updated recommendations will help to improve compliance with screening and reduce the risk of cervical cancer,” said senior author Robert Smith, PhD, Senior Vice President, Early Cancer Detection Science, ACS. “They are made possible as we continue to evolve our approach to screening for cervical cancer, primarily through research advancements, and the development of self-collection tools to broaden access to screening.”
Guideline Updates
The updated cervical cancer screening guidelines expand upon the 2020 ACS guidelines, which provided recommendations for screenings for average-risk women and individuals with a cervix who are at an average risk for developing cervical cancer, following new research and clinical evidence that support these changes.
In the updated guidelines, the ACS acknowledges the benefit of self-collected specimens as a way to increase access to cervical cancer.
“Geographic disparities continue to exist in cervical cancer incidence and mortality, with individuals living in rural areas more likely to be diagnosed with later-stage cervical cancer. Over 46 million, or 14%, of the U.S. population live in rural areas that often require the need to travel long distances to access health care,” said Lisa Lacasse, President of the ACS Cancer Action Network (CAN). “Self-collection options are a critical resource for these individuals and other underserved populations. ACS CAN remains committed to partnering with policymakers to strengthen access to cervical cancer screening and necessary follow-up care without added costs. This is an important step towards ending cancer as we know it, for everyone.”
The guidelines, in alignment with the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee, recommend screening for average-risk individuals between the ages of 25 and 65 years, for which clinician-collected cervical specimen testing is preferred but self-collection is acceptable with a U.S. Food and Drug Administration–approved test. Additionally, the guidelines recommend repeat testing in 3 years following a negative self-collected HPV screening test, and repeat testing at 5 years following a negative clinician-collected screening test. However, for higher-risk individuals clinician-collected samples are still recommended.
The ACS also noted that there has been historically been poor implementation of criteria for when individuals can cease screening. As such, the updated guidelines recommend HPV testing at 60 and 65 years of age, with the last HPV test taking place no earlier than 65 years before exiting screening. Negative consecutive primary HPV tests or negative cotesting with HPV tests and cytology at both 60 and 65 years of age are among the requisites for ending testing. However, in the case of self-collection, the interval should instead be 3 years. Individuals with higher risk factors should continue screening past the age of 65.
“In addition to funding research to help reduce the risk of cervical cancer, the American Cancer Society established the National Roundtable on Cervical Cancer (ACS NRTCC) in late 2022,” Dr. Smith added. “The ACS NRTCC is a coordinated effort with the mission to accelerate the elimination of cervical cancer primarily by improving prevention and screening uptake and addressing health disparities.”
DISCLOSURE: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
