Cervical cancer is usually caused by longtime infection with certain types of the human papilloma virus (HPV). But it is highly preventable—and curable if found early. That’s why screening is so important.
The standard screening procedure for this cancer, precancerous changes, and HPV itself involves a pelvic exam—usually at a doctor’s office—during which a swab of cells is collected from the cervix and examined in one of two ways: A Pap test looks for abnormal cells (which may become cancerous if left untreated) or cervical cancer itself. An HPV test looks for DNA evidence of the virus, specifically the high-risk type of HPV. An HPV test that shows the presence of the virus may require follow-up testing with a Pap test. Using both tests at once is known as co-testing.
These screening methods work: A Pap test can find precancerous cells early so they can be removed, lowering the risk of developing cervical cancer—and widespread use of this screening method has reduced the occurrence of and death from the disease in the U.S. by more than 50 percent over the last 30 years, according to a study several years ago in the American Journal of Clinical Oncology. HPV tests can tell if you’re at higher risk for cervical cancer so your doctor can monitor you more closely.
Unfortunately, nearly 30 percent of those who should be receiving regular screenings are not. And every year, about 11,500 new cases of cervical cancer are diagnosed in the U.S., and 4,000 women die from the disease. Many women forgo screening because they don’t want to have a pelvic exam or don’t have access to a provider who can do this type of screening. Access to regular, quality healthcare is an ongoing problem in the U.S., including for those who have no health insurance or live in rural areas that are medically underserved. Individuals with lower incomes and minority groups are disproportionately affected.
Enter self-screening
In May 2024, the U.S. Food and Drug Administration (FDA) gave the green light to self-tests for HPV, whereby users can now collect their own samples for analysis. This isn’t an at-home test (although that’s in the pipeline) but one that’s conducted by patients themselves in a healthcare setting like a doctor’s office, urgent care center, mobile health clinic, or pharmacy clinic.
To collect your sample, you’ll be in a private room or bathroom, as you would to give a urine sample. You remove the test swab from the tube, insert it into your vagina, and swirl it around three times to gather cells (sort of like a Covid test—but for the vagina). You return the swab to the tube and cap it. The cells are then tested for HPV in the same way they would be after a doctor-administered swab. These self-collected samples can be just as accurate as those collected by medical professionals.
Most cervical cancer occurs in women who have not been screened either recently or ever, says George F. Sawaya, MD, professor of obstetrics, gynecology, and reproductive sciences in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. “The FDA approval for a self-collected test for HPV is designed to expand access to screening specifically among those who have barriers to being seen in medical settings that are equipped to do pelvic examinations,” he says. “And some people may just prefer to do a self-collected test instead of having a speculum examination by a clinician.”
Self-collection, however, isn’t recommended for everyone, including those who are immunocompromised and those being followed for certain prior abnormal HPV or Pap test results or cervical abnormalities.
Next up: At-home testing
A self-test for home use is in development and may be available soon.* It’s part of a program from the National Cancer Institute called the “Last Mile” Initiative, which is focused on fast-tracking the development and approval of self-collection methods for HPV testing, including at-home options. Similar at-home tests are already in use for colon cancer screening in the U.S.
A 2023 study in JAMA examined whether individuals were more likely to be screened for HPV if they had the option to self-collect at home and mail in the sample for testing. The study involved more than 31,000 participants who were all due or overdue for their next screening.
Of those who received standard reminders and education about the importance of screening, 48 percent of those who were due and 19 percent of those who were overdue for screening made an appointment for a doctor’s visit and received the screening. But in the group that also had the option to use a self-screening kit, 62 percent of those due and 36 percent of those overdue were screened.
BOTTOM LINE: Self-collection for HPV testing expands the range of options available and can help break down barriers to being screened for cervical cancer. But whether you try this new self-collection method or continue with traditional Pap and HPV tests, it’s important to keep up to date with your screenings so that any evidence of cervical cancer can be caught—and addressed—early.
Keep in mind also that the most effective way to prevent cervical cancer is to be vaccinated against HPV. The vaccine is recommended for preteens and young adults up to age 26 (or older, depending on a discussion with your doctor).
Screening recommendations vary somewhat across medical groups. The American Cancer Society recommends that everyone ages 25 to 65 with a cervix have a primary HPV test every five years (the preferred test). If that is not available, other options are to have a Pap test every three years, or a co-test (a combined HPV/Pap test) every five years. (A good summary is found here.) The U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists say screening should start at age 21. Your doctor will discuss your testing options based on your history and risk factors.
After age 65, you may not need cervical screening any longer if you have had three Pap tests or two HPV tests in the past 10 years with normal results and you do not have a history of precancerous changes of the cervix in the past 25 years.
What if you have had a total hysterectomy and no longer have a cervix? You may imagine that there would be no need for further screening—but that’s true only if you had your cervix removed for reasons other than cervical cancer. If you had a total hysterectomy because of cervical cancer or a high-grade precancerous lesion, the general recommendation is to continue with regular Pap tests for up to 20 years after (consult with your gynecologist about the best time frame for you). That’s because cervical cells could remain in the upper region of the vagina (referred to as the vaginal cuff), and a Pap test (which would be done in this area, since there is no longer a cervix from which to swipe cells) can detect abnormal changes in them.
