Summary

USPSTF cervical cancer screening recommendation for asymptomatic individuals with a cervix. Screen women 21–29 with cytology every 3 years; screen women 30–65 with cytology every 3 years, primary hrHPV testing every 5 years, or hrHPV/cytology cotesting every 5 years (all Grade A). Do not screen women <21, women >65 with adequate prior screening, or women post-hysterectomy with cervix removed and no prior high-grade lesion (Grade D). Major change from 2012: primary hrHPV testing every 5 years added as a stand-alone option for women ≥30.

Key Recommendations

Screen women aged 21–29 every 3 years with cervical cytology alone (Grade A).
Screen women aged 30–65 every 3 years with cytology alone, OR every 5 years with primary hrHPV testing alone, OR every 5 years with hrHPV/cytology cotesting (Grade A).
Do not screen women younger than 21 years regardless of sexual history (Grade D).
Do not screen women older than 65 with adequate prior screening who are not otherwise high risk (Grade D).
Do not screen women after hysterectomy with cervix removal if no history of CIN 2/3 or cervical cancer (Grade D); confirm cervix removal via surgical records or exam.
Do not use primary hrHPV testing in women <30 due to high rates of transient HPV infection leading to overdiagnosis.
Continue screening per recommendations in women who have received HPV vaccination.
Women with HIV, immunocompromise, in utero DES exposure, or prior high-grade lesion/cancer fall outside this recommendation and require individualized follow-up.
Continue screening for at least 20 years after treatment of a high-grade precancerous lesion, even if this extends beyond age 65.
Focus implementation on ensuring adequate screening, follow-up of abnormal results, and treatment access — particularly in underscreened populations.

Thresholds & Doses

Age 21: start screening (cytology every 3 years).
Age 30: eligible to switch to primary hrHPV alone or cotesting every 5 years.
Age 65: stop screening if adequate prior screening and not high risk.
Cytology interval: every 3 years (ages 21–65).
Primary hrHPV testing interval: every 5 years (ages 30–65).
Cotesting (cytology + hrHPV) interval: every 5 years (ages 30–65).
Adequate prior screening defined as 3 consecutive negative cytology results OR 2 consecutive negative cotesting/HPV results within 10 years before stopping, with the most recent test within 5 years.
Continue post-treatment surveillance for ≥20 years after a high-grade lesion, even past age 65.

Citations

Recommendation Summary table — age-stratified screening grades (A/D)
Clinical Considerations: Timing of Screening — rationale for ages 21, 30, and 65 cutoffs
Clinical Considerations: Women Older Than 65 Years — definition of adequate prior screening
Clinical Considerations: Screening Interval — 3-year cytology vs 5-year hrHPV/cotesting rationale
Update of Previous USPSTF Recommendation — addition of primary hrHPV testing as option vs 2012
Table: Characteristics of Cervical Cancer Screening Tests — modeled mortality reductions per strategy
Clinical Considerations: Patient Population Under Consideration — exclusions (HIV, DES, immunocompromise, prior high-grade lesion)