Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society.

Fontham, Elizabeth T. H.; Wolf, Andrew M. D.; Church, Timothy R.; Etzioni, Ruth; Flowers, Christopher R.; Herzig, Abbe; Guerra, Carmen E.; Oeffinger, Kevin C.; Shih, Ya‐Chen Tina; Walter, Louise C.; Kim, Jane J.; Andrews, Kimberly S.; DeSantis, Carol E.; Fedewa, Stacey A.; Manassaram‐Baptiste, Deana; Saslow, Debbie; Wender, Richard C.; Smith, Robert A.

doi:10.3322/caac.21628

Cited by 968Cervical Cancer and HPV ResearchWomen's cancer prevention and managementEndometrial and Cervical Cancer Treatments

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society.

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Fontham, Elizabeth T. H., Wolf, Andrew M. D., Church, Timothy R., Etzioni, Ruth, Flowers, Christopher R., Herzig, Abbe, Guerra, Carmen E., Oeffinger, Kevin C. +10 more·2020·CA A Cancer Journal for Clinicians

DOI 10.3322/caac.21628

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Abstract

The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

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The incidence of invasive cervical cancer in women aged <25 years is decreasing because of vaccination.
“This change is recommended because the incidence of invasive cervical cancer in women aged <25 years is decreasing because of vaccination (177).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [177]
The ‘Age to Begin Cervical Cancer Screening’ section (page not provided) reports very low cancer burden under age 25 and declining detection of HPV and precancerous lesions since vaccination began. It does not establish that invasive cervical cancer incidence in that age group is already decreasing because of vaccination; the paper attributes the historical decline in cervical cancer incidence largely to screening. (LLM, conf=0.85)
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Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21660 · Cited by 108,699 · see citing works
Cancer Statistics, 2021
Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2021) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21654 · Cited by 16,522 · see citing works
Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
Acceptability and validity of <scp>HPV</scp> self‐sampling for cervical cancer screening among women living in different ecological settings in <scp>India</scp>
Mishra, G. A., Pimple, S. A., Anand, K. V., Kulkarni, V. Y., Patil, A. S., & Biswas, S. K. (2025) · International Journal of Cancer · doi:10.1002/ijc.35222 · Cited by 10 · see citing works

Authors: Fontham, E. T. H., Wolf, A. M. D., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., Guerra, C. E., Oeffinger, K. C., Shih, Y. T., Walter, L. C., Kim, J. J., Andrews, K. S., DeSantis, C. E., Fedewa, S. A., Manassaram‐Baptiste, D., Saslow, D., Wender, R. C., & Smith, R. A.
Affiliations: Louisiana State University (US)
University of Virginia (US)
University of Minnesota (US)
University of Washington (US)
The University of Texas MD Anderson Cancer Center (US)
University at Albany, State University of New York (US)
University of Pennsylvania (US)
Duke Cancer Institute (US)
San Francisco VA Medical Center (US)
Harvard University (US)
American Cancer Society (US)
Thomas Jefferson University (US)
Corresponding author: Smith, Robert A.
ORCID: Wolf, Andrew M. D.
Church, Timothy R.
Etzioni, Ruth
Flowers, Christopher R.
Herzig, Abbe
Guerra, Carmen E.
Oeffinger, Kevin C.
Shih, Ya‐Chen Tina
Walter, Louise C.
Kim, Jane J.
DeSantis, Carol E.
Fedewa, Stacey A.
Manassaram‐Baptiste, Deana
Wender, Richard C.
Smith, Robert A.
Venue: CA A Cancer Journal for Clinicians
Publisher: Wiley
Published: 2020-07-30
Volume: 70
Issue: 5
Pages: 321-346
ISSN: 0007-9235 (ISSN-L)
1542-4863
DOI: 10.3322/caac.21628
OpenAlex: W3045996770
Cited by: 968
References: 157
Citations by year: 2026: 68 · 2025: 155 · 2024: 197 · 2023: 200 · 2022: 197 · 2021: 135 · 2020: 14
FWCI: 97.77
Type: journal article
Language: en
Open access: gold
doi.org
Licence: other-oa
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: CA A Cancer Journal for Clinicians (publishedVersion, other-oa)
PubMed (publishedVersion)
Funders: American Cancer Society
Burroughs Wellcome Fund
V Foundation for Cancer Research
Impact Fund
Pfizer
AstraZeneca
Gilead Sciences
Celgene
Harvard T.H. Chan School of Public Health
TG Therapeutics
BeiGene
National Institutes of Health
Centers for Disease Control and Prevention
Genentech
Pharmacyclics
National Cancer Institute
Topics: Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Keywords: cervical cancer screening, HPV testing, primary HPV testing, cervical cytology, screening age, screening cessation, average-risk women, American Cancer Society guidelines, cervical intraepithelial neoplasia
MeSH terms: Adult, Aged, American Cancer Society, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Female, Humans, Mass Screening, Middle Aged, United States, Vaginal Smears, Papillomaviridae, Papillomavirus Infections, Papillomavirus Vaccines, Early Detection of Cancer

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Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society.

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