On January 5, the Health Resources and Services Administration (HRSA) released updated evidence-based cervical cancer screening guidelines designed to strengthen preventive healthcare and expand access to effective screening options for average-risk women aged 21–65 years. These new recommendations—developed through a rigorous review of scientific evidence and public feedback—represent the first major revision in nearly a decade and mark a concerted shift toward primary high-risk human papillomavirus (hrHPV) testing as the preferred screening modality for women aged 30–65.
Under the updated HRSA guidance, primary hrHPV testing every five years is now recommended as the preferred method for average-risk women ages 30–65, regardless of whether the sample is collected by a clinician or by the patient (self-collection). Co-testing with cytology (Pap test plus hrHPV) every five years and cytology alone every three years remain acceptable alternatives if primary hrHPV testing is unavailable. For women aged 21–29, traditional Pap (cytology) testing every three years continues to be recommended. Importantly, the guideline explicitly endorses HPV self-collection as an acceptable screening option for average-risk women in the 30–65 age group.
The updated guidance also introduces language ensuring that additional necessary follow-up tests—such as cytology, biopsy, extended genotyping, colposcopy, or dual stain technologies—are covered without cost sharing by most health insurance plans beginning January 1, 2027. Coverage protections under the Women’s Preventive Services Initiative mean these services will be included without beneficiary cost sharing, expanding affordability and reducing barriers to complete diagnostic follow-up.
The JAMA viewpoint accompanying the release underscores the importance of these changes, noting that cervical cancer screening has long been one of the most successful public health interventions in the United States, with significant reductions in incidence and mortality over the past five decades. It emphasizes that despite these gains, approximately one in four women is not up to date on recommended screening, and those who are under-screened are more likely to be diagnosed at later, less treatable stages. Expanded options—especially self-collection—provide new opportunities to reach historically underserved populations and reduce disparities in screening uptake.
Central to the guideline update is the recognition that high-risk HPV infection is the principal cause of cervical cancer, and that hrHPV testing demonstrates higher sensitivity than cytology alone for detecting precancerous lesions. Although traditional cytology remains an important tool, evidence suggests that primary hrHPV testing at five-year intervals can optimize early detection while minimizing unnecessary procedures.
Reflecting broad professional support for the evidence-based shift, Samantha Byrnes, PhD., strategy lead covering sexual health and HPV/cervical cancer on the molecular Medical Scientific Affairs team for Roche Diagnostics, commented on the updated guidelines: “The updated 2025 HRSA guidelines send a signal that there is significant consensus in cervical cancer screening to support primary hrHPV testing as the preferred testing method for women aged 30–65 years old. These updated guidelines also highlight the importance of offering the option of HPV self-collection for cervical cancer screening. The update also recognizes that additional testing, such as dual stain technology, may be required to complete the screening process without cost sharing for most insured patients. We strongly support these changes aimed at improving timely patient access to these critical services to screen for and diagnose cervical cancer. It is encouraging to see HRSA and similar organizations support an evidence-based shift to primary hrHPV screening technologies that could have a positive impact on women’s health and get us closer to making cervical cancer a disease of the past.”
Overall, these updated HRSA guidelines align with evolving scientific evidence and parallel recommendations from other major bodies that increasingly favor hrHPV testing and self-collection options as strategies to maintain high screening effectiveness while improving patient accessibility and equity.
