The Health Resources and Services Administration released updated Women's Preventive Services guidelines for cervical cancer screening that, for the first time, include patient self-collection of high-risk human papillomavirus specimens as a recommended screening option. The guidelines designate testing for high-risk human papillomavirus—whether administered by a patient or clinician—as the preferred screening modality for average-risk patients aged 30 to 65 years. Under Section 2713 of the Public Health Service Act, most private health insurers will be required to cover these screening services without beneficiary cost sharing, including copayments or deductibles, beginning January 1, 2027.
The guideline update follows US Food and Drug Administration approval of self-collection tests in 2024 and 2025, along with a rigorous evidence review confirming comparable efficacy between self-collected and clinician-collected specimens. According to a JAMA Viewpoint authored by officials from the US Department of Health and Human Services, approximately one in four patients in the United States are not up-to-date on cervical cancer screening, and about half of all patients diagnosed with cervical cancer have never been screened or are not current with recommended screening protocols. The Health Resources and Services Administration (HRSA) guideline includes new language that requires insurance issuers to cover additional testing needed to complete the screening process for malignancies, without patient cost-sharing.
The updated screening recommendations maintain existing age-based protocols. For patients aged 21 to 29 years, cervical cytology (Papanicolaou test) every 3 years remains the standard. Cotesting with cytology and high-risk human papillomavirus (hrHPV) is not recommended for this age group. For patients aged 30 to 65 years, primary hrHPV testing every 5 years is now designated as the preferred approach, though cotesting every 5 years or cytology alone every 3 years are still alternatives. Patients at average risk should not be screened more than once every 3 years.
The addition of self-collection mirrors its inclusion in newly approved December 2025 guidelines from the American Cancer Society. Depending on which FDA-approved test is selected, self-collection may occur in a clinician's office or at home. For home-based testing, patients may be prescribed a test, collect a vaginal swab at home, and mail the specimen to the processing laboratory—a workflow analogous to home stool collection for colorectal cancer screening.
The guidelines state that if additional testing—including cytology, biopsy, colposcopy, extended genotyping, or dual stain—and pathologic evaluation are indicated, these services are also recommended to complete the screening process.
The clinical rationale for expanding screening options is rooted in persistent disparities in cervical cancer outcomes. The JAMA Viewpoint authors noted that cervical cancer screening represents one of the most significant public health achievements of the 20th century: incidence and mortality rates have decreased more than 50% over the past 50 years, and 5ive-year survival exceeds 90% when cervical cancer is detected early. However, more than half of all cervical cancer diagnoses occur beyond an early stage—37% when cancer has spread regionally to local lymph nodes and 15% when distant metastases are present. Five-year survival for metastatic disease is 20%.
The guideline researchers emphasized that self-collection may help increase screening by reducing procedural discomfort and improving access, particularly for patients in rural areas or those facing transportation or scheduling barriers. Patients living in poverty or with fewer years of formal education have lower screening rates than the general population.
Several important limitations apply. The self-collection option is restricted to average-risk patients only. The guidelines explicitly exclude patients who have human immunodeficiency virus, patients who are immunocompromised because of another etiology, patients exposed to diethylstilbestrol in utero, and patients treated for cervical intraepithelial neoplasia grade 2 or higher within the past 20 years. The guideline researchers also recommended that hrHPV self-collection should be performed only with FDA-approved tests and noted that ongoing research and longitudinal surveillance are needed to determine the optimal age to begin screening with hrHPV self-collection and the appropriate screening interval.
Complementing the screening update, HRSA's Women's Preventive Services guidelines added coverage of evidence-based patient navigation services in 2024 to assist with cervical cancer screening and follow-up, and coverage of navigation services without patient copay began January 1, 2026. Patients retain the option to undergo clinician-administered screening in a medical setting.
Disclosures: The Viewpoint researchers reported no conflicts of interest.
Source: JAMA
