Self-Collected HPV Testing Now Accepted for Cervical Cancer Screening

What Changed in the Screening Guidelines?

The December 2025 ACS guideline update represents a paradigm shift in cervical cancer screening. For decades, screening has required a clinician-performed pelvic examination to collect cervical cells, either for Pap cytology (the traditional "Pap smear") or for HPV DNA testing. While this approach is effective, it creates significant barriers for many patients: discomfort, embarrassment, need for a clinical appointment, lack of access to healthcare providers, and cultural or personal objections to pelvic examinations.

The updated guidelines now include three acceptable screening strategies for individuals aged 25-65:

• Primary HPV testing every 5 years (preferred) - using either clinician-collected or self-collected samples
• Co-testing (HPV plus Pap cytology) every 5 years - requires clinician collection
• Pap cytology alone every 3 years - requires clinician collection

The inclusion of self-collection as an option for primary HPV testing was supported by a comprehensive evidence review that analyzed data from over 50 studies involving more than 580,000 participants globally. The evidence showed that self-collected vaginal samples, when tested with validated PCR-based HPV assays, had comparable sensitivity (95-99%) and specificity to clinician-collected cervical samples.

How Does Self-Collection Work?

The self-collection process is straightforward and designed to be as simple as possible. The individual receives a kit containing a collection device (typically a small flocked swab or brush), a transport tube with preservative solution, clear illustrated instructions, and a prepaid return envelope or instructions for returning the sample to a laboratory.

To collect the sample, the individual inserts the swab approximately 5-7 centimeters into the vagina, rotates it gently for 20-30 seconds to collect cells, removes the swab, and places it into the transport tube. The entire process takes about one minute and can be performed at home, in a bathroom, or in any private setting. No speculum, stirrups, or clinical examination is required.

The sample is then tested in a laboratory using a PCR-based HPV DNA assay, which detects the genetic material of high-risk HPV types (particularly types 16, 18, 31, 33, 45, 52, and 58, which together account for over 90% of HPV-related cervical cancers). Results are typically available within one to two weeks.

It is important to understand that a negative HPV self-test is highly reassuring, with a negative predictive value exceeding 99%. However, a positive HPV result does not mean cancer is present. Most HPV infections clear spontaneously within one to two years. A positive result triggers follow-up with a healthcare provider for a clinical examination, which may include Pap cytology, colposcopy, or both, to determine whether abnormal cell changes are present.

Who Benefits Most from Self-Collection?

In the United States, approximately 14 million people with a cervix are overdue for cervical cancer screening. Screening participation has remained stubbornly below the Healthy People 2030 target of 84.3%, with significant disparities affecting certain populations. Self-collection has the potential to reach many of these underscreened individuals.

Research consistently shows that the primary reasons people avoid cervical screening include discomfort or pain during pelvic examinations, embarrassment and anxiety about the procedure, difficulty scheduling and attending clinical appointments, lack of health insurance or a regular healthcare provider, cultural or religious concerns about pelvic examinations, and history of sexual trauma that makes examinations distressing.

A systematic review of 28 studies examining the acceptability of self-collection found that over 90% of participants found it easy to perform, 85% preferred self-collection to clinician collection, and 75% of previously underscreened individuals said they would be more likely to participate in screening if self-collection were available. Randomized trials in countries where self-collection has been implemented (including the Netherlands, Australia, and Denmark) have shown 15-30% increases in screening participation.