Start cervical cancer screening at age 25, not 21, American Cancer Society says in update

In an update to cervical cancer screening guidelines, the American Cancer Society (ACS) recommends starting screenings at age 25, with primary human papillomavirus (HPV) testing as the preferred method of testing every five years through age 65.

The previous guidelines, released in 2012, called for cervical cancer screening starting at age 21.

The ACS said the update reflects a “rapidly changing landscape of cervical cancer prevention” in the U.S., and now calls for “less and more simplified” screening, according to a news release.

Since not all labs have transitioned to primary HPV testing, the guidelines say acceptable options are HPV testing in addition to a Pap test (called co-testing) every five years, or Pap tests alone every three years.

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The change in the recommended age was also due to low cervical cancer incidence among those aged 20 to 24, and most HPV infections among these individuals become undetectable in one to two years.

Those older than 65 with adequate negative results can stop screenings, the ACS said.

“These streamlined recommendations can improve compliance and reduce potential harms,” said Debbie Saslow, managing director of HPV & GYN Cancers for the ACS. “They are made possible by some important developments that have allowed us to transform our approach to cervical cancer screening, primarily a new understanding of the role of HPV and the development of tools to address it.”

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“Evidence shows the HPV test is more accurate than the Pap test and can be done less often; one HPV test every five years is more effective than a Pap test every three years,” according to the news release.

Since the previous guidelines in 2012, the ACS says HPV vaccination rates have improved in the U.S. and has led to a drop in rates of precancerous cervical changes.

“We estimate that compared with the currently recommended strategy of cytology (Pap testing) alone beginning at age 21 and switching to co-testing at age 30 years, starting with primary HPV testing at age 25 prevented 13 percent more cervical cancers and 7 percent more cervical cancer deaths,” Saslow said.

HPV is the cause of nearly all cervical cancers, the ACS said. HPV is the most common sexually transmitted infection, and about 14 million Americans become newly infected every year, according to NYU Langone Health. The virus spreads easily through skin-to-skin sexual contact.

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