Cervical Cancer Screening: Primary HPV Testing, Self-Collection, and Clinical Follow-Up

Upon completion of this course, the participant will be able to:

1. Differentiate guideline-concordant cervical cancer screening strategies and intervals for average-risk patients aged 21 to 29 and 30 to 65 years, including clinician-collected primary hrHPV testing, co-testing, cytology alone, and patient-collected hrHPV testing.

2. Assess whether an individual patient is an appropriate candidate for patientcollected hrHPV screening using current eligibility criteria and FDA-authorized test, device, specimen, and setting configurations.

3. Select the guideline-concordant next step after common negative and positive hrHPV screening results using ASCCP and Enduring Consensus risk-based management principles, including genotype-informed triage and indications for clinician-collected evaluation. AOA core competency alignment: Patient Care.

4. Describe role-specific responsibilities and closed-loop notification, referral, and tracking processes that support completion of the screening pathway for under-screened populations.

Between January and April 2026, U.S. cervical cancer screening guidance changed in ways that affect test selection, specimen collection, screening intervals, and follow-up. HRSA/WPSI added patient-collected hrHPV testing as an option for average-risk patients aged 30 to 65 years, while ACOG identified clinician-collected primary hrHPV testing every five years as the preferred strategy and qualified patient collection based on patient preference and established documentation, notification, and follow-up processes.

This course addresses the resulting knowledge and practice gap by helping clinicians and supporting teams determine eligibility, select a guideline-concordant strategy and interval, verify appropriate assay-device-specimen-setting configurations, apply genotype-informed follow-up, and close the loop after abnormal results. Cervical cancer treatment and comprehensive HPV vaccination education are outside the scope of this course.

Educational Need and Practice Gap

Clinicians must now work from a screening framework that changed materially between December 2025 and April 2026. Current cervical cancer screening guidance requires understanding several key points: primary hrHPV testing is preferred for adults ages 30 to 65; cytology alone remains the standard every three years for ages 21 to 29; and the American Cancer Society (ACS) begins screening at age 25 with a preference for primary hrHPV testing. Patient-collected hrHPV testing is a conditional option—added by the Health Resources and Services Administration (HRSA)/Women's

Preventive Services Initiative (WPSI) and qualified by the American College of Obstetricians and Gynecologists (ACOG)—and its use depends on regulatory authorization for a specific assay and validated collection method rather than approval of self-collection in general. The 2024 U.S. Preventive Services Task Force (USPSTF) update remains in draft status.

Competence requirements follow from that knowledge. Practitioners must determine average-risk status and exclude patients for whom self-collection is not appropriate, distinguish the three-year recall following a negative patient-collected result from the five-year recall following a negative clinician-collected result, and select genotypeappropriate triage after a positive result. Performance requirements extend further, because screening produces benefit only when results are communicated and followup is completed. National data indicate that 75.4% of screening-eligible women

aged 21 to 65 years were up to date with screening in 2023 (Sabatino et al., 2025), and across three health care systems, 75.3% of patients with an abnormal result for which colposcopy was indicated received one within 12 months (Feldman et al., 2022).

These gaps are supported by a documented guideline and regulatory transition combined with pre-transition performance data. Nationwide post-2026 data quantifying clinician-level errors are not yet available, so the magnitude of the knowledge and competence gaps is in part an educational inference. Improvement in screening uptake, follow-up completion, and patient outcomes should therefore be described as potential rather than expected, and measured through practice audit rather than inferred from post-test performance.