Expanding Access to Cervical Cancer Screening Through Updated Federal Guidelines

Policies regulating preventive care shape how diseases are detected and the accessibility of such care. In the United States, cervical cancer is one of the most preventable cancers, however screening gaps are still persistent across income, geography, and race [6,7,9]. In 2025, the Health Resources and Services Administration (HRSA) updated the Women’s Preventive Services Guidelines to expand national recommendations for cervical cancer screening. The updates introduce changes meant to reduce structural barriers to care [10]. The guidelines now

include self-collected high-risk papillomavirus (HPV) testing as a screening option for average-risk women ages 30-6 and require insurance coverage without cost-sharing for follow-up tests needed to complete the screening [10].  This new policy shows a growing focus on preventive care that prioritizes patients. 

The updated guidelines recommend primary HPV testing every five years for average-risk women aged 30-65, including self-collection using FDA approved tests [10]. Self -collection allows patients to collect their own vaginal sample at home or in a clinical setting without a pelvic exam, using a provided swab kit [5]. Although clinical-collected HPV tests and cytology-based screening are still standard, the self collection screening option doesn’t require a pelvic exam [5]. Importantly, HRSA’s update also clarifies that any follow-up services required to complete the screening must be covered by insurance without cost-sharing under the Affordable Care Act (ACA) [10]. Some of these follow-up services include cytology, colposcopy, or a biopsy after an abnormal result [4]. This second part of the update addresses a longstanding gap in preventive care policy, in which patients often have unexpected costs after their initial covered screening. 

Self-collection matters because it helps address long-standing barriers to cervical cancer screening.

Pelvic exams can be physically uncomfortable for many patients. Also, limited access to OB-GYN care can also make screening difficult, especially for those with a history of trauma [1,9]. Screening gaps are substantial, with about 1 in 4 U.S. women not up to date on cervical cancer screening [2]. These gaps are explicitly clear among women of color  and those in rural areas.  Black women are about 75% more likely to die from cervical cancer than white women , and rural women experience higher cervical cancer incidence and mortality than urban women [3].

These barriers have real health consequences. Cervical cancer rates and deaths are higher among women who are uninsured or lack regular primary care. Missed screening also allows precancerous changes to progress to invasive disease. A 2024 comparative research study also shows that self-collected HPV testing is similarly effective to clinician collected testing, and can help reach women who are often missed by traditional screening [8]. So by reducing the logistical and financial hurdles, the updated HRSA guidelines are intended to support earlier detection, when treatment is actually effective. 

While the guideline update represents meaningful progress, there are still many implementation problems. Self-collection doesn’t eliminate the need for clinical follow-up after positive results, and while insurance covers visits related to completing the screening process, patients still need clear pathways to access that care. Whether expanded screening options lead to better outcomes will depend on how well providers are prepared and how effectively patients are guided through follow-up care [8]. At the same time, differences in Medicaid coverage and provider availability across states are likely to shape how evenly these guidelines are implemented in practice. 

Overall, the updated cervical cancer screening guidelines represent a change in federal preventative care policy. The addition of  self-collected HPV testing and clearer follow-up coverage aligns national recommendations with current evidence and access barriers. The impact of these changes will depend on how consistently they’re implemented, but they show how regulatory updates can expand access to preventive services and reduce health disparities.

References

[1] Bellerose, M., Rodriguez, M., & Vivier, P. M. (2022, May 30). A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women. Health services research. https://pubmed.ncbi.nlm.nih.gov/35584267/ 

[2] Cervical cancer screening. Cancer Trends Progress Report. (n.d.). https://progressreport.cancer.gov/detection/cervical_cancer 

[3] Cryer, K. (2024, June 11). Why do black women have the highest cervical cancer mortality compared to all other groups in the United States? . St. Jude Research. https://www.stjude.org/research/progress/2024/why-do-black-women-have-the-highest-cervical-cancer-mortality.html#:~:text=For%20example%2C%20Black%20women%20are,every%20case%20can%20be%20prevented 

[4] HPV and pap test results: Next steps after an abnormal test. HPV and Pap Test Results: Next Steps after an Abnormal Test - NCI. (n.d.). https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results 

[5]HPV self-collection test. HPV Self-collection Test | American Cancer Society. (n.d.). https://www.cancer.org/cancer/risk-prevention/hpv/hpv-and-hpv-testing/self-collection.html 

[6] Moreno, V. A., Nogueira , D. L., Delgado , D., Valdez, M. J., Lucero , D., Nieto , A. H., Rodriguez-Cruz, N., & Lindsay , A. C. (2025, December 21). Cervical cancer statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/cervical-cancer/statistics/?CDC_AAref_Val=https%3A%2F%2Fwww.cdc.gov%2Fcancer%2Fcervical%2Fstatistics 

[7] Moreno, V. A., Nogueira, D. L., Delgado, D., Valdez, M. J., Lucero, D., Hernandez Nieto, A., Rodriguez-Cruz, N., & Lindsay, A. C. (2025, December). Misconceptions and knowledge gaps about HPV, cervical cancer, and HPV vaccination among Central American immigrant parents in the United States. Human vaccines & immunotherapeutics. https://pmc.ncbi.nlm.nih.gov/articles/PMC12039409/ 

[8] Parapob, N., Lekawanvijit, S., Tongsong, T., Charoenkwan, K., & Tantipalakorn, C. (2024, November). A comparative study of self-collected versus clinician-collected specimens in detecting high-risk HPV infection: A prospective cross-sectional study. Obstetrics & gynecology science. https://pmc.ncbi.nlm.nih.gov/articles/PMC11581809/#:~:text=2 

[9] Ranji, U., Diep, K., Gomez , I., Sobel , L., & Salganicoff, A. (2025, October 8). Health policy issues in women’s health. KFF. https://www.kff.org/womens-health-policy/health-policy-101-health-policy-issues-in-womens-health/ 

[10] Women’s Preventive Services Guidelines. HRSA. (2025, January 6). https://www.hrsa.gov/womens-guidelines