People with a cervix who are aged 25–65 years should receive a human papillomavirus (HPV) test every five years, according to the new American Cancer Society (ACS) guidelines for cervical cancer screening.

The society’s new guidelines identified HPV tests alone as the preferred screening method, although an HPV/Pap cotest every five years or a Pap test every three years are accepted alternatives. The recommendations are slightly different than the society’s 2012 guidelines and the U.S. Preventive Services Task Force’s 2018 recommendations.

“Compared with primary HPV testing, cytology testing—the former mainstay of cervical cancer screening—has inferior sensitivity and provides lesser assurance regarding future risk,” the authors wrote in the guideline. “The combination of cytology and HPV testing (cotesting) offers very little incremental benefit in detection but increases the number of procedures and the risk for harms.”

The new ACS guidelines also say to begin screening at age 25, instead of the previous recommendation of age 21. The society based that change on findings from new studies that showed that the benefits of screening do not outweigh the harms until age 25. 

“Additional burdens associated with a starting age of 21 years are the higher number of colposcopies because of transient infections and the associated stress along with the possible increased risk of adverse obstetrical outcomes in those who undergo cervical excisional procedures,” the authors wrote.

It’s also related to the effects of HPV vaccination, which have reduced the incidence of HPV infections and cervical precancers in younger people, although the recommendation applies to both vaccinated and unvaccinated individuals.