HPV screening and follow-up pathway

Step 1: Screening recruitment

patient and doctor talkingThe recommendations outlined in these steps are intended to be actioned by decision-makers responsible for the delivery of cervical cancer screening and follow-up care.

Learn more about intended audiences and accountability.

Screening eligibility and screening intervals  

Recommendation: Develop clear screening eligibility criteria for HPV primary screening, including screening initiation, screening cessation and screening interval.

Key evidence and implementation considerations:

  • The Canadian Task Force on Preventative Health Care currently provides guidelines for cervical screening with cytology testing but is pursuing an update to the cervical screening guidelines.1 See Table 1 for international guidelines for HPV primary screening.
    • Consider how cytology-based primary screening will be stopped and how screening eligibility and intervals will change with the introduction of HPV primary screening.
  • Screening initiation: Cytology primary screening starts as early as age 21 in some jurisdictions or at 25 in others, and takes place every three years.1 With HPV primary screening, screening initiation could happen at an older age, such as 25 or 30, and screening intervals may be extended.2
    • Screening before age 25–30 can lead to overtreatment of HPV.2 In younger populations, HPV infections often resolve without treatment. Additionally, the implementation of school-based HPV vaccination programs is a safe and effective strategy for reducing the spread of HPV among younger populations.
    • Initiating cervical cancer screening at ages 25–30 may delay or reduce opportunities to offer preventive reproductive health care to those younger than 25, such as effective contraception or screening for other sexually transmitted infections (STIs).3 As these populations will have fewer interactions with health-care providers, jurisdictions should try to increase preventive reproductive health care and education through other avenues.
  • Screening cessation: Many factors, including screening history and recent screening results, determine when an individual should stop screening.1
  • Screening interval: A five-year interval is often recommended for HPV primary screening (see Table 1).2 Screening intervals should reflect best practices to avoid harms of over screening.2
    • Consider screening history, such as history of cervical abnormality and/or medical history (e.g., immunocompromised individuals), when developing recommendations for cervical cancer screening intervals.

Table 1: International guidelines for HPV primary screening

Screening guidelines Australian Institute of Health and Welfare2 Cancer Research UK2 American Cancer Society2 Dutch National Institute for Public Health and the Environment2 World Health Organization*4
Screening initiation age 25 25 25 30 30
Screening cessation age 70–74 64 65 60 Age 50, after two consecutive negative screening results 
Screening interval  5 years 3 years (ages 25–49), 5 years (ages 50–64) 5 years 5 years (ages 30–39), 10 years (ages 40–50) 5–10 years

*The WHO recommendations are intended to allow low-resource countries to optimize their funds.

  1. Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer. CMAJ. 2013; 185(1):35-45.
  2. Canadian Partnership Against Cancer. HPV primary screening and abnormal screen follow-up for cervical cancer environmental scan. 2021. Accessed January 19, 2022. Available from: https://www.partnershipagainstcancer.ca/topics/hpv-primary-screening-environmental-scan/
  3. Chor J, Davis A, Rusiecki J. Cervical cancer screening guideline for individuals at average risk. JAMA. 2021; 326(21):2193. https://doi.org/10.1001/jama.2021.13448.
  4. World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. 2021.