How Would You Screen This 26-Year-Old Woman for Cervical Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Cervical cancer is the third most common gynecologic cancer, with more than 13 000 new cases diagnosed in 2025. The incidence of and mortality from cervical cancer vary across racial and ethnic groups and in persons living in medically underserved or geographically isolated areas, with half of all cervical cancers occurring in women who are underscreened or have never been screened. Persistent infection with high-risk types of human papillomavirus (HPV) is the most important risk factor for cervical cancer and is associated with nearly all cases. Although genital tract HPV infection is common, most HPV infections are transient, and cervical cancer occurs in only a small portion of patients with HPV. For decades, cervical cancer screening relied on annual cytologic assessment. A growing understanding of the role of HPV infection in the natural progression of cervical cancer has led to updated screening recommendations from the American Cancer Society and the Women's Preventive Services Initiative, as well as a draft update from the U.S. Preventive Services Task Force. These recommendations include primary HPV testing as a preferred screening strategy and include an option for self-collected specimens for HPV testing. Here, 2 experts in this field, a primary care physician and an obstetrics and gynecology physician, debate how to apply these guidelines when screening a patient for cervical cancer. They discuss a range of screening options and consider the challenges of applying these guidelines across different age groups and in patients at increased risk.