There are three common cervical cancer screening paradigms in the US

HPV Primary
This is when an HPV test is used alone to find hr-HPV; there are only two HPV primary tests approved by the FDA1
HPV test
A molecular test that detects for either HPV DNA or HPV mRNA; only some HPV tests are approved by the FDA as HPV primary tests2,3
Reflex testing
A Pap test is performed; if the result is ASC-US then an HPV test is performed
Pap test
Also known as Pap smear or smear test this is the traditional method for screening; it utilizes cytology to look for abnormal cells in the cervix that can lead to cancer2,4
Combines an HPV test with a Pap test
Two HPV primary tests
approved by the FDA

All three screening methods can find cervical cancer precursors before they become cancer, but HPV tests are more accurate and reliable than Pap tests4

Learn more with Dr. Lee Shulman and Dr. Anna-Barbara Moscicki on the recent guidelines, the range of cervical cancer screening tests, and the impact on risk stratification and patient management.

Comparing the three screening paradigms:


Has a lower sensitivity as compared to HPV tests, this means that Pap tests may miss some precancers and also need to be repeated frequently4


Is more accurate and reliable than Pap tests; they can also rule out disease and therefore do not require frequent repetition4

The World Health Organization (WHO) recommends using HPV DNA detection as the primary screening method2


Similar performance as HPV testing,3 but less efficient and more costly - as it requires two tests. Co-testing also detects very minor changes that have a low risk of turning into cancer and can therefore lead to unnecessary colposcopy referrals4

The American Cancer Society (ACS) and the World Health Organization (WHO) recommend HPV testing as the preferred screening method2,4

ACS, American Cancer Society; ASC-US, Atypical Squamous Cells of Undetermined Significance; DNA, Deoxyribonucleic acid;
FDA, Food and Drug Administration; HPV, human papillomavirus; hr, high-risk; Pap test, Papanicolaou test; US, United States; WHO, World Health Organization

1. ACS’s Updated Cervical Cancer Screening Guidelines Explained. NIH. 2020. Accessed 3 Nov 2021.
2. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. WHO. 2020. Accessed 3 Nov 2021.
3. Perkins RB et al. J Low Genit Tract Dis. 2020;24(2):102-131.
4. ACS’s Updated Cervical Cancer Screening Guidelines Explained. NIH. 2020. Accessed 3 Nov 2021.