Updated May 2026
The early detection of precancerous lesions through screening can prevent HPV associated invasive squamous cell carcinoma and adenocarcinoma of the cervix. Primary HPV testing is now recommended by the WHO as the preferred method of cervical cancer screening and is being implemented in jurisdictions world-wide1. Compared with cytology, HPV testing is more sensitive for detecting high-grade cervical lesions and allows for longer screening intervals. The randomized FOCAL trial conducted in British Columbia demonstrated that primary HPV testing detects significantly more CIN2+ lesions than cytology and supports the graduated provincial transition to HPV-based screening2. Cervix screening is recommended for people with a cervix (including women and Two-Spirit, transgender, and gender-diverse individuals), aged 25 to 69, who are or have ever been sexually active. The Cervix Screening Program uses HPV testing as the primary screening tool, with options for provider-collected or self-collected samples.
Average risk screening start age
Cervix screening begins at age 253.
Average risk screening interval
For individuals not considered high risk, screening is recommended every 5 years with HPV screening or every 3 years with cytology, depending on availability and prior history.
Average risk screening stop age
Screening may stop at age 69, provided no HPV has been detected between ages 65 and 69, and there is no history of high-grade cervical abnormalities or active surveillance.
Higher than average risk screening recommendations
Individuals at increased risk for cervical cancer require more intensive surveillance. These include:
- Immunocompromised individuals, who should begin HPV-based screening at age 25 (if sexually active) and continue every 3 years until age 74, provided they are not under active surveillance and have had no HPV detected between ages 69–74.
- Those previously treated for high-grade cervical dysplasia (CIN 2 or CIN 3) should receive a co-test (HPV and cytology) at 12 months after discharge from colposcopy. If negative (no HPV detected, and cytology NILM, LSIL, or ASCUS), they may transition to HPV-based screening every 3 years (or annually if immunocompromised) until age 69 or 74, respectively.
- Individuals treated for endocervical adenocarcinoma in situ (AIS) with uterine sparing treatment require ongoing co-testing every 3 years (or annually if immunocompromised) until age 69 or 74, unless abnormalities persist.
- Participants exposed to diethylstilbestrol (DES) in utero should undergo annual colposcopic examination of both the cervix and vagina, including annual co-testing, until age 69.
For detailed information on British Columbia's Cervix Screening Program and clinical management pathways, please visit:
http://www.bccancer.bc.ca/screening/health-professionals/cervix
References
1. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention: World Health Organization, 2021.
2. Ogilvie GS, van Niekerk D, Krajden M, et al. Effect of Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical Intraepithelial Neoplasia at 48 Months: The HPV FOCAL Randomized Clinical Trial. JAMA 2018;320(1):43–52. DOI: 10.1001/jama.2018.7464.
3. Care CTFoPH. Recommendations on screening for cervical cancer. Canadian Medical Association Journal 2013;185(1):35–45. DOI: 10.1503/cmaj.121505.
