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In a new Annals "Beyond the Guidelines" feature, a primary care physician and an obstetrician-gynecologist discuss the optimal approach to cervical cancer screening in a healthy young woman.

The discussion focuses on updated recommendations from the American Cancer Society, the Women's Preventive Services Initiative and the draft U.S. Preventive Services Task Force guidelines, which generally favor primary HPV testing but differ on when screening should begin, preferred testing approaches for younger women and the use of self-collected HPV testing. As such, asking, "How would you screen this 26-year-old woman for cervical cancer?" remains an important clinical question.

The experts reviewed the case of L, a 26-year-old woman with a history of depression, anxiety, attention-deficit hyperactivity disorder and a prior ovarian cyst rupture. Her mother was diagnosed with ovarian cancer at age 59. She has had three prior negative Papanicolaou (Pap) tests beginning at age 21 and has no history of sexually transmitted infections or abnormal cervical cancer screening results.

The feature is published in the journal Annals of Internal Medicine.

She is uncertain of her HPV vaccination status but believes she likely received the vaccine. She is sexually active with one long-term male partner. L expressed openness to self-collected HPV testing, noting that such an option could improve access and comfort for many patients, particularly survivors of sexual violence.

Both experts agree that persistent infection with high-risk HPV is the primary driver of cervical cancer and that increasing screening participation remains a major public health priority.

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