Podcast Summary: ACS Update on Self-Collected VAGINAL HPV Tests

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Host: Dr. Chapa
Episode Air Date: December 5, 2025
Topic: Breaking down the recent American Cancer Society (ACS) update on self-collected vaginal HPV testing for cervical cancer screening

Episode Overview

This episode delivers a timely, practical overview of the American Cancer Society’s brand new cervical cancer screening guideline update, focusing on the approval and recommendations for self-collected vaginal HPV samples. Dr. Chapa discusses how this changes screening intervals, when self-collection is appropriate, and what nuances clinicians should be aware of regarding risk status and screening exit ages. The episode is especially relevant for practitioners keeping pace with evolving best practices in women’s health screening.

Key Discussion Points & Insights

1. Breaking News: ACS Guidelines Update

• Dr. Chapa highlights a major update released just 24 hours prior (December 4, 2025) in the journal Cancer: A Cancer Journal for Clinicians (02:39).
  • “This is a big deal because, for the first time, self patient collection for vaginal samples…is now mentioned in the ACS guideline.” (02:39, Dr. Chapa)
• Emphasizes that while ASCCP and ACS typically align, this news is directly from ACS—expect ASCCP to follow.

2. Self-Collected Vaginal Samples for HPV Screening

• Self-collection is now considered acceptable for primary cervical cancer screening, provided appropriate patient instructions are given. Errors are rare with instruction.

  • “Self collection of a vaginal specimen for HPV testing is legit. The data shows a very small error rate, again with instruction.” (06:28, Dr. Chapa)

• Who is eligible?

  • Asymptomatic, average-risk women aged 25 to 65.
  • Not intended for women with gynecologic symptoms (e.g., abnormal discharge)—such cases likely require clinician visual evaluation.

• Where can this be done?

  • Either at home or in the clinic—location flexibility is now incorporated into ACS guidance.

3. Screening Intervals: Self-Collection vs. Clinician-Collection

• Clinician-collected cervical samples (using speculum):
  • Repeat primary HPV screen every 5 years (after a negative result).
• Self-collected vaginal samples:
  • Repeat at a shorter interval: every 3 years following a negative result.
  • “For self collected vaginal specimens, ACS says…if you're gonna collect it yourself, then you need to repeat the test in three years after the negative result.” (11:00, Dr. Chapa)

4. Dual Stain Technology & Triage Pathways

• For indeterminate results or “other high-risk HPV positives”, labs may use dual stain technology (P16 and Ki67 protein markers) to decide next steps:
  • “If those two stains are positive in a cell…they go to colposcopy as well. If they are dual stain negative, they don’t need colpo and can just repeat the HPV assay in a year.” (08:34, Dr. Chapa)

5. High-Risk Patients Still Require Clinician Collection

• If a patient is considered high-risk (past dysplasia, significant history), clinician-collected samples remain strongly recommended.
  • “For high risk women, clinician collected samples are still recommended…That is for patients at average risk.” (12:12, Dr. Chapa)

6. Clarification on Screening Exit (When to Stop Screening)

• Previous guidance: Screening could stop at age 65 if the last test (done as late as 60) was negative.
• New ACS update: Women must have their final screening test at age 65, not before.
  • “65 is not excluded…It’s included in that revised GU. So they need one at age 65.” (15:37, Dr. Chapa)
  • Must have negative HPV or co-test results at ages 60 and 65 to exit from screening.
  • If HPV or co-testing isn’t available, three consecutive negative Pap smears are required before screening can be discontinued.

Notable Quotes & Soundbites

• “Primary HPV screening started at age 25 really does have a lot of advantages here.” (09:25, Dr. Chapa)
• “Self collection of a vaginal specimen for HPV testing is legit...asymptomatic…this is great. It definitely has a role.” (07:00, Dr. Chapa)
• “If you're gonna collect it yourself, then you need to repeat the test in three years after the negative result.” (11:00, Dr. Chapa)
• “65 is not…when they don’t need it anymore, they need it at 65 and then they can stop.” (16:16, Dr. Chapa)

Important Segment Timestamps

| Timestamp | Segment | |-----------|---------------------------------------------------------| | 02:39 | ACS guideline update explained, self-collected HPV role | | 06:28 | Legitimacy and process: patient instructions clarified | | 07:47 | Differentiating self vs. clinician-collected samples | | 08:34 | Dual stain molecular triage summary | | 09:25 | Rationale for primary HPV starting at age 25 | | 11:00 | Self-collection: 3-year repeat interval | | 12:12 | High-risk populations: need for clinician collection | | 15:37 | Screening exit at age 65 requirement | | 16:16 | ACS recommendation language for screening discontinuation|

Practical Takeaway Pearls (Clinical Pearls!)

• For average-risk women aged 25-65:
  Self-collected vaginal HPV screening is now endorsed, with a 3-year interval after a negative test.
• For high-risk women or those with relevant history:
  Stick with clinician-collected samples as the standard.
• To exit screening:
  Ensure a final HPV or co-test at age 65, not before, for appropriate discontinuation of screening.
• Advancing technology:
  The move toward molecular testing (dual stain, HPV genotyping) is reshaping cervical cancer prevention—there’s less reliance on traditional cytologic appearance.

Final Thoughts

Dr. Chapa celebrates this step forward in cervical cancer screening, noting the patient empowerment, flexibility, and alignment with contemporary evidence. He underscores the importance of tailoring the approach based on risk status and ensuring clear patient education for proper self-collection.

“Found this super interesting...Again, this is in the journal Cancer—and if you’re not sure what that’s about, it’s a cancer journal for clinicians. Sarcasm added.” (12:57, Dr. Chapa)

For further information, listeners are encouraged to review the full ACS guidance and stay tuned for ASCCP updates.