Cervical Screening at Age 25
- Ontario Health (Cancer Care Ontario) is encouraging primary care providers to start cervical screening for patients at age 25 based on moderate quality evidence suggesting that people under age 25 do not benefit from cervical screening[1]. However, people who are immunocompromised who are or ever have been sexually active and fall into one of the following groups should continue to be screened starting at age 21:
- People who are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
- People requiring long-term treatment (either continuously or at frequent intervals) with medications that cause immune suppression
- Organ transplant recipients (solid organ transplant or allogeneic stem cell transplants)
- People who are living with systemic lupus erythematosus, regardless of whether they are receiving immunosuppressant treatment
- People with congenital (primary) immunodeficiency
- For most people, screening people before age 25 may do more harm than benefit.
- Early cervical cell changes are likely to resolve on their own in people under age 25. Even if the cell changes do not resolve, they are unlikely to become cancer before someone is screened for the first time because cervical cancer takes several years to develop.
- Cervical cancer is extremely rare in people under age 25. From 2014 to 2018, 29 new cases of cervical cancer were diagnosed in people under age 25 in Ontario compared with 2,913 cases for all ages. Specifically for people ages 21 to 24 in Ontario, only 23 new cases of cervical cancer were diagnosed across 5 years from 2014 to 2018.
- From 2014 to 2018, the incidence rate of cervical cancer in people under age 25 in Ontario was 0.3 per 100,000 compared with 8.1 per 100,000 for all ages. Specifically for people ages 21 to 24 in Ontario, the incidence rate of cervical cancer was 1.2 per 100,000 across five years from 2014 to 2018.
- Screening people under 25 may result in follow-up tests and treatments that do not benefit them except for people who are immunocompromised.
- Many screening programs recommend starting cervical screening at age 25 or later, including those in British Columbia, Alberta and Nova Scotia in Canada, and other countries internationally.
- The Ontario Cervical Screening Program will formally change the age of initiation for cervical screening from 21 to 25 with the implementation of human papillomavirus (HPV) testing in the program except for people who are immunocompromised. Until the change is formally implemented, we will continue to encourage primary care providers to consider delaying screening until age 25 except for people who are immunocompromised. Reasons include the impact of COVID-19 on healthcare services, and the limited benefit and potential harms of screening in younger people.
- Investigate any visible cervical abnormalities or abnormal symptoms regardless of the patient’s age. Consider referral to a specialist (e.g., colposcopist, gynecologist, gyne-oncologist) as appropriate.
Find cervical screening resources from the Ontario Cervical Screening Program.