Women who get a full dose of the human papillomavirus (HPV) vaccine may only need two cervical cancer screenings in their lifetime, a new study in the Annals of Internal Medicine suggests.

Based on current guidelines, women should receive their first screening at age 25, then every 3 years until age 65, amounting to roughly nine of these tests.

The American College of Obstetricians and Gynecologists recommends screening with a Pap smear every 3 years from age 25 to 29, followed by an HPV test every 5 years after that. These recommendations, however, do not take into account whether a woman is vaccinated against HPV, which can reduce a person’s risk for cervical cancer by more than 90%.

“With risk levels that low, the models have shown that you can reduce the intensity of screening to two, maybe three, screens in a lifetime separated by 15 or 20 years,” said Jane Kim, PhD, professor of health economics at the Harvard T.H. Chan School of Public Health in Boston, who helped author the study.

Kim and her colleagues modeled various screening schedules for hypothetical women living in Norway who had received a full dose of either the 2vHPV or 9vHPV vaccine, which protect against the most common cervical cancer-causing strains of HPV.

The women were divided into seven groups on the basis of how old they were at the first HPV dose, starting at age 12, the first year of recommended vaccination. Other groups included those vaccinated between ages 13 and 15, 16 and 18, and so on in 3-year cohorts until age 30. The model did not include unvaccinated women, who could still benefit from herd immunity.

The team ran 50 scenarios for cervical cancer screening to analyze the benefit of different frequencies. They considered catching cancerous or precancerous polyps and avoiding unnecessary screening or procedures, such as a colposcopy, as benefits.

Kim and colleagues found the younger a woman was at first vaccination, the fewer cervical cancer screenings she needed over her lifetime. For women who received one of the vaccines between ages 25 and 30, lifetime cervical cancer screenings could be reduced from nine to five, recurring every 10 years instead of every 5 years.

For the group vaccinated between ages 19 and 21, only three screenings at ages 25, 45, and 65 were needed. Girls vaccinated with the 2vHPV vaccine between ages 16 and 18 could follow the same schedule, the model suggested. But girls vaccinated at these ages with the 9vHPV vaccine could reduce their lifetime screening to just twice, at ages 25 and 50. Those who received either vaccine before age 16 would only need testing at ages 35 and 60.

Reducing screening based on age of first vaccination could work in countries like Norway, which keeps a national vaccine registry. But the approach would likely prove challenging in the US, said Christine Conageski, MD, associate professor of obstetrics and gynecology at CU Anschutz in Aurora, Colorado.

“The biggest hurdle in the US is that we have no centralized system where we track vaccination status,” she said. “Many of my patients don’t remember specific vaccinations they got, only that their parents took them to the doctor and they got a shot.”

But Conageski said the findings make sense because “you get a much greater immune response when you get it at a younger age. You are also more likely to not have been exposed” to HPV by age 11, she said. Sexual activity raises the risk for exposure to HPV.

Conageski said that cervical cancer screening recommendations could evolve because more people are vaccinated against HPV, but barriers persist that prevent many women from getting the shots.

“We haven’t moved the needle in cervical cancer rates in years, and a lot of that is because the people who don’t have access to care and screening present with later-stage disease,” she said. “Cervical cancer has become a cancer of access.”

The US CDC reduced the dose recommendation for HPV vaccination from two doses to one in January. The landmark ESCUDDO trial, published in December 2025, showed that a single dose of an HPV vaccine appeared to be as effective as two. In 2022, the World Health Organization recommended either one or two doses for people aged 9-20 years, noting that a single dose “offers solid protection against cervical cancer.”

Kim said clinicians should continue to follow current guidelines until more research supports the benefits of fewer screenings for certain people.

“We are trying to build the evidence around the case for changing the guidelines for vaccinated women,” Kim said.

Kaitlin Sullivan is a journalist living in Colorado.