The Spanish Society of Gynaecology and Obstetrics (SEGO) has published in 2025 a full revision of the national cervical cancer screening protocol. This update marks a paradigm shift: the HPV (human papillomavirus) test becomes the primary screening method from age 25, replacing conventional cytology as the first-line approach.

Why is the protocol changing?

Cytology-only screening has shown limitations in sensitivity for detecting high-grade lesions. Evidence accumulated over the past decade shows that high-risk HPV detection as a primary test offers greater sensitivity, allows longer follow-up intervals in women with a negative result, and reduces the number of unnecessary tests.

The new SEGO 2025 consensus integrates this evidence into an algorithm structured by age and result, with clear pathways according to each patient's risk profile.

Key changes in the 2025 consensus

• Screening starts at age 25 with high-risk HPV testing as the primary test. Before age 25, systematic screening is not recommended unless there is a specific clinical indication.
• 5-year interval between tests for women with a negative HPV result, compared to the previous 3-year interval with cytology.
• Co-testing (HPV + cytology) as an option in certain clinical contexts or from age 30, depending on availability and specialist judgement.
• Genotyping triage for HPV 16 and 18 in positive cases, given their greater oncogenic potential, to prioritise referral to colposcopy.
• Redefinition of risk groups: the protocol stratifies patients into standard risk, intermediate risk and high risk, with differentiated follow-up pathways.
• Integration of HPV vaccination history as a modulating factor for the screening interval in correctly immunised women.

Management algorithm by result

The new protocol establishes clear management pathways based on the primary HPV test result:

• HPV negative: repeat test in 5 years. No additional testing required.
• HPV positive for HPV16/18: direct referral to colposcopy, regardless of cytology result.
• HPV positive for other genotypes with normal cytology: repeat the test in 12 months.
• HPV positive with abnormal cytology (ASC-US or higher): referral to colposcopy.

End of screening

The protocol establishes that screening may end at age 65 for women with an adequate prior screening history and negative results in the last 10 years. Women without a screening history or with an incomplete history are recommended to continue until sufficient negative results are obtained.

Women who have had a hysterectomy for benign pathology and have no history of high-grade lesions may cease screening permanently.

Expected impact on clinical practice

Implementation of the new protocol will initially increase demand for HPV tests and colposcopies, particularly in the 25–35 age group. However, in the medium term, a significant reduction in the number of annual cytologies and unnecessary diagnostic procedures in low-risk women is expected.

HPV vaccination and screening: does anything change?

Vaccinated women still need screening, as current vaccines do not cover all oncogenic genotypes and do not eliminate infections acquired prior to vaccination. However, the new protocol allows consideration of slightly longer intervals for women with a complete and documented vaccination schedule, particularly those vaccinated before first sexual exposure.