U.S. Women Increasingly Not Screened for Cervical Cancer

The proportion of women never screened for cervical cancer increased by more than 5% per year from 2005 to 2023, a cross-sectional study showed.

Over this time period, the proportion of women ages 21 to 29 never screened for cervical cancer increased from 12.5% to 31.9% (average annual percentage change [AAPC] 5.2%, 95% CI 4.3-7.5), with a notable increase from 2010 to 2023 (AAPC 7.9%, 95% CI 6.0-14.4), reported Kalyani Sonawane, PhD, of the Medical University of South Carolina in Charleston, and colleagues.

For women ages 30 to 65, the proportion of those never screened for cervical cancer increased from 5.3% to 14.8% (AAPC 6.8%, 95% CI 3.1-12.0), they wrote in a research letter in JAMA Network Open.

Of note, rates of human papillomavirus (HPV) vaccination among women ages 21 to 29 ranged from 5.7% in 2008 to 54% in 2019.

Taken together, these results highlight “substantial missed opportunities for both primary and secondary prevention,” Sonawane and team noted.

Meanwhile, regional-stage and distant-stage cervical cancer incidence has increased by 2.3% and 2.6%, respectively, per year among women ages 30 to 64 since 2017.

“These increases are troubling, particularly when viewed in the context of the proportion of women who have never been screened for cervical cancer over the last 2 decades,” the authors wrote, adding that the findings “underscore a growing gap in cervical cancer prevention among young women and during midlife and highlight the need for targeted strategies to address structural barriers and improve screening uptake.”

Prior studies have also suggested that not enough women are being screened, despite the fact that the U.S. Preventive Services Task Force recommends screening for average-risk women ages 21 to 65, while the American Cancer Society recommends that screening begin at age 25.

One previous study showed that while COVID-19 pandemic disruptions in cancer screening rates had recovered by 2023 and were increasing for breast and colorectal cancer, cervical cancer screening rates decreased by 14% since 2019.

“The persistent decline may in part reflect longer-term declines in patient knowledge and clinician recommendation of cervical cancer screening,” the authors of that report suggested.

In their study, Sonawane and team analyzed data from the National Health Interview Survey (NHIS) cycles 2005, 2008, 2010, 2013, 2015, 2018, 2019, 2021, and 2023, which included a cervical cancer screening questionnaire. The proportions of women who reported never having undergone cervical cancer screening at the time of each survey year were estimated for groups ages 21 to 29 years and 30 to 65 years, and HPV vaccination status (available in NHIS cycles 2008, 2010, 2015, 2018, and 2019) was determined for women ages 21 to 29.

Using U.S. Cancer Statistics data, the authors examined cervical cancer incidence by age (30-64 and ≥65 years) and SEER summary stage (localized, regional, or distant) from 2001 to 2023.

The 2023 NHIS included data for 8,901 women ages 21 to 65 years (mean age 40.5) who were predominantly white (55.8%) with some college education (29.4%), private insurance (62.5%), urban status (88.3%), and living in the South (36.9%).

Among women ages 21 to 29, never-screening rates were higher among Asian (44.3%), Hispanic (37.5%), and Black women (33.9%) compared with white women (28.8%).

Never-screening rates also varied by educational status, with the proportion of women with a high school degree having substantially higher never-screening rates versus those with a master’s or doctoral degree (39% vs 17.1%). Rates also varied by insurance status, with 41.8% of uninsured women never having undergone screening versus 30.3% of those with private insurance.

“The overall increase in never receiving cervical cancer screening is further compounded by inequities across demographic and geographic subgroups,” Sonawane and colleagues noted.

The authors acknowledged that the study was limited by the self-reported nature of the screening data, which was subject to recall bias, as well as the lack of availability of HPV status in the NHIS and cancer registries.