Cervical Cancer Screening Rates Decline
A study shows the proportion of U.S. women never screened for cervical cancer has risen sharply since 2005, alongside increasing rates of advanced-stage
The proportion of U.S. women who have never been screened for cervical cancer has increased by more than 5% per year from 2005 to 2023. This decline in screening coincides with a rise in advanced-stage cervical cancer incidence, according to a research letter published in JAMA Network Open.
Kalyani Sonawane, PhD, of the Medical University of South Carolina, and colleagues analyzed data from the National Health Interview Survey. They found the share of women aged 21 to 29 who had never been screened jumped from 12.5% to 31.9% over that period. For women aged 30 to 65, the never-screened proportion increased from 5.3% to 14.8%.
Screening Trends by Age Group
The study identified a particularly sharp increase in never-screened rates among younger women from 2010 to 2023. The average annual percentage change was 7.9% for women aged 21 to 29 during those years. This trend persists despite recommendations from the U.S. Preventive Services Task Force and the American Cancer Society for regular screening.
One previous study suggested the persistent decline may reflect longer-term drops in patient knowledge and clinician recommendation of cervical cancer screening. Another report noted that while screening rates for breast and colorectal cancer had recovered from pandemic disruptions by 2023, cervical cancer screening rates had decreased by 14% since 2019.
Rising Cancer Incidence
Meanwhile, the incidence of more advanced cervical cancer is climbing. Using U.S. Cancer Statistics data, the authors found that since 2017, regional-stage and distant-stage cervical cancer incidence has increased by 2.3% and 2.6% per year, respectively, among women aged 30 to 64.
"These increases are troubling," the authors wrote. They viewed them in the context of the growing proportion of women who have never been screened over the last two decades. The findings underscore a growing gap in cervical cancer prevention.
Disparities in Screening Access
The 2023 survey data revealed significant inequities. Among women aged 21 to 29, never-screening rates were highest for Asian women at 44.3%, followed by Hispanic women at 37.5% and Black women at 33.9%. The rate for white women was 28.8%.
Screening rates also varied substantially by education and insurance status. Women with only a high school degree had a 39% never-screened rate, compared to 17.1% for those with a master's or doctoral degree. Among the uninsured, 41.8% had never been screened, versus 30.3% of those with private insurance. You can explore more demographic health stats on our site.
HPV Vaccination and Study Limitations
HPV vaccination rates among women aged 21 to 29 increased from 5.7% in 2008 to 54% in 2019. The authors noted the results highlight "substantial missed opportunities for both primary and secondary prevention."
The study was limited by the self-reported nature of the screening data, which is subject to recall bias. The researchers also acknowledged a lack of available HPV status data in the national survey and cancer registries. For a deeper look at research methodologies, check our fixtures page.
The overall increase in never receiving cervical cancer screening is further compounded by inequities across demographic and geographic subgroups, Sonawane and colleagues concluded.
