Nearly 1 in 3 young American women have never undergone cervical cancer screening, according to a study published in JAMA Network Open. The research reveals a sharp increase in the proportion of women ages 21 to 29 who have skipped lifetime screening, rising from 12.5% in 2005 to 31.9% in 2023.
The study, led by Kalyani Sonawane, PhD, of the Medical University of South Carolina (MUSC) Hollings Cancer Center, analyzed data from the National Health Interview Survey (NHIS) across nine cycles between 2005 and 2023. While many national surveys track whether patients are up to date with recommended intervals, this research focused on women who had never received a screening at any point in their lives.
Rising Rates of Unscreened Women
The decline in screening is evident across multiple age groups. For women ages 21 to 29, the proportion who had never been screened grew from 3.5 million in 2005 to 6.2 million in 2023. Researchers noted a particularly steep increase between 2010 and 2023, with an average annual percentage change (AAPC) of 7.9%.
The trend also affected older women. Among those ages 30 to 65, the percentage of women who had never been screened climbed from 5.3% (4.3 million) in 2005 to 14.8% (9.2 million) in 2023. This represents a 5% annual increase in women skipping routine monitoring.
Demographic and Socioeconomic Disparities
The study found substantial inequities in screening rates based on race, education, and insurance status:
- Race: In 2023, approximately 44% of Asian women ages 21 to 29 had never been screened, compared to about 29% of White women.
- Education: About 39% of young women with a high school education had never been screened, while only 17.1% of those with a master’s or doctoral degree reported never being screened.
- Insurance: Among women ages 30 to 65, nearly 32% of those without insurance had never been screened. Other data indicated that 41.8% of uninsured women had never undergone screening, compared to 30.3% of those with private insurance.
Researchers suggested that these disparities indicate that access to healthcare—including barriers like cost, transportation, and time away from work—remains a significant factor.
Link to Advanced Cancer Stages
Cervical cancer typically develops over many years and is caused in more than 9 in 10 cases by persistent infection with high-risk types of human papillomavirus (HPV). While the immune system often clears HPV, persistent infections can cause abnormal cell changes that progress from precancer to invasive cancer.
The researchers observed that since 2017, the incidence of regional-stage and distant-stage cervical cancer among women ages 30 to 64 has increased by 2.3% and 2.6% per year, respectively. Regional cancer has spread to lymph nodes or nearby tissues, while distant-stage cancer has spread to remote parts of the body.
While these trends are concerning, Dr. Leana Wen, a former Baltimore health commissioner, noted that the study cannot determine if reduced screening was directly responsible for the increase in later-stage cancers.
Vaccination and Prevention Gaps
The study also highlighted a gap in primary prevention via HPV vaccination. Based on 2019 NHIS data, 45.5% (8 million) of women ages 21 to 29 had not received the HPV vaccine.
Sonawane suspects some women may mistakenly believe that receiving the vaccine removes the need for regular screenings. However, most guidelines recommend screening even for vaccinated women, as the vaccine protects against nine high-risk strains but does not protect against every cause of cervical cancer.
For women ages 30 to 65, recommended screening options include a Pap test every three years, high-risk HPV testing every five years, or a combination of both every five years.
The authors acknowledged a limitation of the study: screening history was self-reported, meaning the data was subject to recall bias.
