Despite advances in human papillomavirus (HPV) testing and cervical cytology, millions of US women have never been screened for cervical cancer, according to a new study published in JAMA Network Open.
The findings suggest clinical laboratories and pathology groups may need to take a stronger role in helping physicians and other providers prompt women to seek screening and follow-up care after a positive test result.
Researchers at the Medical University of South Carolina analyzed National Health Interview Survey data collected between 2005 and 2023. The study included 23,502 women aged 21 to 29 years and 82,760 women aged 30 to 65 years who were eligible for cervical cancer screening.
Among women aged 21 to 29, the proportion who reported never receiving cervical cancer screening rose from 12.5%in 2005 to 31.9%.in 2023. Extrapolating the survey results for the US population, the number of women who have not received screening went from 3.5 million to 6.2 million.
Among women aged 30 to 65, the never-screened population increased from 5.3%, or 4.3 million women, to 14.8%, representing approximately 9.2 million women.
By 2023, nearly one in three women aged 21 to 29 and approximately one in seven women aged 30 to 65 had never undergone cervical cancer screening.
Some of these findings reflect a broader trend during the pandemic of decreased demand for cancer testing.
Advanced cervical cancer also increased
The researchers compared screening trends with cervical cancer incidence data from US cancer statistics.
Among women aged 30 to 64, the incidence of both regional-stage and distant-stage cervical cancer increased by more than 2% annually after 2017. Distant-stage cancer incidence also increased among women aged 65 and older beginning in 2001.
The researchers cautioned that the study was not designed to establish a causal relationship between declining screening participation and increasing rates of advanced disease. However, the trends raise concerns about missed opportunities to detect precancerous changes or cervical cancer at an earlier stage.
“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,” the study’s authors wrote.
The screening gap also persisted despite increasing HPV vaccination. Among women aged 21 to 29, the percentage reporting at least one HPV vaccine dose rose from 5.7% in 2008 to 54% in 2019. The researchers noted that millions of young women remain both unvaccinated and unscreened, leaving them without either primary or secondary prevention.
These findings may be useful to clinical laboratories working with health systems, federally qualified health centers, public health agencies, and other providers to identify communities with low screening participation. Laboratories could play a role by helping providers monitor screening completion, improve patient access to specimen collection, and ensure positive or abnormal results lead to appropriate diagnostic follow-up.
The analysis relied on self-reported screening histories, which may be affected by inaccurate recall. Nevertheless, the estimated increase in women who have never been screened—combined with rising incidence of regional- and distant-stage disease—signals that existing screening programs are failing to reach a substantial portion of women.
This article was created with the assistance of Generative AI and has undergone editorial review before publishing.
