Rising Numbers of Young Women Forgo Cervical Cancer Screening

A recent national study reveals a significant rise in young American women who have never been screened for cervical cancer. The number has more than doubled over the past two decades, despite cervical cancer screening being crucial for preventing the disease, which results in approximately 4,000 deaths annually in the U.S.

Published in JAMA Network Open, the study indicates that the percentage of women aged 21 to 29 who never underwent cervical cancer screening increased from 12.5% in 2005 to 31.9% in 2023. This translates to an increase in unscreened women from 3.5 million to 6.2 million, with the most significant rise occurring after 2010.

Screening Guidelines for Cervical Cancer

Various major medical organizations provide recommendations for cervical cancer screenings, primarily focusing on HPV-based methods, as HPV infection causes nearly all cervical cancers.

U.S. Preventive Services Task Force (USPSTF)

• Under age 21: No routine screening.
• Ages 21-29: Pap test (cervical cytology) every 3 years.
• Ages 30-65: Options include a Pap test every 3 years, a primary HPV test every 5 years, or HPV/Pap co-testing every 5 years.
• Over age 65: Screening can generally stop if there’s been adequate prior screening and no significant risk factors.

American Cancer Society (ACS)

• Screening should start at age 25.
• Ages 25-65: Preferred method is primary HPV testing every 5 years. Alternatives include HPV/Pap co-testing every 5 years or a Pap test alone every 3 years.
• Screening should cease at age 65 provided there have been adequate, normal screenings and there’s no high risk.

Older Women Also at Risk

The troubling trend extends beyond younger women. Among women aged 30 to 65, the proportion who had never been screened rose from 5.3% in 2005 to 14.8% in 2023. This increase represents a jump from 4.3 million to 9.2 million women. This age group is critically important as cervical cancer risks are highest during these years. Unscreened older women risk advancing to later stages of the disease without symptoms or diagnosis.

Data was gathered from nine cycles of the National Health Interview Survey conducted between 2005 and 2023, coupled with U.S. Cancer Statistics tracking cervical cancer incidence by age and stage from 2001 to 2023.

HPV Vaccination Rates Fall Short

The study also points out low HPV vaccination rates among younger women, increasing risks associated with missing screenings. Among women aged 21 to 29, vaccination rates ascended from 5.7% in 2008 to 54.0% in 2019. Despite the increase, around 45.5% remain unvaccinated, leaving nearly 8 million women in this age group without this protective measure. Nearly a third of these unvaccinated women have also never been screened.

Additionally, diagnoses of cervical cancer at regional and distant stages rose by over 2% annually after 2017 among women aged 30 to 65. The study’s authors clarify that their data cannot conclusively prove screening gaps directly led to this increase, yet the trend is concerning.

Disparities in Screening

The study identifies disparities in cervical cancer screening. Women from minoritized racial groups, those without health insurance, and women residing in Southern states are more likely to have never been screened. These groups already experience higher rates of late-stage cervical cancer diagnosis and mortality, suggesting the screening gap may be worsening existing health inequities.

Researchers noted some limitations, including self-reported screening data, which can be influenced by recall bias. Additionally, the surveys and cancer registries did not include participants’ HPV status. Their goal was not to establish a direct cause between screening gaps and rising cancer rates but to underscore a trend needing further research.

Cervical cancer can largely be prevented through vaccination and regular screenings. Addressing screening access, particularly among young women and vulnerable groups, remains a key public health priority.