A recent national study reveals that nearly one in three young American women has not been screened for cervical cancer. The number of women avoiding screening has more than doubled in less than 20 years. Despite cervical cancer screening being crucial in preventing the disease, around 4,000 women die from cervical cancer annually in the U.S.
The research published in JAMA Network Open shows that the percentage of women aged 21 to 29 who have never undergone screening increased from 12.5% in 2005 to 31.9% in 2023. This shift means that the number of unscreened young women grew from approximately 3.5 million to 6.2 million, especially after 2010.
Screening Recommendations
Major medical organizations have slightly different screening recommendations, focusing on HPV-based screening due to the critical role of persistent HPV infections in causing cervical cancer.
USPSTF (U.S. Preventive Services Task Force)
- Under 21: No routine screening.
- Ages 21-29: Pap test (cervical cytology) every 3 years.
- Ages 30-65: Options include Pap test every 3 years, primary HPV test every 5 years, or HPV/Pap co-testing every 5 years.
- Over 65: Screening may stop for those with adequate prior screening and no high-risk history.
American Cancer Society (ACS)
The ACS recommends starting screening later, focusing on HPV testing. They suggest beginning at age 25.
- Ages 25-65: Preferred is primary HPV testing every 5 years. Alternatives are HPV/Pap co-testing every 5 years or Pap test alone every 3 years.
- Stop at 65 if a person has had adequate normal screening results and is not at high risk.
Older Women Also Affected
The trend extends to women aged 30 to 65. In this group, the rate of those never screened rose from 5.3% to 14.8% between 2005 and 2023, equating to a rise from about 4.3 million to 9.2 million women. This age group is critical, as it marks heightened cervical cancer risk years. Missing years of screening can lead to late-stage diagnosis.
Data from nine cycles of the National Health Interview Survey and U.S. Cancer Statistics emphasize this risk.
Low HPV Vaccination Rates
Low HPV vaccination rates worsen the risks associated with not getting screened. For women aged 21 to 29, vaccination rates went from 5.7% in 2008 to 54.0% in 2019. This data indicates that roughly 8 million women or 45.5% remain unvaccinated. The study notes that almost one-third of unvaccinated women have never been screened, lacking both preventive measures.
Research shows that cancer diagnosed at regional and distant stages rose by over 2% annually after 2017 among women aged 30 to 65. Authors acknowledge the study cannot directly link screening gaps to increased cancer rates but highlight a concerning pattern.
Disparities in Screening
Clear disparities exist among those who have never been screened. Women from minoritized racial groups, those without insurance, and those living in Southern states are less likely to have been screened. These groups already face higher rates of late-stage diagnosis and mortality, suggesting the screening gap may compound existing health inequities.
The study’s authors recognize some limitations. Screening data was self-reported, potentially leading to recall bias. Furthermore, there’s no HPV status data for survey participants. The aim is not to prove causality but to underline patterns needing further investigation. Cervical cancer is mainly preventable through vaccination and screening. Addressing screening access gaps among young women and marginalized groups is a crucial public health task.