Recent research published in JAMA Network Open reveals a troubling rise in the number of American women who have never undergone cervical cancer screening. In 2023, almost one in three women ages 21 to 29—about 6.2 million—reported never having a Pap test or HPV test, a sharp increase from just 12.5% in 2005.
Study Findings
Researchers analyzed responses from more than 106,000 women collected by the U.S. Centers for Disease Control and Prevention’s National Health Interview Survey. The data show that the proportion of women ages 30 to 65 who have never been screened also grew, from 5.3% in 2005 to nearly 15% in 2023, representing roughly 9.2 million women.
Disparities were evident across race, education and insurance status. In 2023, about 44% of Asian women ages 21‑29 had never been screened, compared with 29% of White women. Women with only a high‑school education were twice as likely to miss screening as those holding a master’s or doctoral degree (39% vs. 17%). Uninsured women ages 30‑65 were three times more likely to skip screening than those with private insurance (32% vs. 11%).
Why Screening Matters
Dr. Leana Wen, an emergency physician and former Baltimore health commissioner, explained that cervical cancer typically develops over many years. More than nine in ten cases are linked to persistent infection with high‑risk human papillomavirus (HPV), a virus spread through intimate skin‑to‑skin contact.
Most people clear HPV without issue, but when the virus persists it can cause cellular changes that progress from precancer to invasive cancer. Screening—either a Pap test, an HPV test, or a combination—detects these changes early, allowing for monitoring or removal before cancer develops.
Current Screening Recommendations
The U.S. Preventive Services Task Force advises women ages 21‑29 to be screened with a Pap test every three years. For women ages 30‑65, three options are acceptable: a Pap test every three years, primary high‑risk HPV testing every five years, or co‑testing (Pap + HPV) every five years. The American College of Obstetricians and Gynecologists (ACOG) now prefers primary HPV testing every five years for the 30‑65 age group, while also allowing patient‑collected HPV samples every three years for those who prefer self‑collection.
Vaccination and Screening Still Needed
Even women who have received the HPV vaccine should continue regular screening. The vaccine protects against the most common cancer‑causing HPV types but does not cover all high‑risk strains, and many individuals were vaccinated after they had already been exposed.
Barriers and Possible Solutions
Study authors note that the data cannot pinpoint why screening rates have fallen, but possible factors include limited access to care, lack of insurance, discomfort with pelvic exams, and insufficient public awareness about when and how often to be screened. Self‑collected HPV tests may help reach women who avoid traditional exams.
Dr. Wen urges women who are overdue or have never been screened to contact their primary‑care provider or gynecologist promptly. Screening can be performed outside of an annual physical visit, and patients should also verify their vaccination status during the appointment.
Looking Ahead
While the study cannot directly link reduced screening to higher cancer mortality, it did observe a modest rise in later‑stage cervical cancer diagnoses after 2017 among women ages 30‑64. The trend underscores the importance of restoring and expanding preventive services, especially for underserved populations.
Ensuring that young women receive timely cervical cancer screening remains a critical public‑health priority. By addressing insurance gaps, expanding access to self‑collection kits, and reinforcing education about the benefits of early detection, health leaders hope to reverse the current decline and protect the health of future generations.
Original reporting: KEYT (Ventura/Santa Barbara) — read the source article.
