Cervical Cancer Screening Rates Drop Significantly Across U.S. Women

• Despite recommendations from the U.S. Preventive Services Task Force and the American Cancer Society, cervical cancer screening rates are falling.
• Between 2005 and 2023, the share of women aged 21‑29 who reported never having been screened rose from 12.5% to 31.9% (average annual percentage change [AAPC] 5.2%), with a steeper rise from 2010 to 2023 (AAPC 7.9%).
• Since 2017, incidence of regional‑stage and distant‑stage cervical cancer has climbed by 2.3% and 2.6% per year, respectively, among women aged 30‑64.

The proportion of women never screened for cervical cancer increased by more than 5% each year from 2005 to 2023, according to a cross‑sectional study.

During that period, the percentage of women ages 21‑29 who had never been screened grew from 12.5% to 31.9% (AAPC 5.2%, 95% CI 4.3‑7.5), with a marked increase from 2010 to 2023 (AAPC 7.9%, 95% CI 6.0‑14.4), said Kalyani Sonawane, PhD, of the Medical University of South Carolina in Charleston, and her co‑authors.

For women aged 30‑65, the never‑screened proportion rose from 5.3% to 14.8% (AAPC 6.8%, 95% CI 3.1‑12.0), they reported in a research letter published in JAMA Network Open.

Notably, HPV‑vaccination coverage among women aged 21‑29 ranged from 5.7% in 2008 to 54% in 2019.

Taken together, these findings reveal “substantial missed opportunities for both primary and secondary prevention,” Sonawane and colleagues observed.

Meanwhile, regional‑stage and distant‑stage cervical cancer incidence have increased by 2.3% and 2.6% per year, respectively, since 2017 among women aged 30‑64.

“These trends are troubling, especially when considered alongside the growing share of women who have never undergone cervical cancer screening over the past two decades,” the authors wrote, adding that the results “highlight a widening gap in cervical cancer prevention among young women and during midlife, underscoring the need for targeted interventions to overcome structural barriers and boost screening uptake.”

Earlier research also indicated that screening remains inadequate despite the U.S. Preventive Services Task Force recommending screening for average‑risk women ages 21‑65 and the American Cancer Society advising initiation at age 25.

One prior analysis showed that, although disruptions in cancer screening caused by the COVID‑19 pandemic had largely rebounded by 2023 for breast and colorectal cancer, cervical‑cancer screening rates remained 14% lower than in 2019.

The authors of that study suggested that the persistent decline may partly reflect longer‑term drops in patient awareness and clinician encouragement of cervical cancer screening.

In their investigation, Sonawane and team examined data from the National Health Interview Survey (NHIS) for the years 2005, 2008, 2010, 2013, 2015, 2018, 2019, 2021, and 2023, which include a cervical‑cancer‑screening questionnaire. They estimated the proportion of women who reported never having been screened at each survey date for the age groups 21‑29 and 30‑65, and determined HPV‑vaccination status (available in NHIS cycles 2008, 2010, 2015, 2018, and 2019) for women aged 21‑29.

Using U.S. Cancer Statistics, the researchers analyzed cervical‑cancer incidence by age (30‑64 and 65 +) and SEER summary stage (localized, regional, distant) from 2001 through 2023.

The 2023 NHIS encompassed 8,901 women aged 21‑65 (mean age 40.5), who were predominantly White (55.8%), had some college education (29.4%), held private insurance (62.5%), lived in urban areas (88.3%), and resided in the South (36.9%).

Among women aged 21‑29, never‑screening prevalence was higher for Asian (44.3%), Hispanic (37.5%), and Black (33.9%) participants compared with White women (28.8%).

Never‑screening rates also differed by education, with those holding only a high‑school diploma showing a markedly higher proportion (39%) than those with a master’s or doctoral degree (17.1%). Insurance status played a role as well: 41.8% of uninsured women had never been screened versus 30.3% of those with private coverage.

“The overall rise in never receiving cervical‑cancer screening is further exacerbated by inequities across demographic and geographic groups,” Sonawane and colleagues noted.

The authors acknowledged limitations, including the reliance on self‑reported screening data, which is vulnerable to recall bias, and the absence of HPV‑status information in the NHIS and cancer registries.

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