Cervical Cancer Screening Rose, but Demographic Gaps Persisted

Key Takeaways

• Among female patients aged 21–64 years with a health care encounter, annual cervical cancer screening rose across racial and ethnic groups during 2019–2024, with the largest increase among Hispanic patients.
• Non-Hispanic White patients had the highest annual screening rates during 2019–2021 but the smallest increase over the full period.
• Screening remained lowest among American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients, while rates were comparatively lower in the West and South.
• Patients aged 30–49 years and non–English-speaking patients had the highest annual rates within their respective age and language comparisons.

Cervical cancer screening around the coronavirus disease 2019 (COVID-19) pandemic raises a question: how did annual rates vary by race and ethnicity, age, language, and region? Screening recorded within a calendar year differs from being up to date under multiyear guidelines. Investigators assessed annual screening patterns using encounter-based records.

Investigators conducted a cross-sectional electronic medical record analysis for each year from 2019 through 2024 among female patients aged 21–64 years who had at least one health care encounter. Approximately 9 million to 16 million patients were represented annually, with analytic denominators varying by subgroup. In the JAMA Network Open cervical cancer screening analysis, investigators used descriptive summaries to assess annual screening rates by race and ethnicity, age, language, and census region. They used the Cochran–Armitage test to assess linear trends over calendar years.

Hispanic patients had the largest increase in annual cervical cancer screening, from 10% in 2019 to 16% in 2024; the latter estimate had a 95% confidence interval of 15%–16%.

Non-Hispanic White patients had the smallest increase, from 11% in 2019 to 14% in 2024, despite having the highest annual rates during 2019–2021. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients had the lowest rates throughout the period. Within the age and language comparisons, rates were highest among patients aged 30–49 years and those who did not speak English. Rates in the Western and Southern census regions were lower than in other regions.

Annual rates among people seen in an electronic medical record system are not general-population screening rates. They also do not indicate what proportion of patients were up to date under multiyear screening guidelines, because the outcome captures screening within a calendar year. The cross-sectional comparisons describe differences between groups but cannot establish why those patterns occurred. These distinctions matter when interpreting changes in encounter-based screening alongside persistent demographic and regional variation.

The authors concluded that annual cervical cancer screening increased across racial and ethnic groups while demographic and geographic differences persisted. They identified those continuing differences as areas for future research.

Clinician Questions

Which demographic groups predominated in the cervical cancer screening electronic medical record population?

Most patients represented in the cervical cancer screening electronic medical record analysis were non-Hispanic White, aged 30–49 years, English-speaking, and residents of the South or Northeast. These characteristics describe who was represented, not which groups had the highest annual screening rates.

Did cervical cancer screening trends from 2019 to 2024 follow the same patients over time?

No. Annual cervical cancer screening comparisons were cross-sectional among female patients aged 21–64 years with a health care encounter. Trends therefore describe calendar-year comparisons of encounter populations, not individual screening trajectories.