Never-Screened Cervical Cancer Rates Rose From 2005-2023

Key Takeaways

• Among U.S. women ages 21 to 29, the share reporting they had never received cervical cancer screening rose from 12.5% to 31.9%, and the increase was statistically significant.
• Among women ages 30 to 65, the share reporting they had never received cervical cancer screening rose from 5.3% to 14.8%, also in a statistically significant trend.
• In 2023, higher never-screening was reported among Asian, Hispanic, and Black women ages 21 to 29, and among uninsured women and women with lower educational attainment.
• Human papillomavirus vaccination among women ages 21 to 29 increased over time even as the proportion who had never received cervical cancer screening also rose.

A persistent U.S. cervical cancer prevention gap remains among women who have never entered screening at all, especially younger adults and groups facing insurance, educational, and racial and ethnic inequities. That gap matters separately from whether screening intervals are current because women who have never been screened may represent the greatest missed opportunity for early detection. Repeated national survey and registry data can help clarify how often this pattern is occurring and whether it is moving alongside later-stage disease at the population level.

Investigators used the JAMA Network Open research letter on never receiving cervical cancer screening for a cross-sectional observational analysis of repeated National Health Interview Survey (NHIS) cycles from 2005 through 2023, and the 2023 disparity analysis included 8,901 women with a mean age of 40.5 years. Human papillomavirus (HPV) vaccination was assessed among women ages 21 to 29 in cycles with vaccination data, and stage-specific cervical cancer incidence was examined in U.S. Cancer Statistics data for women ages 30 to 64 and 65 years or older.

In the National Health Interview Survey analysis of cervical cancer screening trends, never-screening among women ages 21 to 29 increased from 12.5% in 2005 to 31.9% in 2023, with AAPC 5.2% (95% CI 4.3%-7.5%). Among women ages 30 to 65, never-screening increased from 5.3% to 14.8%, with AAPC 6.8% (95% CI 3.1%-12%). The younger group also showed acceleration from 2010 to 2023, with APC 7.9% (95% CI 6%-14.4%).

In 2023, higher never-screening was reported among women ages 21 to 29 who were Asian, Hispanic, or Black, and among uninsured women and women with lower educational attainment. As parallel context, HPV vaccination among women ages 21 to 29 increased from 5.7% in 2008 to 54% in 2019.

The source reports that regional-stage and distant-stage cervical cancer incidence increased by 2.3% and 2.6% per year, respectively, among women ages 30 to 64 since 2017.

Interpretation of these parallel trends is limited because screening history was self-reported and subject to recall bias, and HPV status was not available in the National Health Interview Survey or cancer registries. The authors presented screening and incidence patterns together to generate hypotheses rather than establish causality. They also framed subgroup differences in the context of structural barriers rather than as evidence that any single factor explains the widening prevention gap.

The authors said the United States is seeing a larger group of women who have never entered cervical cancer screening, with inequities persisting across age and sociodemographic groups. They described the pattern as a widening prevention gap in cervical cancer while emphasizing that the incidence trends do not prove a direct causal pathway.

Clinician Questions

What counted as never receiving cervical cancer screening in this analysis?

The endpoint was a self-reported history of never having undergone cervical cancer screening among screening-eligible U.S. women in the National Health Interview Survey, using hysterectomy-corrected denominators. That measure is distinct from whether women were up to date with recommended screening over time.

Which datasets were used to compare cervical cancer screening trends with stage-specific incidence in U.S. women?

Investigators used repeated National Health Interview Survey cycles from 2005 through 2023 to estimate never-screening prevalence and to assess human papillomavirus vaccination among women ages 21 to 29, and they used U.S. Cancer Statistics stage-specific incidence data from 2001 through 2023 for women ages 30 to 64 and 65 years or older. The datasets describe parallel national trends rather than an individual-level linkage between screening history and cancer diagnosis.

Do the later-stage cervical cancer incidence findings apply to women ages 21 to 29?

No. The stage-specific incidence analyses were reported for women ages 30 to 64 and for women 65 years or older, whereas women ages 21 to 29 were included in the screening-trend and vaccination analyses.

Why did the authors describe the screening and incidence trends as hypothesis-generating rather than causal?

The work combined repeated cross-sectional survey data with surveillance incidence trends, relied on self-reported screening history, and did not include HPV status in the National Health Interview Survey or cancer registry data. Those features support description of parallel national patterns but do not establish that changes in screening caused the incidence findings.