Nearly one-third of American women in their 20s have never been screened for cervical cancer, according to research published this week in JAMA Network Open — a share that has nearly tripled in less than two decades. [1]
Researchers at the Medical University of South Carolina's Hollings Cancer Center examined nine cycles of the National Health Interview Survey between 2005 and 2023, tracking how many women ages 21 to 29 reported never having received a cervical cancer screening in their lifetime. That figure rose from 12.5% — about 3.5 million women — in 2005 to 31.9%, or 6.2 million women, by 2023. [1] Among women ages 30 to 64, the never-screened rate nearly tripled as well, climbing from 5.3% to 14.8%. Across both groups, the share of women skipping screening entirely has grown by roughly 5% a year. [1]
The distinction matters clinically. National surveys typically track whether women are "up to date" on screening, a measure that can obscure a smaller, higher-risk population that has never engaged with the system at all. "This paper is slightly different because it measures the proportion of women who reported that in their lifetime, they've never received screening," said Kalyani Sonawane, the study's lead author and assistant director for data science and analytics at Hollings. [2]
The researchers found cause for concern beyond the participation numbers themselves: the widening screening gap has coincided with an increase in distant- and regional-stage cervical cancer diagnoses among women ages 30 to 64 — precisely the population screening is designed to catch early. [2] Cervical cancer is among the most preventable cancers when caught before it spreads, and the authors say the trend raises the risk that more cases are now surfacing only after symptoms appear.
Compounding the problem, the study found that 45% of women ages 21 to 29 — about 8 million people, based on 2019 data — had not received the HPV vaccine, meaning many young women have neither of cervical cancer's two lines of defense. [1] Sonawane said some unvaccinated women may mistakenly believe HPV vaccination alone eliminates the need for screening; current guidelines recommend both. Researchers also identified who is falling through the cracks most severely: uninsured women, women living in the South, and women from racial and ethnic minority groups were disproportionately likely to have never been screened. [2]
CIDRAP's coverage of the study centers the screening-participation figures — who is and is not showing up for a routine test. On X, physicians citing the same paper have pushed the emphasis toward what that gap produces downstream. One doctor, sharing the JAMA findings Friday, noted that regional- and distant-stage cervical cancer incidence among women 30 to 64 has climbed 2.3% and 2.6% a year, respectively, since 2017 — tying the incidence trend directly to the screening data rather than treating it as a footnote.
The researchers relied on self-reported survey data, so some respondents may have misremembered whether they had been screened, and the study was not designed to prove that the screening decline directly caused the rise in later-stage diagnoses. Sonawane's team said they do not yet know why the never-screened rate has climbed so steadily; in earlier, unpublished work, many women who skipped screening said they had no particular reason, or that their doctor simply never brought it up. [2] Current guidelines from the National Cancer Institute recommend that women begin cervical cancer screening at 21, regardless of vaccination status, and continue through age 65 — recommendations that, for a growing share of American women, are simply not reaching them.
-- NORA WHITFIELD, Chicago