Cervical cancer remains a preventable cause of morbidity and mortality, particularly among women who are not reached by screening programs. In a research letter published in JAMA Network Open, Sonawane et al emphasized the importance of identifying those who have never been screened and reported findings from a cross-sectional study examining nearly 2 decades of trends and sociodemographic disparities in cervical cancer nonscreening, as well as patterns in cervical cancer incidence.
“This study reports a troubling increase in never-screened women and overlap between populations at greatest risk and those least likely to receive preventive screening,” the investigators commented. “The findings underscore a growing gap in cervical cancer prevention among young women and during midlife….”
Study Details
The investigators analyzed data from nine cycles of the National Health Interview Survey (NHIS) conducted between 2005 and 2023, including 106,262 cervical cancer screening–eligible women aged 21 to 29 years (22%) or 30 to 65 years (78%). They estimated the proportion of women who reported never having undergone cervical cancer screening in each survey year, with denominators corrected for hysterectomy. Human papillomavirus (HPV) vaccination status was also assessed among women aged 21 to 29 years in survey years for which these data were available.
Using U.S. Cancer Statistics data, the investigators examined hysterectomy-corrected cervical cancer incidence from 2001 to 2023 by age (30–64 and ≥ 65 years) and stage at diagnosis (localized, regional, or distant).
Nonscreening and Incidence Trends
Among women aged 21 to 29 years, the HPV vaccination rate was 5.7% in 2008 and 54.0% in 2019. During the broader study period, however, the proportion in this age group who reported never having been screened for cervical cancer increased from 12.5% in 2005 to 31.9% in 2023 (average annual percentage change [AAPC] = 5.2%, 95% confidence interval [CI] = 4.3%–7.5%). The increase was particularly pronounced from 2010 to 2023 (annual percentage change [APC] = 7.9%, 95% CI = 6.0%–14.4%), the investigators wrote.
Over the same 2005-to-2023 period, the proportion of women aged 30 to 65 years who had never been screened increased from 5.3% to 14.8% (AAPC = 6.8%, 95% CI = 3.1%–12.0%).
In the cervical cancer incidence analysis, regional- and distant-stage disease among women aged 30 to 64 years each were found to increase significantly by more than 2% per year after 2017. Among those aged at least 65 years, distant-stage incidence increased beginning in 2001.
Disparities in Nonscreening
In the 2023 NHIS, which included 8,901 women aged 21 to 65 years, never-screening among those aged 21 to 29 years was highest among Asian women, at 44.3%, compared with 28.8% among non-Hispanic White women. Never-screening was also more common among women with a high school education (39.0%) or a college or associate’s degree (35.0%) than among those with a master’s or doctoral degree (17.1%).
Similar patterns were observed among women aged 30 to 65 years, according to the investigators, with additional disparities in never-screening by race and ethnicity, education, insurance status, and geographic region.
“The findings…highlight the need for targeted strategies to address structural barriers and improve screening uptake,” the investigators concluded.
Kalyani Sonawane, PhD, of the Medical University of South Carolina, Charleston, is the corresponding author of the article in JAMA Network Open.
Disclosure: The research was supported by the U.S. National Library of Medicine and the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
