Nearly 1 in 3 Women in Their 20s Have Never Had a Cervical Screening

• Recent research found that nearly 1 in 3 women ages 21 to 29 had never been screened for cervical cancer as of 2023, up from about 1 in 8 in 2005.
• Researchers also found disparities in never-screening based on factors including race and ethnicity, education, and insurance coverage.
• Regional- and distant-stage cervical cancer incidence each increased by more than 2% per year after 2017 among women ages 30 to 64.

Nearly 1 in 3 women ages 21 to 29 had never undergone cervical cancer screening as of 2023, according to new research published in JAMA Network Open on August 27. 

The percentage of younger women who had never been screened rose from 12.5% in 2005 to 31.9% in 2023, with researchers also finding disparities based on factors such as race and ethnicity, education, and health insurance coverage.

The findings are concerning because cervical cancer is largely preventable through human papillomavirus (HPV) vaccination and regular screening, which can detect precancerous changes before they develop into cancer.

Cervical cancer screening rates decline among younger women

The researchers used data from the National Health Interview Survey (NHIS) between 2005 and 2023, which included a cervical cancer screening questionnaire.  

They estimated the proportion of women who reported never having undergone cervical cancer screening in two age groups: 21 to 29 and 30 to 65. The researchers adjusted the population estimates to account for women who had undergone a hysterectomy.

Among women ages 21 to 29, the proportion who had never been screened increased from 12.5% in 2005 to 31.9% in 2023. Among women ages 30 to 65, it increased from 5.3% to 14.8%.

The researchers also identified disparities based on race and ethnicity, education, insurance coverage, and geographic region.

Asian women had the highest prevalence of never being screened in both age groups, while uninsured women ages 30 to 65 were also significantly more likely to have never been screened.

Cervical screening rates remain lower than pre-pandemic levels, unlike breast cancer and colorectal cancer. It’s possible that these decreased screening rates may also be due in part to barriers like:

• cost 
• insurance 
• transportation 
• misinformation about HPV vaccination
• discomfort 
• lack of awareness

“The [findings of] this study did not surprise me at all.  There is ongoing confusion about how often a pap smear is needed, who should be screened, HPV vaccination access and necessity, access to healthcare providers, insurance coverage, and cultural, ethnic, and racial interference, all contributing to who is, and who is not, getting screened for cervical cancer and HPV prevention,” said Sherry Ross, MD, board certified OB/GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, who wasn’t involved in the study. 

Why is cervical cancer screening important?

Cervical cancer screening can detect precancerous cell changes before they develop into cancer. It can also detect cervical cancer at an early stage, when it is generally easier to treat.

“PAP smears can definitely be lifesaving as they identify cancerous– but more importantly, precancerous conditions which can be readily treated or mitigated,” Kecia Gaither, MD, double board certified in OB/GYN and Maternal Fetal Medicine, and an Associate Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medicine, told Healthline.

Gaither was not involved in the study. 

According to the Centers for Disease Control and Prevention (CDC), more than 9 in 10 cases of cervical cancer are caused by HPV. However, most HPV infections clear on their own within 2 years. Persistent infection with certain high risk types of HPV can cause cervical cell changes that may eventually develop into cancer.

Each year, 10,800 women are diagnosed with cervical cancer due to HPV, and nearly 200,000 are diagnosed with cervical pre-cancer. 

Who should get cervical cancer screening?

The ACS recommends that women and other people with a cervix who are at average risk of cervical cancer begin regular screening at age 25 and continue until at least age 65.

The preferred screening option is a primary HPV test using a cervical sample collected by a healthcare professional every 5 years. Other options include:

• a Pap test alone every 3 years if HPV testing is not available
• a self-collected HPV test every 3 years
• an HPV/Pap co-test every 5 years

Regular screening is still recommended even if you’ve received the HPV vaccine or are not currently sexually active. The HPV vaccine greatly reduces the risk of cervical cancer but does not eliminate it, and HPV infections that can cause cervical cancer may appear decades after initial exposure.

If you are at a higher risk, a healthcare professional may recommend more frequent screenings. You may need a different screening schedule if you have certain risk factors, including:

• previous abnormal screening test results or cervical precancer
• cervical cancer in the past
• weakened immune system
• exposure to diethylstilbestrol (DES) before birth

“There needs to be an ongoing conversation with your health care provider to understand your personal risk for cervical cancer and the frequency of your personal testing schedule,” said Ross.