1 in 3 Young American Women Have Never Had a Life-Saving Cancer Screening

A recent national study reveals that one in three young American women has never undergone cervical cancer screening, a critical measure in preventing a disease that claims approximately 4,000 lives annually in the U.S. The frequency of women avoiding screening has more than doubled in just under two decades, despite its proven effectiveness.

Published in JAMA Network Open, the research found that the proportion of women aged 21 to 29 who reported never having cervical cancer screening increased from 12.5% in 2005 to 31.9% in 2023. This equates to a surge in the population of unscreened young women, from around 3.5 million to 6.2 million, with the largest increase after 2010.

Dr. Liz Swenson, an obstetrician and gynecologist, commented on the data, stating that the findings confirm the widespread issue of screening lapses, not due to women's lack of concern, but because the healthcare system has not kept pace with the evolving needs of women. The rapid rise in unscreened young women coincides with guideline revisions after 2010, which caused confusion among providers and patients.

Additionally, roughly 45.5% of women aged 21-29 remain unvaccinated against HPV, a major risk factor for cervical cancer.

Different major medical organizations have varying recommendations, but all are shifting towards HPV-based screening due to the fact that persistent HPV infection leads to nearly all cervical cancers. The USPSTF recommendations guide many insurers' coverage requirements and are widely used in clinical practice. The American Cancer Society (ACS) updated its guidance to start screening later and emphasize HPV testing, reflecting the evolving understanding of cervical cancer prevention.

However, the concerning trend is not confined to younger women. Among those aged 30 to 65, the proportion who had never been screened rose from 5.3% to 14.8% between 2005 and 2023, a significant increase from roughly 4.3 million to 9.2 million women. This age group is especially crucial as it captures the years when cervical cancer risk is highest. Older women who have not been screened for years face a higher risk of the disease progressing to later stages before being diagnosed.

The study, based on data from nine cycles of the National Health Interview Survey (2005-2023) and U.S. Cancer Statistics, also unveiled low HPV vaccination rates among younger women, which exacerbate the risks of skipping screening. Only 5.7% of women aged 21-29 were vaccinated in 2008, rising to 54.0% in 2019, leaving nearly 45.5% of this age group unvaccinated. Alarmingly, nearly a third of these unvaccinated women also had never been screened, leaving them without any protective measure against the disease.

The researchers caution against assuming that screening gaps directly caused the rise in later-stage cervical cancer diagnoses after 2017 among women aged 30-65, though the pattern is alarming. Dr. Swenson emphasizes that the disparity is not evenly spread, with women lacking insurance and consistent access to primary care disproportionately under-screened, leading to a rise in later-stage diagnoses.

Cervical cancer is one of the most preventable cancers, and the increasing number of late-stage diagnoses signals that the screening infrastructure is failing to reach the most vulnerable populations.

To address this issue, the study advocates for modernizing care delivery and lowering barriers through scalable solutions such as at-home HPV self-collection. The researchers acknowledged limitations, including the self-reported nature of the screening data, which could be subject to recall bias, and the absence of HPV status information in the health survey and cancer registries.

Despite these limitations, their goal was to highlight a concerning trend that warrants further research. Cervical cancer is largely preventable through vaccination and regular screening, making closing the screening gap among young women and vulnerable groups a critical public health priority.