Almost a third of women in their 20s have never been screened for cervical cancer

The percentage of women in their 20s who have never been screened for cervical cancer has been increasing at a disturbing rate over the past 20 years – to the point that now, almost a third of women between the ages of 21 and 29 have never been screened.

The increase is troubling, said researchers at MUSC Hollings Cancer Center, who published their work in JAMA Network Open this week.

Cervical cancer is one of the most preventable cancers, with human papillomavirus (HPV) vaccination as the first line of defense and regular screening as the next.

Yet even among women between the ages of 30 and 64, almost 15% have never been screened, this new paper detailed.

“A lot of times national surveys look at the up-to-date rate, meaning how many women are up to date on their screening,” explained first author Kalyani Sonawane, Ph.D., assistant director for data science and analytics at Hollings. “But this paper is slightly different because it measures the proportion of women who reported that in their lifetime, they've never received screening.”

The researchers relied on self-reported data from the National Health Interview Survey, so there is a chance that some women misremembered whether they’d been screened.

The lack of screening – increasing by 5% each year – was accompanied by an increase in distant- and regional-stage cervical cancer diagnosed in women between the ages of 30 and 64. The goal of screening is to find precancer and early-stage cancer, when it’s easier to treat. It’s possible that, because fewer women are being screened, cancer is now more likely to be diagnosed after it has spread, once a woman notices symptoms and goes to the doctor – however, this study was not designed to investigate how these two trends are related. The researchers mention the increase in regional and distant cancer diagnoses to indicate where more research is needed.

The researchers also note that a substantial proportion of women in their 20s – 45% – are not vaccinated against HPV, meaning they aren’t protected by either the first line of defense or the second.

Sonawane said the research team wasn’t sure why the unscreened rate has been on the upswing. In previous unpublished work, they looked at women’s answers to a question about why they weren’t screened. Many said they didn’t have a particular reason or that their healthcare provider didn’t bring it up.

She also speculated that perhaps some women who are vaccinated against HPV think that means they don’t need screening, though guidelines recommend screening even after vaccination.

The research also uncovered particular gaps in screening. Uninsured women, women living in the South and racial minorities were especially likely to have never been screened.

Cervical cancer screening recommendations:

• Ages 21 to 29: Pap test every three years.
• Ages 30 to 65: HPV/Pap co-testing every five years.

The above recommendations are general guidelines for the average-risk woman. Each woman should speak with her healthcare provider about the screening schedule that is best for her as an individual.