Many women who never received HPV vaccine also not up to date on cervical cancer screening
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A considerable proportion of women who never received an HPV vaccine also never underwent cervical cancer screening or were not up to date on screening in 2019, according to findings published in JAMA Network Open.
“We showed that young women who have not received HPV vaccine (one in three women) were less likely to receive cervical cancer screening compared to vaccinated women (one in six women),” Ashish A. Deshmukh, PhD, MPH, an associate professor of management, policy and community health at UTHealth School of Public Health in Houston, told Healio Primary Care
Cervical cancer screening rates have dropped in the U.S. during the last decade, ending a downward trend in cervical cancer rates for the first time in several decades, according to Deshmukh.
“Poor cervical cancer screening uptake among U.S. women who are not vaccinated for HPV is a major public health concern,” Deshmukh and colleagues wrote.
The researchers examined cervical cancer screening uptake and adherence in a cross-sectional study. Using National Health Interview Survey data from 2019, Deshmukh and colleagues compiled information from 1,872 women aged 21 to 29 years and 2,637 women aged 31 to 39 years. Among the younger cohort, 54.1% of women were white, 62.4% had private insurance, 89.3% lived in an urban area and 40.1% lived in the South. Among the older cohort, 54.2% were white, 65.2% had private insurance, 87.4% lived in an urban area and 37.8% lived in the South.
The researchers found that 24.6% of the younger cohort and 11.5% of the older cohort never underwent cervical cancer screening. Moreover, 29.1% and 17.5%, respectively, did not adhere to screening recommendations.
Among the younger cohort, a higher proportion of women who were not vaccinated against HPV never received cervical cancer screening compared with those who were vaccinated (32.2% vs. 17.9%, P < .001) and were not up to date on cervical cancer screening recommendations (37.4% vs. 21.6%, P < .001). Similarly, among the older cohort, unvaccinated women were more likely than vaccinated women to have never received screening (13.5% vs. 5%; P < .001) or adhere to screening recommendations (19.9% vs. 9.3%; P < .001), according to Deshmukh and colleagues.
Asian women in the younger cohort had a higher likelihood of never receiving screening (adjusted OR [aOR] = 2.07; 95% CI, 1.03-4.16) compared with white women. In the older cohort, Hispanic (aOR = 2.77; 95% CI, 1.71-4.51), Asian (AOR = 3.03; 95% CI, 1.70-5.40) and Black women (aOR = 2.25; 95% CI, 1.37-3.69) had a higher likelihood of never receiving screening compared with white women. Deshmukh and colleagues observed similar findings for women who were not up to date on screening recommendations.
“Timely HPV vaccination and cervical cancer screening are cornerstone interventions for cervical cancer elimination in the U.S. and globally. Lack of either or both strategies could increase the vulnerability of women for acquiring cancer-causing HPV infection and its progression to cancer,” Deshmukh said.
He added that primary care physicians should make strong recommendations to patients and put increased emphasis on cervical cancer screening.
Perspective
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Christina S. Chu, MD
Sonawane and colleagues have examined national data examining women who had not received the HPV vaccine and how likely they were to undergo pap test screening for cervical cancer. The HPV vaccine is highly effective at preventing cervical cancer, but fewer than 50% of eligible adolescents and only 65% of young women have received the vaccine. Unfortunately, we also know that there has been a marked decrease in the number of young women getting recommended pap to screen for cancer in the past several years. The investigators noted that of 1,872 women aged 21 to 29 years, 25% had never had a pap test, and 29% did not follow screening recommendations. Among women aged 31 to 39 years, 11.5% had never had a pap test, and 17.5% did not follow screening recommendations.
Among women not vaccinated for HPV, more women reported never getting a pap (32% vs. 18% for women aged 21 to 29 years; 14% vs. 5% for women aged 31 to 39 years). Unvaccinated women of Asian and Hispanic origin, as well as those who had only received a high school diploma or were uninsured were most likely to not have undergoing pap test screening.
It is unfortunate to note that a substantial proportion of unvaccinated women have never undergone screening for cervical cancer or were not up to date with their screening. These unvaccinated women are at much higher risk for cervical cancer than vaccinated women, and we need to make much stronger efforts to try to reach these at-risk populations.
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