Timely cervical cancer screenings decreased since 2005, largely due to lack of awareness

The proportion of women in the U.S. who were not up to date on recommended cervical cancer screening significantly increased from 2005 to 2019, according to findings published in JAMA Network Open.

“Lack of knowledge of screening and lack of screening recommendations from health care professionals may be two modifiable barriers to timely cervical cancer screening,” Ryan Suk, PhD, MS, an assistant professor of management, policy and community health at UTHealth School of Public Health in Houston, and colleagues wrote.

Other barriers to timely screening generally include a lack of time to communicate with patients during visits, lack of resources and difficulty identifying patients who are due for screening, Suk told Healio.

In a pooled population-based, cross-sectional study, the researchers analyzed data from the U.S. National Health Interview Survey from 2005 and 2019. In total, 20,557 women aged 21 to 65 years without a previous hysterectomy were included in the analysis. The researchers examined whether the participants received U.S. Preventive Services Task Force guideline-concordant cervical cancer screenings.

A majority of the women were aged 30 to 65 years (76.3%) and had private insurance (67%). Also, 61% of the women were non-Hispanic white, 17.2% were Hispanic, 13.1% were non-Hispanic Black and 6.1% were Asian.

Overall, the proportion of women without timely cervical cancer screening increased from 14.4% in 2005 to 23% in 2019 among all sociodemographic groups, according to Suk and colleagues.

In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) compared with women aged 30 to 65 years (29.1% vs. 21.1%). The researchers also observed significantly higher rates of overdue screening among Asian women compared with white women (31.4% vs 20.1%), those identifying as LGBQ+ compared with heterosexual women (32% vs 22.2%), those living in rural areas compared with urban areas (26.2% vs 22.6%), and those without insurance compared with those with private insurance (41.7% vs 18.1%).

The most common reason reported to explain the absence of timely screening across all groups was lack of knowledge, which was lowest among women identifying as LGBQ+ (47.2%) and highest among Hispanic women (64.4%). Also, a significantly higher proportion of women aged 30 to 65 years reported not receiving screening due to lack of access (11.6%) compared with women aged 21 to 29 years (8.5%), according to Suk and colleagues. The proportion of women aged 30 to 65 years who did not receive a recommendation for screening from a health care professional increased from 5.9% in 2005 (95% CI, 45.-7.2) to 12% in 2019 (95% CI, 10-14). A previous HPV vaccination was not a primary reason for not having timely screening, the researchers noted.

Since the lack of knowledge about screening increased over time, “this suggests a need for interventions targeting screening awareness for all women,” Suk and colleagues wrote.

In addition to increasing HPV vaccine uptake, “improving cervical cancer screening rates represents an important strategy for national campaigns to eliminate cervical cancer as a public health concern,” they added.

Cervical cancer is preventable in 93% of all cases, according to Suk. 

“This study suggests that a more inclusive and sustainable approach is needed in cervical cancer screening implementation with programs that can address the lack of knowledge in eligible women,” she  said.