Fewer Pap tests post-COVID shows need for better screening access, focus on rural areas

Key takeaways:

• In 2022, Pap smear testing rates were significantly lower for women living in rural vs. urban areas.
• Women aged 60 to 65 vs. 21 to 29 years had 37% lower odds of Pap smear testing in the past year.

Past-year Pap smear testing rates were lower in 2022 than in 2019, highlighting the need to increase screening access, especially in rural areas, to prevent cervical cancer, researchers reported in JAMA Network Open.

“The [U.S. Preventive Services Task Force] recommends Papanicolaou testing every 3 years for individuals aged 21 to 29 years and either Papanicolaou testing every 3 years, high-risk HPV testing every 5 years or a combination of the two tests every 5 years among individuals aged 30 to 65 years,” wrote Tyrone F. Borders, PhD, director of the Rural and Underserved Health Research Center, the Center for Health Services Research and professor at the College of Nursing at the University of Kentucky, and Amanda Thaxton Wiggins, PhD, lecturer and statistician at the University of Kentucky College of Nursing. “Although there is an option under these recommendations to have a high-risk HPV test instead, a study based on insurance claims data for females 30 to 65 years of age found the Papanicolaou test to be the most common form of cervical cancer screening.”

Borders and Thaxton Wiggins conducted a cross-sectional study using data from 188,243,531 women (mean age, 43.7 years) aged 21 to 65 years from the Health Information National Trends Survey, which asked respondents about cancer screenings, sources of health information, and health and health care technologies. Researchers evaluated Pap smear testing rates from 2019 to 2022 among women overall and those living in rural and urban areas in the U.S.

Overall, 18.8% of participants self-identified as Hispanic, 5.2% as Asian, 12.2% as Black, 59.6% as white and 4.1% as other races/ethnicities. More than half (55.8%) of women had a spouse or partner, and 90.4% had health insurance. In addition, 5.8% of women had less than a high school diploma and 39.1% had some college education.

A total of 12.5% of women lived in rural areas.

In 2022, Pap smear testing rates within the past year were lower among women living in rural vs. urban areas (48.6% vs. 64%; P < .001). Researchers observed no significant differences between women living in rural vs. urban areas in 2020 or 2019. The adjusted odds for Pap smear testing in the past year were also lower in 2022 vs. 2019 (OR = 0.7; 95% CI, 0.52-0.95; P = .02).

Women aged 60 to 65 years had 37% lower odds of Pap smear testing in the past year vs. women aged 21 to 29 years (OR = 0.63; 95% CI, 0.41-0.98; P = .04). Conversely, researchers observed 89% higher odds of Pap smear testing in the past year among Black vs. white women (OR = 1.89; 95% CI, 1.31-2.72; P = .001), 61% higher odds among women with spouses or partners vs. single women (OR = 1.61; 95% CI, 1.26-2.04; P < .001), nearly fourfold increased odds among women with vs. without health insurance (OR = 3.82; 95% CI, 2.58-5.68; P < .001) and twofold increased odds among women with a college degree vs. less than a high school diploma (OR = 1.84; 95% CI, 1.07-3.18; P = .03).

“Delayed or missed screenings may be a factor in increased incidence of cervical cancer and more advanced stages of disease at diagnosis in the future,” the researchers wrote. “Health care organizations, especially those serving rural females, should consider, at least temporarily, expanding access to Papanicolaou tests to increase cervical cancer screening rates to pre-pandemic levels.”