A rising number of women have never been screened for cervical cancer. Here are the risks

Cervical Cancer Screening Gaps Are Widening Across American Women

Goldlaner.com – A preventable form of cancer is slipping through the cracks of routine preventive care at an accelerating pace. New research published on August 27 in the journal JAMA Network Open reveals that the share of American women who have never undergone cervical cancer screening has climbed sharply over two decades, with the steepest increases concentrated among younger adults. The findings underscore a troubling erosion of a screening practice that, when performed consistently, can intercept precancerous changes years before they become life-threatening disease.

The Scale of the Problem

Researchers examined data drawn from a nationally representative survey administered by the U.S. Centers for Disease Control and Prevention, covering more than 106,000 women eligible for screening between 2005 and 2023. In 2005, roughly 12.5 percent of women aged 21 to 29 reported never having received a cervical cancer screening. By 2023, that figure had nearly tripled to close to 32 percent — a jump that translates into approximately 6.2 million young women who have never had the test.

The trend is not confined to younger cohorts. Among women aged 30 to 65, the proportion with no prior screening rose from 5.3 percent in 2005 to nearly 15 percent in 2023, representing roughly 9.2 million women. Together, these figures signal a broad-based retreat from a cornerstone of women’s preventive health.

Who Is Most Affected

The study surfaced pronounced disparities along racial, educational, and insurance lines. In 2023, about 44 percent of Asian women aged 21 to 29 had never been screened, compared with approximately 29 percent of White women in the same age bracket. Educational attainment showed a similar gradient: roughly 39 percent of young women holding only a high school diploma had never been screened, while the figure dropped to 17 percent among those with a master’s or doctoral degree. Insurance status proved equally decisive for older women — nearly 32 percent of uninsured women aged 30 to 65 had never been screened, versus 11 percent of those carrying private insurance.

Expert Perspective

To contextualize the findings, CNN wellness contributor Dr. Leana Wen — an emergency physician, clinical associate professor at George Washington University, and former Baltimore health commissioner — offered the following assessment:

“In 2005, 12.5% of American women ages 21 to 29 reported they had never been screened for cervical cancer. By 2023, that proportion had increased to nearly 32%. That percentage translates to about 6.2 million young American women who had never been screened.”

Wen noted that while the survey’s reliance on self-reported screening history introduces the possibility of misremembering, the magnitude of the upward trend across two decades makes the signal difficult to dismiss. She also cautioned that the study cannot pinpoint the causes of the decline. Plausible contributors include reduced access to care, gaps in insurance coverage, patient discomfort with the procedure, and diminished public awareness about when screening should begin and how often it should repeat.

Why Early Screening Matters

Cervical cancer develops slowly, typically over many years. More than nine in ten cases trace back to persistent infection with high-risk strains of human papillomavirus, a virus transmitted through intimate skin-to-skin contact. For most people, the immune system clears HPV without lasting consequence. In a subset, however, the infection endures and triggers abnormal cellular changes in the cervix. Left unchecked, those changes can advance from precancerous lesions to invasive cancer.

That slow progression is precisely what makes screening so effective. A Pap test collects cells from the cervix and examines them under a microscope for precancerous or malignant changes. HPV testing, the second principal screening modality, detects the viral DNA or protein markers associated with high-risk strains. When screening identifies an abnormality early, clinicians can monitor the lesion or remove it before it matures into cancer. Women who have never been screened forfeit that window of intervention entirely.

The HPV vaccine, available for both sexes, can cut the incidence of certain HPV-associated cancers by roughly half. Yet vaccination complements rather than replaces screening; guidelines still call for periodic cervical checks even in fully vaccinated adults.

Worsening Outcomes

The study’s authors also observed that among women aged 30 to 64, the rate of later-stage cervical cancer climbed by more than 2 percent per year after 2017. Among women 65 and older, rates of more advanced disease followed a similar upward trajectory. Wen emphasized that while these trends are alarming, the study’s design does not allow researchers to conclude that reduced screening directly caused the rise in advanced-stage diagnoses. Other variables — changes in diagnostic coding, shifts in patient demographics, or evolving treatment patterns — could contribute.

What Women Should Know

Current clinical guidance recommends that most women begin cervical cancer screening at age 21 with a Pap test, transition to combined Pap and HPV testing (or HPV testing alone) by age 30, and continue at intervals of three to five years through age 65. Women with a history of hysterectomy for non-cancer reasons may qualify for different schedules, and those with prior abnormal results may need more frequent follow-up.

The data presented in the new study make clear that a substantial and growing segment of the U.S. female population has never entered that screening pathway. Closing the gap will require sustained public-health messaging, expanded access points, insurance coverage that removes cost barriers, and clinical practices that normalize the conversation about cervical health beginning in early adulthood. The opportunity to prevent cancer exists; the challenge now is ensuring that every woman actually receives it.