Nearly 1 in 3 Young US Women Have Never Been Screened for Cervical Cancer

The proportion of US women who have never undergone cervical cancer screening increased substantially between 2005 and 2023, with the sharpest rise occurring among women aged 21 to 29 years, according to a research letter published in JAMA Network Open.

Analyzing data from nine National Health Interview Survey (NHIS) cycles, investigators found that the percentage of women aged 21 to 29 years who reported never having received cervical cancer screening increased from 12.5% (approximately 3.5 million women) in 2005 to 31.9% (6.2 million women) in 2023. Among women aged 30 to 65 years, the proportion nearly tripled, increasing from 5.3% (4.3 million women) to 14.8% (9.2 million women) during the same period.

The investigators analyzed screening trends among 23,502 women aged 21 to 29 years and 82,760 women aged 30 to 65 years who were eligible for cervical cancer screening. They also examined national cervical cancer incidence trends using US Cancer Statistics data to determine whether changes in screening corresponded with shifts in disease stage at diagnosis.

Later-stage cervical cancer rates also increased

The increase in women who had never been screened paralleled concerning trends in cervical cancer incidence. Among women aged 30 to 64 years, both regional-stage and distant-stage cervical cancer incidence began increasing after 2017. Among women aged 65 years and older, distant-stage cervical cancer incidence increased throughout the study period.

The authors emphasized that while some women aged 21 to 29 years may not yet have reached the recommended timing for initial screening, the magnitude of the increase remains concerning because early engagement with screening often predicts lifelong participation in preventive care. By 2023, nearly one-third of women in this younger age group had never been screened.

Disparities persist across multiple populations

Using 2023 NHIS data, the investigators found important disparities in screening uptake. Never-screening was particularly common among Asian women, uninsured women, individuals with lower educational attainment, and women living in the South. Similar patterns were observed among women aged 30 to 65 years, with additional disparities by race and ethnicity, insurance status, and geographic region.

The authors noted that these disparities mirror populations already known to experience higher rates of late-stage cervical cancer diagnosis and mortality, suggesting that structural barriers to preventive care remain a significant challenge.

The findings underscore the importance of identifying women who have never entered the cervical cancer screening pathway rather than focusing solely on patients who are overdue for repeat screening. According to the investigators, the growing population of never-screened women—particularly younger adults entering screening eligibility—represents a widening gap in both primary and secondary prevention efforts.

The study's limitations include reliance on self-reported screening histories, which may be subject to recall bias, and the inability to evaluate HPV status within the linked survey and cancer registry data. The authors also emphasized that the analysis was observational and was intended to generate hypotheses rather than establish causal relationships between screening trends and cancer incidence.

References

1. Sonawane K, Damgacioglu H, Amboree TL, et al. Rates of never receiving cervical cancer screening among US women, 2005-2023. JAMA Netw Open. 2026;9(8). doi:10.1001/jamanetworkopen.2026.31550