Persistent Low Cervical Cancer Screening Tied to Nearly Double Incidence and Mortality in US Counties

Counties in the US with persistently low cervical cancer screening coverage have almost double the incidence, late-stage diagnosis, and mortality rates compared with counties with consistently high coverage, according to a cross-sectional analysis published in JAMA Network Open.¹

“We know that higher screening uptake prevents disease and subsequent mortality,” first author Trisha Amboree, PhD, assistant professor of public health sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, said in a press release. “In the previous papers, we didn't have any individual-level screening data. This paper helps to contextualize our previous findings to say what we're seeing is at least probably partially a result of repeatedly low screening.”²

Researchers analyzed data from the Surveillance, Epidemiology, and End Results (SEER)–22 database to identify cervical cancer cases in women aged ≥20 years from 2016 to 2021 (excluding 2020). Mortality data came from the National Center for Health Statistics. County-level screening coverage estimates were derived from SEER small area data for 1086 counties.¹

Counties were classified as “repeat low coverage” (<70% screening during 2011–2016 and at least 1 earlier period), “repeat high coverage” (≥80% in both periods), or “other.” The <70% threshold is nearly 10 percentage points below the national target of 79.2%, while the ≥80% threshold exceeds national benchmarks.¹

Of the counties analyzed, 70 were repeat low coverage, 141 were repeat high coverage, and 875 were other. Most low-coverage counties were rural (87.1%) with median household incomes <$75 000, while most high-coverage counties were urban (84.4%) and more than half had median incomes ≥$75 000. Nearly half of the repeat low coverage counties were in Texas, with others concentrated in Idaho and New Mexico.¹

Compared with high-coverage counties, cervical cancer incidence was 28% higher in “other” counties (rate ratio [RR], 1.28; 95% CI, 1.25–1.31) and 83% higher in low-coverage counties (RR, 1.83; 95% CI, 1.67–2.00). Mortality was 42% higher in “other” counties (RR, 1.42; 95% CI, 1.35–1.50) and 96% higher in low-coverage counties (RR, 1.96; 95% CI, 1.66–2.30).¹

Stage-specific analyses showed localized-stage incidence was 22% and 75% higher, regional-stage incidence was 33% and 87% higher, and distant-stage incidence was 35% and 84% higher in “other” and low-coverage counties, respectively, compared with high-coverage counties.¹

Authors noted that the study’s cross-sectional design precludes causal inference and that unmeasured sociodemographic factors may contribute to differences. However, they emphasized that targeting counties with persistently low screening rates could help address rural and lower-income disparities in cervical cancer outcomes.¹

References:

1. Amboree TL, Montealegre JR, Damgacioglu H, et al. County-level cervical cancer screening coverage and differences in incidence and mortality. JAMA Netw Open. Published online August 1, 2025. doi:10.1001/jamanetworkopen.2025.26709
2. Counties with low rates of cervical cancer screening see higher rates of incidence and death. News release. Medical University of South Carolina. August 13, 2025. Accessed August 13, 2025. https://hollingscancercenter.musc.edu/news/archive/2025/08/13/cervical-cancer-low-screening-counties