US Counties With Low Screening See Higher Cervical Cancer Death Rates: Daily Dose

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On August 13, 2025, we reported on a study published in JAMA Network Open that examined differences in cervical cancer incidence and mortality by county-level screening in the US.

The study

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. 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.

The findings

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.

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).

Authors' comments

"Our study findings underscore the urgent need to improve cervical cancer screening in rural and lower-income counties. Particularly, counties where screening coverage is repeatedly low should be targeted."

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