Cervical Screening Adherence and HPV Knowledge Worsened After COVID-19

Cervical cancer screening adherence and knowledge of the human papillomavirus (HPV) vaccine among women decreased following COVID-19, a recent study reported in PLOS Global Public Health.¹

Persistent HPV infections combined with high-risk HPV types are known to cause cervical cancer and have been associated with other cancers of the vulva, vagina, mouth and throat, and penis or anus.² The US Preventive Services Task Force (USPSTF) recommends women aged 21 to 29 years screen for cervical cancer every 3 years, whereas women aged 30 to 65 years have more options.¹ They can either get a Pap smear every 3 years, get a combination of a Pap smear and HPV testing every 5 years, or get HPV testing alone every 5 years. However, the current study showed that awareness of the HPV vaccine decreased during the COVID-19 pandemic, as did cervical cancer screening adherence, creating a gap in HPV and cervical cancer preventive care. Furthermore, the disruptions to health care services caused by the pandemic disproportionately impacted underserved populations that may have already faced barriers to accessing health care, especially preventive care.

Cervical screening adherance and knowledge of HPV vaccines decreased due to the COVID-19 pandemic. | Image Credit: @Khunatorn-AdobeStock.jpeg

“Understanding these disparities as well as other factors associated with lower adherence rates is critical for developing targeted interventions aimed at improving these services among underrepresented populations,” the study authors wrote.

This cross-sectional study used data from the National Cancer Institute’s Health Information National Trends Survey from 2019 to 2022. The study population was split into 2 groups based on women’s adherence to USPSTF cervical screening recommendations and knowledge of the HPV vaccine in 2019 and 2022. In 2019 the study population consisted of 1905 adult women—representative of a female adult population of about 92 million—with a mean age of 44.5 years. Among them, 61.3% were non-Hispanic White, and 35.4% had a college education or higher. In 2022, the study population consisted of 2194 adult women—representative of a female population of about 87 million—with a mean age of 44.4 years. Of them, 56.5% were non-Hispanic White, and 37.9% had a college education or higher.

Nonadherence and HPV Knowledge Pre– vs Post COVID-19 Pandemic

In 2019, 19.2% of women did not adhere to the cervical screening guidelines, meaning they’d gone more than 3 years without a screening (95% CI, 16.3%-22.5%). On the other hand, in the adjusted model, non-Hispanic Black women had a lower nonadherence rate (prevalence ratio [PR], 0.47; 95% CI, 0.29-0.75) than non-Hispanic White women). Women who frequented their health care provider (≥2 visits vs none) had a lower likelihood of nonadherence (PR, 0.35; 95% CI, 0.24-0.53).

In comparison, in 2022, 25.8% of women did not adhere to the cervical screening guidelines (95% CI, 22.9%-29.1%). In the adjusted model, having a lower education was associated with a higher likelihood of nonadherence (PR, 1.63; 95% CI, 1.00-2.67), whereas age and race were not (P > 0.05). Correspondingly, in 2022, women who frequented their health care provider were also associated with a higher likelihood of adherence to cervical screening guidelines (PR, 0.58; 95% CI, 0.42-0.81).

When categorized by race, non-Hispanic White women had a lesser increase in nonadherence from 2019 to 2022, at 5.6% (95% CI, 5.4%-5.6%), than non-Hispanic Black women, who had an increase of 13.9% (95% CI, 12.0%-15.20%). Although these results showed that Black women had better levels of adherence prepandemic, which aligns with prior research, nonadherence was still significantly higher postpandemic.

“This is an especially important result suggesting that the pandemic increased barriers faced by minorities and marginalized female adults, which has been shown for healthcare services other than cervical cancer screening,” the study authors wrote.

Regarding HPV vaccine knowledge, among all women, in 2019, 8.9% (95% CI, 16.0%-22.1%) did not hear about it, whereas 21.7% (95% CI, 18.5%-25.3%) were unaware of it in 2022. When classified by race, non-Hispanic White women saw a 2.5% increase in awareness of the vaccine whereas there was a 9.4% decrease in awareness in Black women. Researchers identified predictors of knowledge about the HPV vaccine; they saw that older age, being Black, and having a lower education were significantly associated with not hearing about the vaccine in 2019 and 2022.

When the study authors narrowed in on adherence by age group, although there was an observed increase from 2019 to 2022 in all women regardless of age, the change was not statistically significant.

“These findings suggest that racial/ethnic and socioeconomic disparities in cervical cancer screening and HPV vaccine awareness persisted post-pandemic, with certain groups facing greater healthcare access challenges, highlighting the need to identify methods to provide more equitable access to healthcare services,” the study authors explained.

This study has several limitations, including reliance on self-reported data, which may lead to misestimates of screening adherence, and the absence of HPV screening information in the data set, which may underestimate overall adherence. The lack of data from 2020-2021, exclusion of institutionalized individuals, and limited sample size for younger participants may also affect the accuracy and generalizability of the findings. Additionally, residual confounding factors such as insurance status and the complexity of measuring knowledge could have influenced results.

“Further studies are needed to elucidate barriers associated with greater non-adherence rates and to explore targeted interventions, such as educational campaigns, community outreach programs, and initiatives to improve healthcare access for underserved populations, which may promote more equitable screening uptake and healthcare access,” the study authors concluded.

References

1. Bilalaga MM, Gaddipati G, Devkota A, et al. HPV knowledge and non-adherence to cervical cancer screening before and following the COVID-19 pandemic in the United States. PLOS Glob Public Health. 2025;5(9):e0004800. doi:10.1371/journal.pgph.0004800

2. Human papillomavirus and cancer. World Health Organization. Accessed September 11, 2025. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer