Never-Screened Cervical Cancer Rates Climb Among US Women

Nearly 1 in 3 women aged 21 to 29 years had never been screened for cervical cancer by 2023, up from roughly 1 in 8 in 2005, according to a new research letter published in JAMA Network Open.¹ The study found the share of never-screened women aged 30 to 65 years also grew over the same period, reaching nearly 1 in 7.

Never-Screened Rates Nearly Tripled Among Younger Women

Drawing on 9 cycles of the National Health Interview Survey (NHIS) conducted between 2005 and 2023, researchers found the proportion of women aged 21 to 29 years who reported never being screened for cervical cancer rose from 12.5% (3.5 million women) to 31.9% (6.2 million women), an average annual percentage change (AAPC) of 5.2% (95% CI, 4.3%-7.5%). The increase accelerated sharply after 2010, climbing at an annual rate of 7.9% (95% CI, 6.0%-14.4%) through 2023. Among women aged 30 to 65 years, never-screening rose from 5.3% (4.3 million) to 14.8% (9.2 million), an AAPC of 6.8% (95% CI, 3.1%-12.0%).

Additionally, human papillomavirus (HPV) vaccination uptake among women aged 21 to 29 years climbed from 5.7% in 2008 to 54.0% in 2019 but remains incomplete. The study authors noted that nearly 8 million women in this age group remain unvaccinated, and almost a third of them have also never been screened for cervical cancer.

Advanced-Stage Diagnoses Are Also Increasing

The researchers paired the survey findings with US Cancer Statistics incidence data from 2001 to 2023, stratified by age and stage at diagnosis. Among women aged 30 to 64 years, both regional-stage and distant-stage cervical cancer incidence increased by more than 2% annually after 2017. Among women 65 years and older, distant-stage incidence has been climbing since 2001. The authors cautioned that the study was not designed to establish a causal link between nonscreening and rising incidence, but rather to generate hypotheses for future research.

An analysis of the 2023 NHIS cohort, comprising 8901 women aged 21 to 65 years, found substantial disparities. Among women aged 21 to 29 years, never-screening was highest among Asian women, at 44.3% (95% CI, 32.07%-56.58%), compared with 28.8% (95% CI, 25.07%-32.57%) among non-Hispanic White women.

Educational attainment also tracked with screening gaps: 39.0% of women with only a high school diploma had never been screened, compared with 17.1% of those with a master’s or doctoral degree. Similar disparities by race and ethnicity, education, insurance status, and region emerged among women aged 30 to 65 years, with uninsured women and those living in the South facing elevated risk.

Screening Guideline Confusion Compounds the Problem

The findings track with a broader pattern of eroding cervical cancer prevention identified in other recent research.² A December 2025 report on commercially insured US adults found that guideline-concordant cervical cancer screening adherence was below 10%, with rapid changes to US recommendations, including the 2012 addition of cotesting and the 2018 addition of primary HPV testing, contributing to confusion among patients and clinicians. That analysis similarly pointed to disparities by race and socioeconomic status as a persistent barrier to consistent screening.

The authors of the new research letter called for targeted strategies to address structural barriers among racial and ethnic minority groups, uninsured women, and residents of Southern states, populations that face both lower screening rates and higher rates of late-stage diagnosis and mortality.¹ Limitations of the study include its reliance on self-reported screening data, which is subject to recall bias, and the unavailability of HPV vaccination status in national cancer registries.

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):e2631550. doi:10.1001/jamanetworkopen.2026.31550
2. Grossi G. Disparities in cervical cancer screening, HPV awareness, guidance nonadherence are increasing. AJMC®. December 10, 2025. Accessed August 26, 2026. https://www.ajmc.com/view/disparities-in-cervical-cancer-screening-hpv-awareness-guidance-nonadherence-are-increasing