Cervical Cancer Screening

Cervical Cancer Screening in United States

United States

Cervical cancer is preventable and treatable due to the availability of screening tests and vaccines. Increased screening in the form of routine Pap tests have contributed to significant declines in cervical cancer mortality over the past 40 years. However, in 2012 nearly 8 million women ages 21-65 reported that they had not been screened in the last five years and screening rates have declined further during the COVID-19 pandemic. 

According to the Centers for Disease Control and Prevention (CDC), 4,152 women died of cervical cancer in 2019 in the United States and 12,795 new cases were diagnosed. The main cause of cervical cancer is the human papillomavirus (HPV), a group of common viruses transmitted during sexual contact. It is estimated that nearly all sexually active people will get HPV at some point during their lifetimes, but recommended HPV vaccinations effectively protect against and reduce rates of cancer-causing strains.

The prevalence of cervical cancer screening is higher among:

• Non-Hispanic Black, non-Hispanic white and multiracial women compared with Asian women. 
• Women ages 25-44 compared with women ages 21-24.
• Women with some post-high school education and college graduates compared with those with less than a high school education.
• Women with an annual household income of $50,000 or more compared with those with incomes less than $50,000.
• Women who were born in the United States compared with foreign-born women. 
• Insured women compared with those who are uninsured.
• Women with a usual source of care compared with those who had none or used emergency departments for care.
• Heterosexual women compared with lesbians.

The CDC recommends regular screening via Pap and/or HPV tests, as well as early HPV vaccination to prevent cervical cancer. Current strategies to improve cervical cancer screening rates among women include:

• Improving health insurance coverage: Women who are uninsured and/or lack a consistent medical provider are less likely to get proper screening at appropriate intervals.
• Increasing awareness of cervical cancer and the benefits of screening.
• Having health care providers directly recommend and/or educate patients on screening: Direct communication between patient and provider often leads to screening and can be effective among populations of women whose cultural beliefs and practices may disagree with screening.
• Knowing current screening recommendations: The U.S. Preventive Services Task Force (USPSTF) strongly recommends women ages 21-29 get a Pap test every three years. For women ages 30-65, the USPSTF recommends either: a) a Pap test every three years, b) HPV testing every five years, or c) a combined HPV and Pap test every five years.

Healthy People 2030 aims to increase the proportion of women ages 21-65 who receive cervical cancer screening. 

Dorsainvil, Merlyn A. “Increasing Cervical Cancer Screening in Underserved Populations.” Journal of Christian Nursing 34, no. 3 (July 2017): 152–58. https://doi.org/10.1097/CNJ.0000000000000405.

Miller, Maureen J., Lanfang Xu, Jin Qin, Erin E. Hahn, Quyen Ngo-Metzger, Brian Mittman, Devansu Tewari, et al. “Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21–65 Years in a Large Integrated Health Care System — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020.” MMWR. Morbidity and Mortality Weekly Report 70, no. 4 (January 29, 2021): 109–13. https://doi.org/10.15585/mmwr.mm7004a1.

Tracy, J. Kathleen, Alison D. Lydecker, and Lynda Ireland. “Barriers to Cervical Cancer Screening Among Lesbians.” Journal of Women’s Health 19, no. 2 (February 2010): 229–37. https://doi.org/10.1089/jwh.2009.1393.

White, Arica, Trevor D. Thompson, Mary C. White, Susan A. Sabatino, Janet de Moor, Paul V. Doria-Rose, Ann M. Geiger, and Lisa C. Richardson. “Cancer Screening Test Use — United States, 2015.” MMWR. Morbidity and Mortality Weekly Report 66, no. 8 (March 3, 2017): 201–6. https://doi.org/10.15585/mmwr.mm6608a1.