Guideline-Concordant Cervical Cancer Screening Rates Declining in US

By Lisa Rapaport

February 02, 2022

(Reuters Health) - The proportion of U.S. women without up-to-date cervical cancer screenings based on guidelines from the U.S. Preventive Services Task Force (USPSTF) appears to be rising, according to a new study.

Researchers examined data on a cross-sectional sample of 20,557 women representative of 113 million women nationwide eligible for cervical cancer screening in the U.S. from 2005 to 2019. The goal was to assess rates of guideline-concordant cervical cancer screening and self-reported reasons that screenings might not be up to date.

Overall, the proportion of women lacking up-to-date cervical cancer screenings climbed from 14.4% in 2005 to 23.0% in 2019, the study team reports in JAMA Network Open.

"Cervical cancer screening campaigns and education might have been less prioritized than before due to the introduction of the HPV vaccine," said lead study author Ryan Suk, an assistant professor of management, policy and community health with UTHealth School of Public Health in Houston, Texas.

"However, there are many of those who were not eligible for the vaccine and those who were already exposed to high-risk HPV before their receipt of the HPV vaccine," Suk said by email. "Also, the HPV vaccine protects against most but not all HPV types that cause cervical cancer."

One thing that may have impacted the decline in guideline-concordant screening rates is a change in guidelines during the study period, Suk said. In 2005, guidelines recommended screening every 2 years for women 21 to 65 years old. By 2019, these guidelines remained the same for women 21 to 29, but changed for women 30 to 65 to offer the option of a Papanicolaou test every 3 years or screening every 5 years with high-risk HPV testing or co-testing.

As of 2019, a higher proportion of women aged 21 to 29 years old (29.1%) were overdue for screening as compared with women aged 30 to 65 years old (21.1%).

Lack of awareness about the need for screening was the most common reason for lacking up-to-date screenings among both women aged 21 to 29 years old (60.0%) and women aged 30 to 65 years old (54.8%).

During the study period, the proportion of women who said they didn't get a recommendation to do this from a health care provider became a more common reason for failing to get guideline-concordant screenings, the study also found. The proportion of women reporting this reason roughly doubled from 5.9% in 2005 to 12.0% in 2019.

The shift in guidelines during the study period might have left some clinicians uncertain of the timing for screening, Suk said, which might explain why more women reported lacking a recommendation from a health care provider.

The proportion of women who said they didn't know they needed screening also climbed, from 45.2% in 2005 to 54.8% in 2019.

One limitation of the study is that many women may face multiple barriers to screening, the authors note. The study also didn't examine barriers to follow-up care based on any abnormal screening findings, which might not be the same as barriers to screening.

"Continued efforts to raise awareness of and recommend cervical cancer screening would be crucial, even if they might think the patients already know about the screening or initially refused," Suk said. "There need to be more effective and efficient tools and protocols that help clinicians stay up to date without feeling burnt out."

SOURCE: JAMA Network Open, online January 18, 2022.