The share of American women in their twenties who have never had a cervical cancer screening more than doubled between 2005 and 2023, reaching nearly one in three, according to a new analysis of federal survey data.
The finding matters because cervical cancer is unusual among cancers. Most screening tests are designed to catch cancer early. Cervical screening can prevent the cancer from developing at all by identifying precancerous changes that can be treated before they turn malignant. A woman who has never been screened has never had that chance.
The research letter, published in JAMA Network Open by researchers at the Medical University of South Carolina's Hollings Cancer Center, drew on nine cycles of the National Health Interview Survey covering 2005 through 2023.
The Numbers Behind the Trend
Among women aged 21 to 29, the share reporting they had never been screened rose from 12.5 percent in 2005, about 3.5 million women, to 31.9 percent in 2023, about 6.2 million women. That works out to an average annual increase of 5.2 percent, and the climb accelerated after 2010, running at close to 8 percent a year through 2023.
Among women aged 30 to 65, never-screening nearly tripled, from 5.3 percent to 14.8 percent. In raw numbers, that group grew from 4.3 million to 9.2 million women.
The researchers also documented where the gaps concentrate. In the 2023 survey cycle, which covered 8,901 women aged 21 to 65, never-screening among women in their twenties was highest among Asian women at 44.3 percent, compared with 28.8 percent among non-Hispanic White women. Education tracked closely with the gap as well: 39 percent of women whose schooling ended with a high school diploma had never been screened, against 17.1 percent of those with a master's or doctoral degree. Uninsured women and women living in the South also reported higher rates.
A Different Measure Than the One Usually Reported
National reports typically track whether women are up to date on screening, meaning they had a test within the recommended interval. This study asked a different and blunter question.
"This paper measures the proportion of women who reported they've never received screening," said Dr. Kalyani Sonawane, the study's first author and assistant director for data science and analytics at Hollings, drawing the contrast with the up-to-date rate that national surveys usually report.
That distinction changes the interpretation. Someone who is overdue for a test has at least been in the system once. Someone who has never been screened may not have a clinician, may not know screening exists, or may believe it does not apply to them.
Sonawane said the research team is not certain why never-screening has risen. In earlier unpublished work, the team looked at women's stated reasons. Many said they had no particular reason, or that a health care provider had never raised it. Sonawane also suggested that some vaccinated women may assume the HPV shot replaces screening. Current guidelines recommend screening even after vaccination.
The Vaccination Gap Compounds the Screening Gap
The same paper tracked HPV vaccination among women aged 21 to 29, which rose from 5.7 percent in 2008 to 54 percent in 2019. The authors noted that nearly 8 million women in that age group remain unvaccinated against human papillomavirus, the virus responsible for nearly all cervical cancers, and that almost a third of those women have also never been screened.
HPV vaccination is the first line of defense and screening is the second. A substantial group of young women has neither.
The researchers paired the survey data with national cancer incidence figures from 2001 through 2023. Among women aged 30 to 64, both regional-stage and distant-stage cervical cancer diagnoses rose by more than 2 percent a year after 2017, meaning more cancers found after they had spread beyond the cervix. Among women 65 and older, distant-stage incidence has been climbing since 2001.
That pairing is suggestive, and the authors are careful about it. The study was not designed to test whether declining screening caused the shift toward later-stage diagnoses. It is a cross-sectional analysis describing population trends, not a study of individual risk, and the screening data are self-reported, so recall error is possible. The authors flagged the later-stage finding to point toward future research rather than to claim a causal chain.
Practical Steps for Women Who Are Overdue
Guidance from the U.S. Preventive Services Task Force recommends screening every three years with a Pap test for average-risk women aged 21 to 29. For women aged 30 to 65, it lists three acceptable options: a Pap test every three years, a high-risk HPV test every five years, or both tests together every five years. Federal guidelines used to set insurance coverage now name HPV testing every five years as the preferred approach for average-risk women in that older group. Individual schedules should still be set with a clinician based on personal history.
For women without insurance or a regular provider, the CDC's National Breast and Cervical Cancer Early Detection Program offers free or low-cost screening through state and territorial programs for people who meet income and age requirements. Federally qualified health centers and Planned Parenthood affiliates also provide screening on a sliding scale in most metro areas.
Self-collection is now an option for some women. Federal guidelines added patient-collected HPV testing for average-risk women aged 30 to 65, and most private plans must cover it, along with the follow-up testing needed to complete screening, without cost sharing starting Jan. 1, 2027. Self-collection is intended for average-risk screening, and anyone with symptoms or an abnormal history should ask about the appropriate test.
Symptoms that warrant a clinician visit regardless of screening schedule include bleeding between periods, bleeding after intercourse, bleeding after menopause, unusual discharge, or pelvic pain. These symptoms have many causes, and most are not cancer, but they are not something to wait out.
The research was supported by the National Library of Medicine and the National Cancer Institute. The authors reported federal funding rather than industry support.
Cervical cancer screening remains one of the clearest examples in medicine of a test that prevents disease rather than just detecting it. The most useful action for anyone reading this is narrow and specific: find out when you were last screened, and if the answer is never, raise it at the next appointment.
Key Questions Answered
What did the study find? The share of women aged 21 to 29 who had never been screened for cervical cancer rose from 12.5 percent in 2005 to 31.9 percent in 2023. Among women aged 30 to 65, it rose from 5.3 percent to 14.8 percent.
Does this mean cervical cancer is rising? The researchers observed an increase in later-stage diagnoses among women aged 30 to 64 after 2017, but the study was not designed to determine whether the two trends are connected.
Who is least likely to have been screened? Uninsured women, women living in the South, women with less formal education, and women from several racial and ethnic minority groups.
Does the HPV vaccine replace screening? No. Current guidelines recommend screening even for women who are fully vaccinated. The study also found that nearly 8 million women in their twenties remain unvaccinated.
How often should someone be screened? General guidance is a Pap test every three years from age 21 to 29. /From 30 to 65, the options are a Pap test every three years, an HPV test every five years, or both together every five years.
Where can uninsured women get screened? The CDC's National Breast and Cervical Cancer Early Detection Program funds free or low-cost screening through state programs for people who meet eligibility rules. Federally qualified health centers also offer sliding-scale services.
How strong is this evidence? It is a cross-sectional analysis of self-reported national survey data. It describes a population trend reliably. It does not establish cause, and self-reported screening history can be inaccurate.
