A nationwide study has found a troubling rise in the number of women who have never been screened for cervical cancer, with the proportion increasing by more than five percent per year between 2005 and 2023. Researchers at the Medical University of South Carolina analyzed data covering more than 100,000 women eligible for screening and found that nearly one in three women aged 21 to 29 and one in seven aged 30 to 65 had missed out on screening entirely.
Rates of Never-Screened Women
For women aged 21 to 29, the share who had never been screened climbed from 12.5 percent in 2005 to 31.9 percent in 2023, an annual increase of 5.2 percent. The rate of increase accelerated after 2010, reaching 7.9 percent per year through 2023. Among women aged 30 to 65, the proportion rose from 5.3 percent to 14.8 percent over the same period, at a rate of 6.8 percent annually.
The study, published in JAMA Network Open, drew on the National Health Interview Survey, which collects data every two to three years. The women reviewed were predominantly White, with some college education, private insurance, and living in urban areas of the Southern United States. HPV vaccination rates among younger women improved over time, reaching 54 percent by 2019, but still left millions unvaccinated.
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Kalyani Sonawane, assistant director for data science and analytics at MUSC Hollings Cancer Center, said the findings were surprising even to the research team. “Although the team expected to see some decline in screening participation, the magnitude and pace of the increase in women who have never been screened was surprising,” she said.
The data showed that regional- and distant-stage cervical cancer incidence each increased by more than two percent per year from 2017 onward among women in the 30-to-65 age group. The researchers called this trend “troubling, particularly when viewed in the context of the proportion of women who have never been screened for cervical cancer over the last two decades.”
The study did not examine why women are choosing not to be screened, but Sonawane pointed to prior research indicating multiple barriers. “Prior research points to barriers such as limited access to healthcare, lack of insurance coverage, lower awareness of screening recommendations, competing life priorities, and missed opportunities for provider recommendation,” she said. “Structural and socioeconomic factors also play an important role in determining whether women can access preventive services.”
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The data suggests that despite the availability of the HPV vaccine, millions of young women remain unvaccinated and also unscreened. According to the report, nearly eight million women aged 21 to 29 remain unvaccinated, and almost one-third of those have also never been screened. The researchers wrote that “early engagement with screening sets the trajectory for lifelong screening behavior,” and that the near-doubling of unscreened younger women is concerning.
Sonawane said the findings show a gap in prevention that warrants attention. “Understanding who remains unscreened can help guide more targeted outreach, risk assessment, and prevention strategies to reduce cervical cancer disparities,” she said. The researchers are calling for efforts to address both vaccination and screening access, particularly among populations facing the greatest barriers.
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