The number of women screened for cervical cancer in the United States declined between 2005 and 2019, with lack of knowledge about the need for screening cited as the primary reason for not being up to date, according to findings from a recent population-based, cross-sectional study (Suk R, et al. JAMA Netw Open. 2022;15:e2143582).
Although cervical cancer screening has been associated with a reduction in the incidence and mortality of the disease, Suk and colleagues noted that studies have shown a decline in screening rates, particularly among younger women. They wanted to assess changes in these rates over time, as well as why women did not undergo up-to-date screening.
Between 2005 and 2019, the researchers evaluated data from 20,557 women included in the US National Health Interview Survey. The cohort included women aged 21 to 65 years without previous hysterectomy and included data on sociodemographic factors such as race, ethnicity, sexual orientation, health insurance type, and rurality of residence.
Based on weighted population estimates, 6.1% of women were Asian, 17.2% were Hispanic, 13.1% were non-Hispanic black, 61% were non-Hispanic white, and 2.7% were other races and/or ethnicities.
Suk and colleagues discovered that the proportion of women overdue for screening increased from 14.4% in 2005 to 23.0% in 2019. In women aged 21 to 29 years, 14.2% were overdue for screening in 2005, which increased to 29.1% in 2019. In those aged 30 to 65 years, the percentages were 14.5% and 21.1%, respectively.
Asian women had the highest rates of overdue screening (31.4%), compared with non-Hispanic white women, who had the lowest rate (20.1%). Higher rates of overdue for screening were also noted among those identifying as LGBTQ+ versus heterosexual (32.0% vs 22.2%, respectively), those with no insurance versus private insurance (41.7% vs 18.1%, respectively), and those living in rural versus urban areas (26.2% vs 22.6%, respectively).
Regardless of age, not knowing that screening was indicated was the most common reason cited for failing to be up to date. Among racial and ethnic groups, Hispanic women were more likely to report this as a reason for not being screened (64.4%), whereas non-Hispanic white women were less likely to report this as the primary reason (50.0%). In addition, a significantly higher proportion of women aged 30 to 65 years reported not receiving screening due to lack of access (11.6%) compared with women aged 21 to 29 years (8.5%). The proportion of women aged 30 to 65 years who did not receive a recommendation for screening from a healthcare professional increased from 5.9% in 2005 to 12% in 2019.
“Lack of knowledge of screening and lack of screening recommendations from health care professionals may be two modifiable barriers to timely cervical cancer screening,” the authors concluded. “However, the findings also revealed that barriers to screening significantly varied by sociodemographic factors, suggesting cultural adaptation of interventions will be an important factor in the success of efforts to increase cervical cancer screening uptake among priority populations in the U.S., including women of Asian race and Hispanic ethnicity, women without insurance, women living in rural areas, and/or women identifying as LGBQ+.”