Cervical cancer is supposed to be one of the easiest cancers to catch early. A quick, routine test can spot warning signs years before they become dangerous. Yet a growing number of young women in the U.S. have never been screened, according to a new analysis of federal health data. By 2023, nearly one in three women between 21 and 29 had never been screened for cervical cancer, up from roughly one in eight in 2005.
That gap matters because screening works. It can catch abnormal cell changes long before they become cancer, and the disease is highly treatable when caught early. The fact that more women are reaching adulthood without ever being screened, especially those just entering the age when screening starts, worries public health researchers.
Researchers from the Medical University of South Carolina and other institutions combed through national health survey data collected between 2005 and 2023, along with federal cancer registry records, to see how many American women had never been screened and whether that pattern lined up with changes in cancer diagnoses. Their findings, published in JAMA Network Open, point to a prevention system that’s losing ground with younger generations, even as more advanced cases of the disease appear to be climbing among women in their 30s, 40s, and beyond.
How Researchers Tracked Cervical Cancer Screening Over Time
Data came from the National Health Interview Survey, a long-running federal survey that asks Americans about their health habits, including whether they’ve been screened for cervical cancer. The team pulled data from nine survey years between 2005 and 2023, covering more than 106,000 women. About 23,500 of them were between 21 and 29, and roughly 82,760 were between 30 and 65.
For each year, researchers calculated the percentage of women in each age group who said they’d never been screened, adjusting the numbers to account for women who’d had a hysterectomy. They also tracked HPV vaccination rates, since the vaccine protects against the virus responsible for most cervical cancers, and compared screening trends with cervical cancer case data from a national cancer registry spanning 2001 to 2023. In the most recent survey year, 2023, the sample included 8,901 women between 21 and 65. A majority were White, had private insurance, and lived in urban areas, and the largest single share lived in the South, though no single education level made up a majority of the group.
The Numbers Behind the Cervical Cancer Screening Decline
Among women aged 21 to 29, the share who’d never been screened rose from 12.5% (about 3.5 million women) in 2005 to 31.9% (about 6.2 million women) in 2023. The increase picked up speed starting around 2010 and kept climbing through 2023.
Older women showed the same pattern, even though their overall numbers were lower. Among women aged 30 to 65, the never-screened rate rose from 5.3% (about 4.3 million women) in 2005 to 14.8% (about 9.2 million women) in 2023. That means roughly one in seven women in this broader age group has never been screened.
There’s a bright spot: HPV vaccination among the youngest group climbed from 5.7% in 2008 to 54.0% in 2019. But the authors noted that their findings, together with an earlier analysis of 2019 federal survey data, indicate that nearly 8 million women aged 21 to 29 remained unvaccinated against HPV, and almost a third of those women had also never been screened for cervical cancer. That means missed opportunities for both vaccination and screening.
Who Is Most Likely to Skip Screening
Not every woman faces the same odds of falling through the cracks. In 2023, never-screening was highest among Asian women aged 21 to 29, at 44.3%, compared with 28.8% among White women in the same age group. Education mattered too: 39.0% of women with only a high school diploma had never been screened, versus 17.1% of women with a master’s or doctoral degree.
Those same broad patterns showed up among women aged 30 to 65, with additional gaps that weren’t as clearly evident in the younger group. Among women aged 30 to 65, uninsured women were significantly more likely to have never been screened than women with private or other insurance, and those living in the South and Northeast had higher rates than women in the West. Asian and Hispanic women in the older age group also had higher never-screened rates than White women. By contrast, differences in insurance status and region among women aged 21 to 29 were not statistically significant, suggesting those barriers may weigh more heavily on older women.