Cervical screening never-rates rose from 12.5% to 31.9% among women 21-29 between 2005 and 2023

The study pooled Behavioral Risk Factor Surveillance System responses from more than 200,000 women, excluding those with hysterectomy, and tracked self-reported Pap or HPV testing history. Never-screening also rose among women 30-65, from 5.3% to 14.8%. Post-2017 incidence of regional and distant cervical cancer increased more than 2% annually in the older group, consistent with delayed detection. Self-report bias and lack of claims linkage limit precision, yet the trend aligns with documented drops in preventive visits during and after the pandemic.

Disparities were largest for Asian women and the uninsured, echoing earlier CDC reports on HPV vaccination uptake and primary-care access. The shift coincides with 2018 guideline changes that raised the starting age to 25 and lengthened intervals, creating confusion among clinicians and patients. Regional variation suggests state-level Medicaid expansion and Title X funding influence outcomes more than national averages indicate.

Next steps require linking survey data to registries and testing whether self-sampling kits or reminder systems reverse the trajectory within two years. Without such interventions, absolute numbers of late-stage diagnoses will likely continue climbing through 2027.