Cervical cancer screening declines post-COVID

Cervical cancer screening declines post-COVID | Image Credit: © SewcreamStudio - © SewcreamStudio- stock.adobe.com.

Higher rates of not adhering to cervical cancer screening have been reported following the COVID-19 pandemic, according to data published in PLOS Global Public Health.¹

Widespread use of cytological screening programs has been linked to reduced cervical cancer incidence in developed countries, thanks to early detection and treatment of precancerous lesions.² This method is also cost-effective and has been recommended regularly in women aged 21 to 65 years.¹

“Nonetheless, various aspects of health care delivery were disrupted by the COVID-19 pandemic and have not yet recovered to their pre-pandemic levels of operation, including preventative health care,” wrote investigators. “Limited studies explored how screening rates changed in a population-based sample following the pandemic.”

Cervical cancer outcomes

The population-based repeated cross-sectional study was conducted to evaluate non-adherence rates to cervical cancer screening and human papillomavirus (HPV) vaccination knowledge before and after the COVID-19 pandemic. Data was obtained from the National Cancer Institute Health Information National Trends Survey.

Rounds 5 and 6 of the survey were evaluated for the pre-pandemic and post-pandemic periods of 2019 and 2022, respectively. Women aged 21 to 65 years with no self-reported cervical cancer history were included in the analysis.

Adherence to cervical cancer screening was reported as the primary outcome, determined based on the time of patients’ last Papanicolaou (PAP) smear. Non-adherence was defined as a time of last PAP smear of 3 years or greater.

HPV vaccine outcomes and study population

HPV vaccination knowledge was also evaluated. Older age groups were included in this analysis to assess public knowledge despite the vaccine not being recommended for women aged over 26 years.

Women reporting not hearing about the vaccine were classified as unaware. Covariates included race and ethnicity, age, education, and frequency of health care visits.

There were 1905 participants representing a population of 92,019,982 women included in the 2019 analysis, 61.3% of whom were non-Hispanic White and 35.4% had at least a college-level education. In the 2022 analysis, these rates were 56.5% and 37.9%, respectively, among 2194 patients representing 87,170,765 women.

Trends in non-adherence

Mean ages in 2019 and 2022 were 44.5 and 44.4 years, respectively. Additionally, rates of non-adherence to cervical cancer screening were 19.2% and 25.8%, respectively, highlighting an increase in prevalence.

In 2019, reduced non-adherence rates were reported in non-Hispanic Black patients, with a prevalence ratio (PR) of 0.47 vs non-Hispanic White patients. Non-adherence was also less common in patients with 2 or more health care provider visits vs none, with a PR of 0.47.

In 2022, a 1.63-fold increased risk of non-adherence was reported for cervical cancer screening among women with lower education levels. However, no associations with age or race were reported.

Overall, an increase in non-adherence of 6.6% was reported in 2022 vs 2019. For non-Hispanic White patients, the increase was 5.9%, vs 13.9% in non-Hispanic Black patients.

HPV vaccination knowledge trends

An increase in the prevalence of being unaware of HPV vaccination was also reported, from 18.9% in 2019 to 21.7% in 2021. This highlighted a decrease in HPV vaccine awareness of -2.8%. Additionally, an increase in knowledge of 2.5% was reported in non-Hispanic White patients, vs a decrease of -9.4% in non-Hispanic Black patients.

Factors linked to reduced HPV vaccine knowledge in 2019 were older age, being Black, and having lower education. The latter 2 factors remained linked with reduced knowledge in 2022.

Overall, the results indicated significant increases in non-adherence to cervical cancer screening. These trends were especially prominent in underrepresented communities such as Black patients and those with a lower education level.

“Further studies are needed to elucidate barriers associated with greater non-adherence rates and to explore targeted interventions, such as educational campaigns, community outreach programs, and initiatives to improve health care access for underserved populations,” wrote investigators.

References

1. Malak Bilalaga M, Gaddipati G, Devkota A, et al. HPV knowledge and non-adherence to cervical cancer screening before and following the COVID-19 pandemic in the United States. PLOS Global Public Health. 2025. doi:10.1371/journal.pgph.0004800
2. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–e203. doi:10.1016/S2214-109X(19)30482-6