Lower cervical cancer screening rates linked to higher late-stage diagnoses and mortality

Lower cervical cancer screening rates linked to higher late-stage diagnoses and mortality | Image Credit: © Parilov - stock.adobe.com.

Women living in US counties with persistently low cervical cancer screening rates experience nearly twice the rate of cervical cancer diagnoses, particularly of late-stage disease, and mortality compared with those in high-screening counties, according to a new analysis from researchers at the MUSC Hollings Cancer Center.^1,2

The study, published in JAMA Network Open, builds on prior work showing that cervical cancer incidence and death rates are higher in low-income and rural counties. “We know that higher screening uptake prevents disease and subsequent mortality,” said lead author Trisha Amboree, PhD. “In the previous papers, we didn't have any individual-level screening data. This paper helps to contextualize our previous findings to say what we're seeing is at least probably partially a result of repeatedly low screening.”

Study methods and definitions

Using data from the Surveillance, Epidemiology, and End Results (SEER)–22 database, investigators identified cervical cancer cases among women aged 20 years and older, along with corresponding mortality data from the National Center for Health Statistics. Screening coverage estimates were obtained from SEER’s small area estimates for 1,086 counties.

Counties were classified as “repeatedly low screening” if coverage was below 70% during 2011–2016 and at least 1 earlier time period (2004–2007 or 2008–2010). “Repeatedly high screening” counties had coverage of 80% or greater during those periods. Nationally, the cervical cancer screening goal is 79.2%.

Of the counties studied, 70 were classified as repeatedly low screening, 141 as repeatedly high screening, and 875 as intermediate. Most low-screening counties were rural (87.1%) and had median household incomes below $75,000. Nearly half were located in Texas, with others in Idaho and New Mexico.

Incidence and mortality differences

From 2016 to 2021 (excluding 2020), age-adjusted cervical cancer incidence was 83% higher in low-screening counties compared with high-screening counties (rate ratio [RR], 1.83; 95% CI, 1.67–2.00). Localized-stage incidence was 75% higher, regional-stage incidence 87% higher, and distant-stage incidence 84% higher.

Cervical cancer mortality was nearly doubled in low-screening counties, with a 96% higher death rate compared with high-screening counties (RR, 1.96; 95% CI, 1.66–2.30).

Barriers and disparities

The analysis found that nearly all repeatedly low-screening counties were rural and low-income, reflecting structural barriers to preventive care. In South Carolina, where the state’s data were not part of the national database, access issues remain significant. Fourteen counties have no obstetrician-gynecologists, and several others have only a handful or a single family physician providing screening.

Timely screening, such as Pap smears or HPV testing, can detect precancerous lesions or early-stage cancer, improving the chances of successful treatment. Current US Preventive Services Task Force guidelines recommend Pap testing every 3 years for women aged 21 to 65 years, or HPV testing (alone or with a Pap) every 5 years for those aged 30 to 65 years.

Addressing gaps in care

“This latest analysis reinforces the need for improved access to screening and treatment, particularly in rural and low-income counties,” the authors wrote. Hollings Cancer Center addresses these gaps in South Carolina through its Mobile Health Unit, which provides cervical cancer screening in underserved areas.

While the study’s cross-sectional design precludes causal conclusions and results may be influenced by socioeconomic factors and self-reported screening data, the findings underscore a clear association between low screening coverage and worse outcomes.

“Our study findings underscore the urgent need to improve cervical cancer screening in rural and lower-income counties,” the authors concluded. “Particularly, counties where screening coverage is repeatedly low should be targeted.”

References:

1. Amboree TL, Montealegre JR, Haluk Damgacioglu, et al. County-Level Cervical Cancer Screening Coverage and Differences in Incidence and Mortality. JAMA Network Open. 2025;8(8):e2526709-e2526709. doi:https://doi.org/10.1001/jamanetworkopen.2025.26709
2. Medical University of South Carolina. Counties with low rates of cervical cancer screening see higher rates of incidence and death. Eurekalert. August 13, 2025. Accessed August 14, 2025. https://www.eurekalert.org/news-releases/1094428