Nearly 18 million US women aged 45 to 64 overdue for cancer screening, study finds

Nearly 18 million middle-aged women in the United States are estimated to be overdue for at least 1 recommended cancer screening test, according to a cross-sectional study published in JAMA Women's Health. The findings highlight persistent and widespread gaps in breast, cervical, and colorectal cancer screening uptake among women aged 45 to 6, an age group for which all 3 screenings are currently recommended, and identify access-related factors as key drivers of incomplete screening.¹

Cancer is the leading cause of death among women in this age group and the second most common cause of death among all women in the United States, with breast, cervical, and colorectal cancers collectively accounting for more than 70,000 deaths per year. Screening tests exist for all 3 cancers and are associated with reduced late-stage diagnosis and cancer-specific mortality, yet uptake remains suboptimal across the population.

Researchers conducted a retrospective analysis of the Behavioral Risk Factor Surveillance Survey, a population-based survey of the United States, using data collected from January to December 2024. The final sample included 68,111 women with a mean age of 54.8 years (mean [SD] age 54.8 [5.8] years), reflecting the age range in which women are currently recommended to complete screening for all 3 cancers. Survey-weighted means and both univariable and multivariable regressions were used to evaluate up-to-date (UTD) screening use across the 3 cancer types, and the proportion and estimated total number of US women due for each combination of screenings were reported.

How often are women being screened for cancers?

Among the study sample, a weighted 50.3% of women reported being UTD with all 3 cancer screening tests. The remaining participants fell into one of 3 groups with incomplete screening:

• 19,389 women (weighted 28.8%) were UTD with 2 screenings
• 8776 women (weighted 13.2%) were UTD with only 1 screening
• 4899 women (weighted 7.7%) were UTD with no screenings

Extrapolated to the broader US population, these figures represent an estimated 17.9 million women aged 45 to 64 who were overdue for 1 or more screening tests. Additionally, 42.2%, were due for multiple tests simultaneously, underscoring the compounding nature of screening gaps in this population.

Barriers to cancer screenings in women

The authors noted that disparities in UTD screening use across age, race and ethnicity, rurality, and income are well established in the existing literature, and that those without health insurance demonstrate stark differences in colorectal, breast, and cervical cancer screening use compared with insured individuals. While evidence-based interventions exist to increase screening access and uptake, most target a single screening test—a limitation the study's findings suggest may need to be reconsidered given the scale of multi-test gaps identified.

Recent changes to national screening guidelines have expanded the age range in which women require all 3 screenings. Guidelines have shifted the colorectal cancer screening start age to 45 years^2,3 and have strengthened recommendations for initiating breast cancer screening at age 40 or 45, making the 45-to-64 age range a critical window for multi-cancer screening. Data consistently show lower uptake of colorectal cancer screening compared with breast or cervical screening, as well as relatively slow uptake among women in the 45-to-50-year age range specifically.¹

“Access-related policies or bundled clinical interventions that improve screening across multiple tests should be prioritized to most effectively reduce the burden of screen-detectable cancers,” wrote the study authors.

References:

1. Spencer JC, Montealegre JR, Calderón-Mora J, Pignone MP. Breast, cervical, and colorectal cancer screening rates in women aged 45 to 64 years. JAMA Netw Open. 2026;9(5):e2612976. doi:10.1001/jamanetworkopen.2026.12976
2. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281. doi:10.3322/caac.21457
3. Davidson KW, Barry MJ, Mangione CM, et al; US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238