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More and more U.S. women were behind on guideline-recommended cervical cancer screening in recent years, with lack of knowledge about needing screening cited as the primary reason for not being up to date, researchers reported.

In a pooled, population-based, cross-sectional study, the percentage of women not up to date on their screening increased from 14.4% in 2005 to 23.0% in 2019, according to Ryan Suk, PhD, MS, of the University of Texas Health Science Center at Houston School of Public Health, and colleagues.

The most common reason given for not receiving timely cervical cancer screening was not knowing screening was needed, increasing from 45.2% to 54.8% over the study period, they wrote in .

Lack of access declined as the primary reason for not receiving screening (from 21.8% in 2005 to 9.7% in 2019) while not receiving recommendations from a healthcare professional increased from 5.9% to 12.0%. Vaccination status played little role, with previous receipt of a human papillomavirus (HPV) vaccine cited in fewer than 1% of responses.

"Lack of knowledge of screening and lack of screening recommendations from health care professionals may be two modifiable barriers to timely cervical cancer screening," wrote Suk and coauthors. "However, the findings also revealed that barriers to screening significantly varied by sociodemographic factors, suggesting cultural adaptation of interventions will be an important factor in the success of efforts to increase cervical cancer screening uptake among priority populations in the U.S., including women of Asian race and Hispanic ethnicity, women without insurance, women living in rural areas, and/or women identifying as LGBQ+."

The (USPSTF) currently recommends that average-risk women ages 21 to 29 receive cytological screening every 3 years, while screening intervals for those ages 30 to 65 should be extended to every 5 years if receiving HPV testing alone or HPV co-testing with cytological screening. That 2018 Task Force guidance is currently being , according to the USPSTF.

While cervical cancer screening has been associated with a reduction in the incidence and mortality of cervical cancer, Suk and colleagues noted that studies have shown that screening rates have been declining, particularly among younger women. They wanted to assess changes in screening rates over time, as well as why women did not undergo up-to-date screening.

The nationally representative study population consisted of 20,557 women with 2005 and 2019 data from the CDC . Most were ages 30-65 and had private insurance. Only women without previous hysterectomy were included.

In women ages 21-29, Suk and colleagues found that 14.2% were overdue for screening in 2005, which increased to 29.1% in 2019. For women ages 30-65, the percentages came in at 14.5% and 21.1%, respectively.

In addition, higher rates of overdue screening in 2019 were found among women:

• Of Asian descent versus non-Hispanic white race and ethnicity: 31.4% vs 20.1% (P=0.01)
• Living in rural versus urban areas: 26.2% vs 22.6% (P=0.04)
• Without insurance versus those with private insurance: 41.7% vs 18.1% (P<0.001)
• Identifying as LGBQ+ versus heterosexual: 32.0% vs 22.2% (P<0.001)

As for why women failed to be up to date on screening in 2019, not knowing screening was needed was the most common response among both younger women (60%) and women ages 30-65 (54.8%). Among racial and ethnic groups, Hispanic women were more likely to report this as a reason for not being screened (64.4%), while white women were less likely to report this as the primary reason (50.0%).

"The fact that this reason increased over time across most sociodemographic groups suggests a need for interventions targeting screening awareness for all women," Suk and colleagues observed.

Study limitations included the fact that women could only identify one primary reason for not receiving up-to-date screening. It's likely many women -- particularly those from racial and ethnic minority groups, without insurance, and identifying as LGBQ+ -- could face multiple barriers to screening, the authors stated.

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