Nearly 1 in 3 young women haven’t had cervical cancer screening. A doctor explains the risks

By Katia Hetter, CNN

(CNN) — Cervical cancer is one of the most preventable cancers, yet a growing number of American women have never been screened.

Nearly 1 in 3 women ages 21 to 29 in 2023 had never received cervical cancer screening. This proportion was up from about 1 in 8 in 2005, according to a new study published August 27 in the journal JAMA Network Open.

Screening can detect precancerous changes so they can be treated before cancer develops, but the proportion of women ages 30 to 65 who had never been screened has also increased.

It’s concerning that so many women are missing this preventive care, so I turned to CNN wellness expert Dr. Leana Wen to learn what people should know about when and how to be screened. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

CNN: What did this study find about how cervical cancer screening has changed?

Dr. Leana Wen: Researchers analyzed data from a nationally representative survey conducted by the US Centers for Disease Control and Prevention. The analysis included more than 106,000 women eligible for cervical cancer screening between 2005 and 2023.

In 2005, 12.5% of American women ages 21 to 29 reported they had never been screened for cervical cancer. By 2023, that proportion had increased to nearly 32%. That percentage translates to about 6.2 million young American women who had never been screened.

Among women ages 30 to 65, the proportion who had never been screened increased from 5.3% in 2005 to nearly 15% in 2023. That 2023 figure represented about 9.2 million women.

There were substantial disparities by race, education and insurance status. In 2023, about 44% of Asian women ages 21 to 29 had never been screened, compared with about 29% of White women. About 39% of young women with a high school education had never been screened, compared with 17% of those with a master’s or doctoral degree. Among women ages 30 to 65, nearly 32% of those without insurance had never been screened, compared with 11% of those with private insurance.

CNN: What are some limitations of the study?

Wen: One limitation is that screening history was self-reported, so respondents could have incorrectly remembered whether or when they were screened. Still, the same national survey was used to examine trends over time, and the increase in women reporting that they had never been screened is significant.

The study also cannot tell us why screening declined. Possible explanations could include lack of access to care, inadequate insurance coverage, discomfort with the procedure, and lack of awareness about when screening should begin and how frequently.

Nor can the study establish that the decline in screening caused worse cancer outcomes. The researchers did find that among women ages 30 to 64, rates of later-stage cervical cancer increased by more than 2% per year after 2017. Among women 65 and older, rates of more advanced cancer also increased. These trends are concerning, but the study cannot determine whether reduced screening was responsible.

CNN: Why is it worrisome that so many young women have never been screened?

Wen: Cervical cancer typically develops over many years. More than 9 in 10 cases are caused by persistent infection with certain high-risk types of human papillomavirus. HPV is extremely common and is transmitted through intimate skin-to-skin contact, including sexual activity.

In most people, the immune system clears HPV without causing problems. In some, the infection persists and causes abnormal changes to cells in the cervix. These changes can progress from precancer to invasive cancer. This progression is an opportunity for prevention. Screening can identify high-risk HPV or abnormal cervical cells. Precancerous lesions can then be monitored or removed before they develop into cancer.

Women who have never been screened have missed this opportunity entirely. The authors make the point that establishing screening among young adults can also set the pattern for preventive care later in life, when cervical cancer risk is higher.

CNN: How is cervical cancer screening done, and what are the current recommendations?

Wen: There are two main types of cervical cancer screening. The Pap test involves collecting cells from the cervix and examining them for precancerous changes or cancer. HPV testing looks for high-risk types of the virus that can cause these cellular changes.

The recommendations have evolved as our understanding of HPV has advanced. The US Preventive Services Task Force recommends that women ages 21 to 29 be screened every three years with a Pap test. For women ages 30 to 65, it recommends one of three options: a Pap test every three years, testing for high-risk HPV every five years, or both tests together every five years.

The American College of Obstetricians and Gynecologists issued updated guidance in 2026. It continues to recommend Pap testing every three years for women ages 21 to 29. For those ages 30 to 65, ACOG now prefers primary high-risk HPV testing every five years, though other screening approaches remain acceptable. The group also added patient-collected HPV testing every three years as an option for women ages 30 to 65 who prefer to collect their own sample.

These recommendations apply to people at average risk. Women who have had abnormal screening results, cervical precancer or cancer, have a weakened immune system, or certain other risk factors can require a different schedule. Patients should decide that schedule together with their primary care physician or gynecology provider.

CNN: What about women who have received the HPV vaccine — do they still need cervical cancer screening?

Wen: Yes. HPV vaccination and cervical cancer screening are complementary forms of cancer prevention.

The HPV vaccine is extremely effective at preventing infections with the HPV types responsible for most cervical cancers. Ideally, vaccination occurs before exposure to HPV, which is why the American Academy of Pediatrics recommends HPV vaccination for all children starting between ages 9 and 12.

But vaccination does not eliminate the need for screening. The vaccine does not protect against every HPV type that can cause cervical cancer, and some people may have received the vaccine after they had already been exposed to HPV.

CNN: Are there ways to make screening easier for women who have difficulty getting a traditional Pap test?

Wen: Yes, and I think this could help reach some people who are currently not being screened. Traditional cervical cancer screening involves a pelvic examination in which a clinician uses a speculum to visualize the cervix and collect a sample. Some women avoid screening because they find pelvic examinations painful and uncomfortable. There are now HPV tests that allow patients to collect their own vaginal sample, which could make screening more accessible for these women.

CNN: What should women do if they realize they are overdue for screening or have never been screened?

Wen: Patients should contact their primary care clinician or gynecologist and ask what screening is appropriate based on their age and medical history. Someone who is behind does not need to wait for an annual physical to get back on track.

During the visit, they should also verify their vaccination history. People who have not completed HPV vaccination should ask whether they are still eligible to receive it.

No one should wait for symptoms before seeking screening. Precancerous cervical changes generally do not cause symptoms; by the time cervical cancer causes symptoms such as abnormal vaginal bleeding, pelvic pain or pain during sex, the disease could be quite advanced. This is precisely why screening — and HPV vaccination — is crucial.

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