Cervical cancer screening rates are dropping. Here’s why that’s an issue.

While cervical cancer was once one of the most deadly cancers for American women, deaths from the disease have dropped by more than 50% since the 1970s due to prevention awareness and screening. But rates of cervical cancer have stopped dropping and stabilized over the past few years. Today, the disease causes about 4,000 deaths in the United States each year.

Now, new research finds that cervical cancer screening rates are dropping as well — and doctors aren’t happy.

The study, which was published in JAMA Network Open, analyzed nationally representative health survey data from more than 188 million women in the U.S. that was collected over three years. The researchers found that the use of a Pap test, which is a procedure that examines cells from the cervix to screen for cervical cancer and other health issues, were “significantly lower” in women who lived in rural areas compared to those who lived in urban areas. (Fewer than 49% of rural residents said they had gotten a Pap test in the past year compared to 64% of people who lived in urban areas.)

Women were also less likely to say in 2022 that they had gotten a Pap test within the previous year compared to what they reported in 2019. This, the researchers concluded, suggests “a need to increase access to screenings to prevent an uptick in cervical cancer incidence.”

When should women be screened for cervical cancer, and how often?

There are three main ways to screen for cervical cancer: A human papillomavirus (HPV) test that looks for cells from high-risk HPV types that can cause cervical cancer; a Pap test and an HPV/Pap co-test that uses an HPV test and Pap test together to look for high-risk HPV and cervical cell changes, the National Cancer Institute (NCI) says. Almost all cervical cancers are caused by HPV, according to the Centers for Disease Control and Prevention.

The United States Preventive Services Task Force (USPSTF) recommends that women get their first Pap test at age 21, followed by Pap testing every three years. Between ages 30 and 65, the USPSTF recommends getting screened every three years with a Pap test or every five years with an HPV test or HPV/Pap co-test. After age 65, the USPSTF recommends that women talk to their doctor to see if screening is still needed.

The American Cancer Society (ACS) suggests starting screening at age 25 with an HPV test and having HPV testing every five years through age 65. But the ACS also says that having an HPV/Pap co-test every five years or a Pap test every three years is still acceptable.

If you’ve had abnormal Pap test results in the past, your provider may recommend that you get the procedure done more often in the future, according to the NCI.

Why are women getting screened less?

Dr. Kamilah Dixon, an ob-gyn at the Ohio State University Wexner Medical Center, tells Yahoo Life that the findings are “definitely alarming but unfortunately, not surprising.”

This is a trend with cancer screenings in general, according to Dr. Monica Avila, a medical oncologist in the Gynecologic Oncology department at Moffitt Cancer Center. “Cancer screenings are down across the board during and post COVID,” Avila tells Yahoo Life. “This includes other disease sites like breast and colon.”

Dr. Diana Pearre, a gynecologic oncologist at the Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in Burbank, Calif., agrees. “People in general did not seek routine care as much during the pandemic, and that effect transcended to years beyond,” she tells Yahoo Life.

“Additionally, for some, changes in employment meant changes in health care coverage and ability to follow up on screening,” Dixon says. “I have seen many patients in my office and on the mobile unit that had a disruption in care due to COVID.”

What’s more, Avila adds, “There is a lack of patient knowledge overall about cancer screenings and, in the case of cervical cancer, there has also been a decrease in popular knowledge linking cervical cancer to HPV,” she says.

Cervical cancer screening recommendations are also a little confusing, Jane Montealegre, a researcher and behavioral epidemiologist in the Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, at MD Anderson Cancer Center, tells Yahoo Life. “The recommendations are pretty complex at this point,” she says. “It’s not the old ‘get it annually,’ which was easier to remember.”

Pearre agrees, calling the guidelines around cervical cancer “confusing” for patients and even health care providers, making it hard to keep track of when the next screening should be done. There’s also no system in place to let people know when they’re due for their next screening, raising the risk that people will miss them, Montealegre points out.

But there’s an ongoing physician shortage too, including ob-gyns and primary care providers who offer cervical cancer screenings, Avila says. That’s even worse in rural areas, which may explain why women who live in these areas were less likely to say they had been recently screened, Montealegre notes. “We’re seeing some pretty severe exacerbation of access to care, and they’re barriers that are really disproportionately affecting rural residents,” she says. “There are clinic and hospital closures, and people having more barriers to get to their health care centers.”

Why are lower screening rates an issue?

Doctors stress that cervical cancer screenings work. “Cervical cancer screening with Pap smears has made the greatest impact on incidence of cervical cancer over the past 30-plus years,” Dr. Gina M. Mantia-Smaldone, associate professor in the Department of Surgical Oncology at Fox Chase Cancer Center, tells Yahoo Life. “Without an increase in patient access to screening, there may be an increase in cervical dysplasia and cancer cases.”

Cervical cancer screening is designed to catch abnormal cell changes early, either before they turn into cancer or in the early stages, Avila says. But when screening rates decrease, “prevention strategies are failing,” she says. “Primary prevention with use of [HPV] vaccination are also down, for lack of knowledge,” she says.

As a result, Avila says that doctors are seeing higher rates of advanced-stage cancers when they’re detected. Those cancers are also harder to treat effectively, she points out.

“Cervical cancer is almost entirely preventable if people get vaccinated against HPV and get screened appropriately so that we can find these cancers early and treated when they’re still precancerous,” Montealegre says.”If we have disruptions in people’s ability to get screened, they have a higher likelihood of not having those cancers found early, when we can treat them.”

What to do about cervical cancer screenings

Avila stresses the importance of being on top of cervical cancer screenings. But she also says that it’s OK to start screening at any point, even if you’ve never been screened in the past. “It is never too late or early to screen,” she says.

If you happen to miss an annual visit, where Pap tests are usually given, Avila says you can always reschedule it. “Pre-cancers and early-stage cancers are highly curable, and the earlier we catch the disease, the better,” Avila says.