Nearly a third of women in their 20s have never been screened for cervical cancer

Cervical cancer is one of the most preventable cancers in medicine. A vaccine exists. Screening protocols are well established. Yet in 2026, nearly a third of women between 21 and 29 have never been screened for it—a proportion that has climbed steadily over the past two decades, growing by roughly 5 percent each year. Researchers at MUSC Hollings Cancer Center, publishing this week in JAMA Network Open, found the trend alarming enough to warrant urgent attention.

The data comes from the National Health Interview Survey, which asks women directly whether they have ever received cervical cancer screening in their lifetime. This approach differs from typical national surveys, which measure whether women are currently up to date on screening. By asking about lifetime screening history, the researchers captured a fuller picture of who has fallen through the cracks entirely. Kalyani Sonawane, the study's first author and assistant director for data science and analytics at Hollings, emphasized that this distinction matters: the question is not whether women are keeping current appointments, but whether they have ever been screened at all.

The numbers extend beyond women in their 20s. Among women aged 30 to 64, nearly 15 percent have never been screened. That gap becomes more troubling when paired with a second finding: diagnoses of advanced cervical cancer—cancers that have spread regionally or distantly—have increased in this older age group. The connection is suggestive rather than proven; the study was not designed to establish causation. But the implication is clear: fewer women being screened means cancer is more likely to be discovered only after it has progressed, when a woman develops symptoms and seeks medical care, rather than during the preventable early stages when treatment is most effective.

The vulnerability runs deeper still. Forty-five percent of women in their 20s have never received the HPV vaccine, the first line of defense against cervical cancer. For these women, neither vaccination nor screening protects them. Sonawane and her team acknowledged uncertainty about why screening rates have declined. In unpublished earlier work, they asked women why they hadn't been screened. Many reported having no particular reason, or said their healthcare provider had never mentioned it. Some women who had been vaccinated appeared to believe vaccination alone was sufficient, despite clinical guidelines recommending screening regardless of vaccination status.

The gaps are not evenly distributed. Uninsured women face substantially higher rates of never having been screened. Women living in the South encounter greater barriers. Racial minorities are disproportionately represented among the unscreened. These disparities point toward a public health challenge that extends beyond individual choice or awareness—they suggest structural barriers in access, insurance coverage, and healthcare delivery that affect certain populations far more than others.

What remains unknown is why this reversal has occurred over twenty years. The researchers have identified the problem with precision but not its root cause. Whether the decline stems from reduced healthcare access, changing insurance patterns, shifts in how primary care providers counsel patients, or something else entirely, remains an open question. What is certain is that a highly preventable cancer is becoming less prevented, and the consequences are beginning to show up in diagnosis rates among women who should have had every opportunity to catch the disease early.