COVID Pandemic May Have Disrupted Cervical Cancer Screenings

New research found women aged 21-65 years who were due for a Papanicolaou (Pap) test to screen for cervical cancer were about 30% less likely in 2022 to report having received one in the past year than women were in 2019. The likelihood of Pap testing in the past year did not differ between 2019 and 2020, during the early part of the pandemic.

The study, published on June 14 in JAMA Network Open, also found in 2022 that weighted rates of past-year Pap testing were significantly lower among women living in rural areas than for urban residents, although that difference was not observed after controlling for sociodemographic factors including age, race, ethnicity, and whether a woman had insurance.

“Cervical cancer is largely preventable by early detection,” said Ty Borders, PhD, director of the Rural and Underserved Health Research Center at the University of Kentucky in Lexington, Kentucky, who led the new study. “And what is a concern is that these reductions in Pap testing rates are substantial enough that unless women go get a Pap test or other type of cervical cancer screening sooner than later than we could see a slight uptick or increase in the rates of cervical cancer in the years to come.”

“What is novel is that authors have added data in 2022 while other prior studies have measured until 2021,” said Priti Bandi, PhD, the scientific director for risk factors and screening research at the American Cancer Society, in an email. Bandi was not affiliated with the study.

Borders and his colleague Amanda Thaxton Wiggins, PhD, a statistician at the University of Kentucky College of Nursing, Lexington, Kentucky, used data from 3706 participants in the Health Information National Trends Survey (HINTS), a nationally representative survey of women aged 21-65 years. (This figure translated to 188,243,531 women when the survey was weighted to the US population.) Those who had a Pap test more than 1-3 years prior to a HINTS interview were excluded from the analyses because they were likely not due for a test, according to the researchers.

The study found that the adjusted odds of past-year Pap testing were lower in 2022 than in 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02).

In 2022, unadjusted rates of past-year Pap testing were significantly lower among rural women than in their urban-dwelling counterparts (48.6% [95% CI, 39.2%-58.1%] vs 64% [95% CI, 60.0%-68.0%]; P

That difference points to “the concern that rural females are at higher risk of cervical cancer and also are at higher risk of not getting regular recommended cervical cancer screening, according to our findings,” Borders said.

Borders acknowledged the urban-rural difference disappeared after adjustment for potential cofounders, including age, race, and ethnicity, but he said the link merits attention.

“It’s pretty frequent that we do find a rural versus urban difference in other health outcomes or healthcare utilization, but again, rural-urban residence is sort of a proxy in some ways for other individual-level characteristics and healthcare system factors,” Borders said.

In light of the findings, healthcare organizations and especially those serving rural families “should consider, at least temporarily, expanding access to Papanicolaou tests to increase cervical cancer screening rates to prepandemic levels,” Borders and Wiggins wrote.

The researchers also examined whether the difference between urban and rural women in 2022 was significantly different from the split in 2019, but it was not.

The study excluded women who had received a Pap test more than 1-3 years prior to the HINTS interview, even though these women already may have received testing for high-risk human papillomavirus, which is a component of recommended screening for women aged 30-65 years and can be done every 5 years either alone or in combination with a Pap test.

“So it could be that some women were getting this alternative screening, but we didn’t know it,” Borders said.

Borders reported receiving grants from the Health Resources and Services Administration (HRSA) during the conduct of the study. No other disclosures were reported. The study was supported by cooperative agreement U1CRH30041 from the Federal Office of Rural Health Policy, HRSA, and the US Department of Health and Human Services.

Joanna Broder is a science and breaking news editor and reporter.