Counties With Low Cervical Cancer Screening Have Higher Incidence and Mortality Rates

Women living in US counties with persistently low rates of cervical cancer screening face nearly double the risk of being diagnosed with the disease, particularly at a late stage, and of dying from it, according to new research from the MUSC Hollings Cancer Center.

Study focus on county-level screening patterns

The research team examined screening data from 2004 to 2016, dividing the timeframe into three periods. Counties were considered to have repeatedly low screening if fewer than 70% of eligible women were screened in at least two of the three periods. Repeatedly high screening counties were those where at least 80% of eligible women received screening. The national goal for cervical cancer screening is 79.2%.

Most US counties fell between these two extremes. However, counties in the low-screening group had an 84% higher rate of distant-stage cervical cancer diagnoses and a 96% higher death rate compared with high-screening counties.

Rural and low-income communities most affected

The analysis found that almost all low-screening counties were rural and had a median annual household income of less than $75,000. These findings build on earlier research showing higher cervical cancer incidence and mortality in rural and low-income counties, adding evidence that limited screening access plays a key role.

Implications for South Carolina

While South Carolina data were not part of the national dataset, researchers believe the same pattern likely applies. Fourteen counties in the state have no obstetrician-gynecologists, and several have only one or a few family physicians able to perform screenings. To help address this gap, Hollings operates a Mobile Health Unit that travels to underserved areas to provide cervical cancer screening.

Current screening recommendations

The US Preventive Services Task Force advises that average-risk women aged 21 to 65 receive a Pap smear every three years. For those aged 30 to 65, HPV testing, either alone or in combination with a Pap smear, is recommended every five years. Screening can identify and allow treatment of precancerous changes before they develop into cancer and can detect cancers at an earlier, more treatable stage.

Reference: Amboree TL, Montealegre JR, Damgacioglu H, et al. County-Level Cervical Cancer Screening Coverage and Differences in Incidence and Mortality. JAMA Netw Open. 2025. doi:10.1001/jamanetworkopen.2025.26709

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