Women living in U.S. counties with consistently low cervical cancer screening rates face nearly double the risk of late-stage diagnoses and death, according to new research from MUSC Hollings Cancer Center.
The analysis, led by Trisha Amboree, Ph.D., builds on prior studies showing that cervical cancer incidence and mortality are elevated in low-income and rural counties.
Unlike earlier work, which relied on county-level statistics without individual screening data, this study examines county-level screening trends over time to better understand the connection between screening rates and cancer outcomes.
“Previous research couldn’t link individual screening histories to cancer outcomes,” Amboree explained. “Our findings suggest that the higher cervical cancer rates we observed are likely driven, at least in part, by persistently low screening.”
Timely screening is critical for detecting precancerous lesions before they progress to cancer and for identifying early-stage disease when treatment is most effective.
Using data from 2004 to 2016, the researchers categorized counties based on screening participation: counties were labeled “repeatedly low-screening” if fewer than 70% of eligible women were screened in at least two of three time periods, and “repeatedly high-screening” if at least 80% were screened. The national cervical cancer screening goal is 79.2%.
Comparing outcomes, the study found that women in repeatedly low-screening counties were 84% more likely to be diagnosed with distant-stage cervical cancer and 96% more likely to die from the disease than women in high-screening counties.
Nearly all low-screening counties were rural, with median annual household incomes below $75,000.
The findings underscore the urgent need for improved access to screening and treatment, particularly in rural and low-income regions. In South Carolina, for example, 14 counties have no obstetrician-gynecologists, and several have only one family practice physician.
To address gaps, MUSC Hollings operates a Mobile Health Unit providing cervical cancer screening in underserved areas.
Current U.S. Preventive Services Task Force recommendations advise women ages 21 to 65 to receive a Pap smear every three years, or women ages 30 to 65 to receive HPV testing—alone or with a Pap—every five years.
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