Cervical cancer screening rates have declined over the last 25 years in spite of innovation in vaccines and screening tools. Human papillomavirus (HPV) vaccinations are extremely effective at preventing this form of cancer, as almost all cervical cancers are linked to persistent infections of HPV. Equally important in the effort to eliminate this disease are the screening tools used to detect infections and cervical cancer, helping patients receive care early during disease progression, when it is most effective.
And while these tools have driven a national decline in cervical cancer incidence and mortality, researchers have found that the burden of cervical cancer is much higher in rural areas and among specific populations, indicating that significant regional disparities still exist. Eliminating cervical cancer will require developing solutions that improve our ability to identify and assess risk throughout the entire screening and diagnostic pathway for all communities.
As these tools, policies, and guidelines continue to evolve, the question becomes: how to reach people who aren’t currently being screened? Clinicians, as the face-to-face connector with patients and the most trusted source for health care information, are best positioned to share new pathways for screening and to reach individuals who are behind on routine screening. Reaching these populations is critical in the fight to eliminate cervical cancer as more than half of all new cases occur in people who have rarely or never been screened.
Factors associated with disparity in screening
Cervical cancer is more prevalent in rural areas, where women living in rural counties experience a 25 percent higher incidence of cervical cancer and a 42 percent higher mortality rate compared with those in urban areas. Even more concerning, the gap in cervical cancer rates between rural and urban populations seems to be increasing, rather than shrinking.
Real physician voices, twice a week
Free, and one click to unsubscribe.
Minorities are also disproportionately affected by cervical cancer. Studies have shown that the burden of disease is greater in Hispanic, Black, and American Indian/Alaska Native individuals, who are more likely to have the disease, have more advanced disease at presentation, and have worse survival outcomes compared to other ethnic groups. Importantly, vaccination rates do not appear to be a driver of this disparity, with Black and Hispanic adolescents having higher up-to-date vaccination rates than their white peers. People identifying as LGBTQIA+ also face disparities in screening rates, according to a recent study published in Cancer.
Expanding screening access
Screening guidelines across multiple organizations, including the American College of Obstetricians and Gynecologists (ACOG) 2026 guidelines, the U.S. Preventive Services Task Force (USPSTF) draft 2024 guidelines, and the Health Resources & Services Administration (HRSA) 2026 guidelines, support testing for high-risk strains of HPV (hrHPV) as the preferred screening method for people aged 30 to 65. The increased sensitivity of HPV testing, compared to cervical cytology testing only, allows for screening intervals to be expanded from three years to five years, making it easier for patients to adhere to screening guidelines.
Samples used for hrHPV testing can also be self-collected. For people who have difficulty accessing centralized medical centers, or for people with medical or other trauma, self-collection can be a powerful tool for improving access to cervical cancer screening. Surveys show people have a strong willingness to use HPV self-collection tests, indicating that self-collection has the potential to help physicians and care centers address gaps in care. Some mammogram vans are now expanding their scope and including cervical cancer screening with HPV self-collection in their outreach to people in rural areas.
Since the first HPV tests with self-collection in a clinical setting were approved by the Food and Drug Administration in 2024, there have been a number of studies conducted to evaluate its impact in communities with low screening rates and assess new avenues for bringing cervical cancer screening directly to these populations. A University of Rochester study, funded by Roche, explored offering HPV self-collection to patients in the emergency department during patient wait times. People who use the emergency department as their usual source of care are likely to be underscreened. This study showed that nearly 80 percent of individuals enrolled in the study were able to successfully complete self-collection with 15.9 percent screening positive.
Another study funded by Roche at the Oregon Health & Science University brought cervical cancer screening using HPV self-collection to communities through collaboration with community groups and local organizers. The specific aim of this study was to target unscreened and underscreened individuals who lived far away from traditional screening sites with one of the community collection sites being 90 miles from the nearest hospital. All 156 participants in this study were able to successfully complete HPV self-collection, and when surveyed, over 90 percent found the process “easy” or “very easy.”
While patients appear to be open to utilizing HPV self-collection, adoption of this sample collection method is relatively slow for several reasons, including the need for more patient and provider education, and the need to update laboratory operations and information systems. While insurance generally covers preventive screenings without cost-sharing, follow-up diagnostic services currently may require patient cost-sharing, a factor contributing to cervical cancer screening gaps. Under updated HRSA guidelines, non-grandfathered commercial health plans must cover initial cervical cancer screenings as well as any follow-up testing required to complete the diagnostic process without cost-sharing, starting in 2027.
These triage measures include dual-stain cytology testing, a biomarker-based tool that aids in the detection of cervical cancer. Unlike Papanicolaou (Pap) tests, interpretation of dual-stain cytology results is not limited to specialized cytopathologists and can instead be assessed by any trained pathologist. Alaska Native Medical Center uses dual-stain cytology as a triage for HPV-positive results in alignment with the 2025 ASCCP management guidelines. Dual-stain cytology testing is another critical tool for rural areas, where access to cytopathologists may be more limited.
Establishing a continuum of care
The potential for eliminating cervical cancer in the U.S. is real. After years of hard work, the tools, policies, and medical guidelines are in place. Moving forward, health care systems should consider the diverse needs of all people, as well as creative approaches, such as screening for HPV in the emergency department and mobile settings, to increase the chances of connecting with people who are not normally screened.
Self-collection can be a powerful tool for building trust and initiating cervical cancer screenings in communities that may otherwise fall through the gaps in the health care system. By meeting people where they are, with care informed by a person’s background, health care providers can provide solutions across the continuum of cervical cancer care to improve outcomes.
Samantha Byrnes is a diagnostics scientist.
