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Are complex guidelines the cause of low cancer screening rates?
Researchers argued that better messaging could clarify complex timing and guidelines for various methods of cervical cancer screening.
Only 7.3% of the eligible population is getting the appropriate cervical cancer screening, with more than half getting too many cancer screenings and a third not getting enough, according to a new JAMA Network Open research note.
These findings might suggest that cervical cancer screening guidelines are too complex, made particularly complicated by the numerous testing modalities currently available.
The U.S. has long been staring down a primary and preventive care problem, with numerous reports showing low adherence to cancer screenings, in particular. While poor cancer screening is a multifaceted issue, one potential solution that's emerged is creating more convenient tests.
In 2025, the Prevent Cancer Foundation found that 64% of adults who are behind on at least one cancer screening would be more likely to get the screen if they could use an at-home test, a less invasive test or a faster or less frequent test.
Life sciences companies have answered that call, creating numerous types of tests that can address specific types of cancers. For cervical cancer screening, three major types of tests have changed the game: quintennial cotesting, primary HPV testing and triennial cytology testing.
These tests leverage different methods, and patients need to get them done on different cycles, which the JAMA researchers posited could be leading to confusion and, ultimately, poor cervical cancer screening adherence.
Few patients are adherent to cervical cancer screening guidelines
In an analysis of Optum Clinformatics data from 2013 to 2021, the researchers measured adherence to different types of cervical cancer screening for 670,000 insured and eligible individuals. The researchers said they excluded primary HPV testing because it was not recommended by the United States Preventive Services Task Force (USPSTF) until 2018.
Ultimately, adherence to cervical cancer screening was low, with only 7.3% of eligible individuals getting a cervical cancer screening that was adherent to USPSTF guidelines.
Instead, the researchers found a serious problem with over- and under-testing. More than half (61.6%) of eligible individuals were over-tested, while 31.1% were under-tested.
Both trends are concerning. Over-testing adds burden to the patient, increases the risk of false positives and can increase healthcare spending. Meanwhile, undertesting can increase the risk of a missed diagnosis.
The populations most likely to be over-screened include non-Hispanic Black people, younger patients, those of higher socioeconomic status and patients with comorbidities. On the flip side, non-Hispanic Asian people, older patients, those with lower socioeconomic status and patients with comorbidities were among the most likely to be under-screened.
Notably, use of co-testing (meaning a patient got both a Pap smear and HPV test) resulted in both over-testing and under-testing. Those who received co-testing had a 96.2% positive predictive value for over-screening, compared to 82.4% positive predictive value for cytology alone.
The solution is not to limit the types of cervical cancer screenings available to patients, the researchers noted. Rather, they suggested an industry- and institutional-level review to improve guideline messaging and reduce complexities.
"More evidence-based strategies are needed to expand capacity for guideline-adherent screening, reduce over-screening, and align payer and health system incentives, particularly as new modalities, such as HPV self-sampling, emerge," they concluded.
"Findings also suggest that the impact of newer modalities on screening quality varies by race and ethnicity, underscoring the need for community-tailored interventions to avoid widening disparities."
Sara Heath has reported news related to patient engagement and health equity since 2015.
