Cervical Cancer Incidence Declines in the US, Varies by State

Cervical cancer incidence has declined in the U.S. in recent years, at different rates in different states. Both increased use of screening and the growing effect of HPV vaccine are likely contributors to this health win. But there are big state-to-state differences in this trend and ongoing disparities in application of effective prevention and treatment that need to be addressed in order to more equally and continue to decrease incidence in every community.

Why It Matters

Cervical cancer is one of the most preventable forms of cancer because the interval between carcinogenic HPV infection and development of invasive cervical cancer is typically long, encompassing several years during which interventions to prevent cancer can be effective. Most cervical cancers arise from HPV infection, which causes cancerous changes to cells on the surface of the cervix. In addition to HPV vaccination, there are two other established methods for cancer prevention: screening and treatment of precancer.

While overall numbers show that young women in the HPV vaccine era are at lower risk for cervical cancer at the national level, not all states are created equal. In this post, we look at national trends in risk as well as trends within each state and see how risk has changed over time. We find that there has been a dramatic decline in risk at the national level, but that this decline varies by state with some states having experienced large declines in risk and others little change. Given that effective tools to fight cervical cancer are expensive and typically delivered through the clinical sector, it is especially important that these tools are used effectively and equitably.

A new report from the Centers for Disease Control and Prevention looks at state and DC-level vaccination coverage and vaccination prevention. The report, which examines differences between the 50 states on cervical cancer incidence and the HPV vaccine, found that cervical cancer incidence decreased by approximately 27% — from 5.1 cases per 100,000 women in the pre-HPV vaccine era to 3.7 cases per 100,000 women in the HPV vaccine era. More than 10 states experienced declines of greater than 50%, while about one-third of states did not see any decrease. However, the report found that states with higher HPV vaccination rates experienced the steepest declines in cervical cancer incidence, with each 10% increase in HPV vaccination coverage associated with an additional decline of 3.8 cases per 100,000 women. The findings underscore the importance of robust vaccine delivery and routine healthcare access, and affirm that prevention can work here too.

It seems that the HPV vaccination is beginning to change our perspective on what is going on in screening programs for cervical cancer. Surveillance systems are finding that the incidence of cervical precancers is declining dramatically among the younger women who would most likely have been vaccinated before coming into contact with any HPV type that could lead to cervical cancer. For Surveillance, Epidemiology, and End Results (SEER) areas among screened women aged 20 to 24, the incidence of all cervical precancers decreased by about 79% over time, including the highest-grade lesions, which decreased by about 80%. The incidence of the highest-grade lesions in screened women aged 25 to 29 is also declining dramatically. These lesions are a good indicator of what the trends in cancer cases will be in the future. Precancers of yesterday are cancers of today, but happily there are fewer precancers as these vaccinated cohorts start to age.

With a cervical cancer vaccine soon to be available, many people wonder if screening will still be needed. Although the HPV vaccine will greatly reduce the risk of cervical cancer by covering the HPV types that cause most of the cancers, it won’t be 100% effective for all cancer-causing types of HPV. By the time those vaccinated become eligible for vaccination, most adults will already be infected with HPV. Thus, even with a cervical cancer vaccine, a solid prevention plan will involve both vaccination and screening to detect disease present despite vaccination early, at which time treatment is most effective.

Most cervical cancer cases are the result of missed opportunities for appropriate screening and follow-up for a woman’s risk factors. Many could have been prevented had the woman been appropriately screened for cervical cancer and follow-up arranged; and had she undergone a timely diagnostic evaluation for abnormal screening test results. A single misstep in this process can result in the silent development of a high-grade lesion into invasive cancer. Therefore it is fundamental that the “screening and treatment” approach saves lives. Screening must immediately lead to diagnostic evaluation and appropriate treatment for abnormal results.

Even though the approach to cervical cancer screening has changed to include longer intervals between Pap tests and greater use of HPV testing, patients may still have the image in their minds of the yearly Pap test. High-sensitivity for detecting high-risk HPV infection, which is essential for both Pap testing and HPV testing, indicates that longer intervals are safe for average-risk women. It is therefore crucial to ensure that patients understand the rationale for varying screening intervals by age and test type in order to ensure that they are not lost to follow-up.

These screening recommendations are written in simple language for patients and parents. Please see the professional policy statement for full details. Those at risk of developing cervical cancer (those with a cervix) should begin screening at age 21. Women 21-29 years old should have a Pap test every 3 years. Women 30-65 years old have several options: they may have HPV testing every 5 years, Pap testing every 3 years, or combined HPV and Pap testing every 5 years. People younger than 21 generally are not candidates for cervical cancer screening, and many women older than 65 can stop cervical cancer screening if they have a adequate screening history and are considered to be of low risk for cervical cancer. Those with higher-risk conditions need an individualized plan.

Including self-collected HPV testing in screening programmes can improve access to screening for women for whom attending a clinic for a cervix examination is a barrier to screening. Newer guidelines support the use of self collected HPV samples in clinically directed screening programmes. These approaches are particularly important for women who avoid screening due to discomfort or trauma associated with speculum based cervix examination, cultural or social reasons, or other reasons. Innovations in access to screening must be matched with innovations in care coordination to ensure that all women receive timely appropriate treatment.

Cervical cancer prevention works – but its benefits are not equally shared. While effective tools exist to prevent the vast majority of cervical cancer cases (vaccination, screening, and treatment), these interventions are not being delivered effectively in many countries. The next crucial step in reducing cervical cancer deaths is effective delivery of these simple interventions in all settings worldwide.

Who it affects

It is primarily women and all people with a cervix aged 20-65 who are affected by the current screening landscape for this disease. Most guidelines and quality measures for screening and follow up are targeted to this age group. It is also the age group where prevention of invasive cancer has the greatest impact, by identifying and treating precancer.

Youth are an important target population for cancer prevention efforts because vaccination can be most effective if administered before HPV exposure occurs. In addition to routine vaccination of preteens, catch-up vaccination is also recommended for teens and young adults through to young adulthood, because early vaccination is less likely to occur and has the potential to provide the best protection before exposure to HPV. Improving vaccination rates is a pediatric issue, but it can also impact cancer rates in the long term.

Barriers to vaccination, screening and follow-up care can prevent underserved populations from receiving timely health care. For a variety of reasons, underserved populations carry a higher preventable burden of disease. Rural settings present unique challenges, such as a lack of local clinics and long distances to colposcopy and treatment centers. Individuals with unstable insurance often face barriers to receiving timely health care. Poor communities and populations of color struggle with issues of transportation, child care and time off from work. As a result, many cancer screenings are not completed and follow-up care is delayed until symptoms become apparent and the cancer is diagnosed at a more advanced stage.

Among women with cervical cancer, it is typically those most vulnerable, either having never had a screening test or being on an irregular screening schedule, who are at highest risk. Women with cervical cancer represent the failure of prevention at one or more steps in the pathway from outreach and reminders to test navigation, as well as delayed follow-up on abnormal results.

Don’t forget the older ladies! Many current guidelines recommend stopping screening at age 65. However, approximately 10% of cervical cancers are diagnosed in women greater than age 65. Decisions to stop screening at age 65 should be based on a woman’s screening history and risk factors. Women who have never had adequate screening or whom have been inadequately screened in the past should continue to be screened beyond age 65.

Healthcare workers are the main workforce carrying out prevention activities and fighting certain diseases and health problems. Individuals and teams from primary health care to public health—healthcare providers such as nurses, midwives, and OB-GYN clinicians—vaccinate, screen, counsel, and follow up with patients to help them get and give the best health possible. They are challenged to find credible health information to answer patients’ questions, and to coordinate referrals to other providers to make sure patients get the best possible care. In a time of year that is busy enough in any clinical setting, clinics need simple workflows, good protocols, and some quick reminders to make sure that preventive opportunities are not missed. Many clinics are facing serious staff shortages, and others are thinly spread trying to serve the outbreak-affected communities.

We also count on individuals and organizations from all sectors to help reach the families who need information and resources about HPV prevention. Ultimately, acceptance of the HPV vaccine is up to each family and their health care provider. But how will they learn about the benefits of HPV vaccination? How will messages and programs be framed within their communities to build trust and encourage adoption? By clearly making the link between HPV vaccine and cancer prevention, community-based partnerships can help educate families about the benefits of HPV vaccination while working to reduce stigma associated with cancer.

Organizations reaching families that do not have regular access to primary health care and resources are using schools and community-based programs, as well as mobile clinics and community health workers.

Prevention declines faster when it is left to the marketplace. While business leaders and health professionals can play important roles in cancer prevention efforts, decisions with the greatest impact on the access and affordability of prevention measures are typically made by state policymakers. Their decisions regarding insurance coverage, public health funding for cancer control activities, school mandates for vaccine-preventable cancers, and cancer screening policies have the potential to impact cancer incidence rates. When these measures are available and affordable, cancer incidence rates decline more rapidly. When they are not, a system of cancer care can become fragmented and perpetuate health disparities, rather than reducing them.

• The decline in cervical cancer reinforces a simple message: prevention works when the full pathway is supported. HPV vaccination reduces future risk, screening finds disease early, and treatment of precancer prevents invasive cancer. Health systems should focus on strengthening every link in this chain, especially the follow-up step after abnormal results.
• Vaccination strategies should emphasize on-time vaccination and series completion. Many states have improved first-dose uptake, but completion and consistent delivery still lag in certain areas. Practical steps include offering HPV vaccine at every eligible visit, using standing orders, adding reminder and recall systems, and framing the vaccine clearly as cancer prevention. Strong clinician recommendation remains one of the most effective drivers of vaccine uptake.
• Screening programs should reduce confusion by explaining test choices and intervals clearly. Longer screening intervals can feel risky to patients who remember annual Pap tests. Healthcare teams can explain that modern screening balances benefits and harms, using sensitive HPV testing to identify those at risk while avoiding unnecessary procedures for those at low risk. Simple patient education handouts, clear scheduling systems, and culturally appropriate counseling improve adherence.
• Self-collection and other access innovations should be paired with strong follow-up systems. Self-collected HPV testing can expand screening for women who avoid pelvic exams, but only if clinics have reliable workflows for results notification and rapid referral when needed. Navigation services, text reminders, and community health worker support can reduce loss to follow-up, which is a major driver of preventable cancer.
• States with slower progress need targeted investment, not blame. Low vaccination and screening rates often reflect real barriers such as clinic shortages, transportation challenges, and unstable insurance coverage. Solutions can include expanding community health centers, funding mobile screening services, improving reimbursement for preventive care, and strengthening referral networks so women can access colposcopy and treatment without long delays.
• Better use of data can guide local action and resource allocation. Cancer registries, immunization information systems, and screening program data can identify counties or neighborhoods with low coverage. When public health teams share these insights with local health systems, they can build outreach lists for overdue screening, focus vaccination campaigns, and track improvements over time.
• Equity-focused programs can accelerate declines and narrow disparities. Removing cost barriers, offering services in multiple languages, and addressing mistrust directly improves participation in screening and vaccination. Practical supports like transportation vouchers, extended clinic hours, and assistance with childcare can make the difference between a missed appointment and a completed prevention pathway.
• The long-term goal is cervical cancer elimination as a public health problem, and it requires coordinated action. Global targets emphasize high vaccination coverage, high screening coverage using high-performance tests, and timely treatment for those with cervical disease. In the US, the same principles apply: raise HPV vaccination, maintain high-quality screening, and ensure treatment access across all states. If progress becomes more uniform, cervical cancer can continue to decline and become increasingly rare.

What changes

References:

https://www.cdc.gov/mmwr/volumes/73/wr/mm7309a4.htm https://www.cdc.gov/cancer/hpv/basic\_info/prevention.htm https://www.cdc.gov/cancer/cervical/statistics/index.htm https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html