Cancer Trends Progress Report

The percentage of women aged 21 to 65 years who were up-to-date with cervical cancer screening, by race/ethnicity, income, and education level. For 2013 and before, up-to-date was defined as having a Pap test within the past 3 years. For 2014-2018, up-to date is defined as having a Pap test within the past 3 years for all women aged 21 to 65 years, or having a Pap test, with or without an HPV test, in the past 5 years for women aged 30 to 65 years.

Starting in 2018, up-to-date on cervical screening was additionally defined as having an HPV test alone in the past 5 years for women aged 30 to 65 years.

Measurement challenges

We track cervical cancer screening rates in U.S. women using a large, national, in-person survey in which people are asked about their health behaviors and the medical care they receive (see Data Source, below). There are important limitations to this method that impact what information we can accurately collect and how confident we can be in the findings. Studies have found that certain types of healthcare survey questions can be difficult for people to clearly understand and answer, and it is easy for some questions to be misinterpreted. Guidelines for cervical cancer screening have increased in complexity over time, which results in a greater likelihood for missing or incomplete self-reported information about the screening tests women received. Different approaches by researchers for handling this missing information can result in somewhat varied estimates presented for up-to-date cervical cancer screening status, depending on publication.

In the case of cervical cancer screening, it can be challenging to determine by self-report alone which type of test a woman received (i.e., a Pap smear, HPV test, or both). Both tests appear identical to the woman experiencing them; a person may only be aware which test she received if informed by her healthcare provider.

Additionally, cancer screening is looking for cancer before a person has symptoms, when they are not known to have had that specific cancer type before. Looking for new or recurrent asymptomatic cancer in a person previously diagnosed and treated for that cancer type represents a different type of testing known as surveillance testing. Finally, people may not always accurately recall the specific time they received a particular test. As people do not always accurately recall what medical tests they have received, the purpose of that testing, or its exact timing, our measure captures any type of cervical cancer screening received by a woman, and the population may include those with a prior diagnosis of cervical cancer. Our measure is a reasonable approximation of the true U.S. cervical cancer screening rate, but it is not perfectly comparing the actual frequency of women’s use of specific cervical cancer screening tests to national recommendations.

Even though the National Health Interview Survey cervical cancer screening measures have limitations, it is the best nationally representative data we have available to assess cervical cancer screening rates. It is frequently used by governmental and other organizations to track screening use over time in the US.