Temporal Trends and Drivers of Cervical Cancer Overscreening Among Adolescent Girls and Young Women, 2011-2023

In adolescent girls and young women (AGYW), cervical cancer screening is not recommended as it offers little benefit and may cause harm. We describe temporal trends in cervical cancer overscreening among AGYW and examine its potential clinical drivers over time.

Using 2011-2023 National Survey of Family Growth on AGYW aged 15-20 years (n = 5,375), we examined temporal trends in the prevalence of cervical cancer overscreening, defined as receipt of a Papanicolaou test or human papillomavirus test in the past 12 months as part of a routine exam. We estimated risk ratios (RRs) and differences (RD) for potential clinical drivers of overscreening, including past guideline indications (e.g., sexual history, human immunodeficiency virus [HIV] testing) and cooccurring clinical situations (e.g., sexually transmitted infection [STI] testing).

From 2011 to 2023, the prevalence of cervical cancer overscreening declined from 22.1% to 4.5%. For a history of sexual intercourse, both the RR [95% confidence interval] (4.25 [1.62, 6.89]) and RD (24.37 [16.24, 32.50]%) decreased over time, but the RD remained statistically significant in 2022-2023 (5.89 [0.93, 10.66]). For HIV testing, neither the RR (1.16 [0.37, 1.96]) nor RD (1.83 [-6.54, 10.20]) were statistically significant in 2022-2023. For STI testing, however, the RD increased from 10.47 (-1.43, 22.37)% in 2011-2013 to 27.63 (6.63, 48.64)% in 2022-2023.

Cervical cancer overscreening among AGYW declined substantially since 2011. However, overscreening remains more prevalent among AGYW with a history of sexual intercourse and STI testing, underscoring the need to ensure evidence-based cervical cancer screening for AGYW.