Gaps in Cervical Cancer Screening and Follow-Up: A Growing Concern As More Women Are Diagnosed With High-Risk HPV

Recent years have brought troubling declines in critical follow-up care despite a rise in high-risk HPV for some age groups.

Cervical cancer was once the leading cause of cancer-related deaths among women in the U.S. However, the implementation of Pap testing in the 1950s brought significant declines in mortality, furthered by the 2006 introduction of the human papillomavirus (HPV) vaccine. Despite these advancements, recent data indicates that cervical cancer rates among women ages 30 to 44 have risen in recent years, possibly due to gaps in screening​. 

The Pap test, which detects precancerous changes in the cervix, allows for early intervention and treatment before cancer develops. The HPV vaccine targets the high-risk strains of the virus that are responsible for most cervical cancer cases, thereby reducing the incidence of HPV infections and, consequently, cervical cancer. Public health initiatives, improved access to healthcare, and broader awareness of cervical cancer prevention have also contributed to this decline in mortality rates.

MapView: Event Pathways Dashboard

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An abnormal test result usually leads to a follow-up procedure, which might include repeat Pap tests, HPV testing, or a colposcopy to closely examine the cervix. During a colposcopy, a biopsy may be performed to analyze cervical tissue. Treatment options for precancerous or cancerous cells include a loop electrosurgical excision procedure (LEEP), cryotherapy, or surgical methods. Retesting is essential after treatment to ensure that all abnormal cells are removed and to monitor for recurrence​. For less severe abnormalities, watchful waiting is employed through regular follow-up tests to ensure that any changes are detected early. 

But are women with HPV getting the follow-up care they need? That is, how often are the recommended treatment pathways followed? With late-stage cervical cancer on the rise, we were interested to see the rate at which watchful waiting and monitoring was used compared to active treatment and how often women do not get the follow-up care they need. We used our MapLab™ tool to analyze a group of over 3.5 million patients diagnosed with high-risk HPV (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) between 2016 and 2023. Several of Komodo’s MapView™ dashboards were used, including the Event Pathways and Patient Journey dashboards.   

Here’s what we found: 

The number of women diagnosed with high-risk HPV increased by 23% between 2016 and 2023, while rates of both Pap tests and colposcopies decreased. 
Between 2016 and 2023, the rate of high-risk HPV diagnosis per 100,000 patients increased by 23% — from 342 per 100,000 in 2016 to 421 in 2023. In 2023 alone, more than 700,000 patients in Komodo’s Healthcare Map™ were diagnosed with high-risk HPV. 

Concurrently, Pap tests decreased by 12% and colposcopies by 9%. These declines are likely due to the widespread uptake of the HPV vaccine, which has significantly lowered the need for follow-up interventions. With the vaccine, updated screening guidelines now recommend less-frequent testing. Screening adherence may also be lower due to the COVID-19 quarantine, which, as we previously reported, saw declines during lockdown that, as of 2022, have not fully rebounded. 

Removal procedures (such as LEEP) in patients with high-risk HPV have declined by 34% since 2016. 
The rate of high-risk HPV patients who then underwent procedure to remove cervical tissue with cellular changes (via cervical biopsy, endocervical scraping, LEEP, or cone biopsy) decreased by 34% between 2016 to 2023 (from 47 per 100,000 to 31). While 14% of the high-risk HPV group went on to receive a removal procedure in 2016, this dropped to 7% in 2023. Procedures did decline slightly more steeply in the years following COVID lockdowns, but they were still a part of a consistent downward trend. This could reflect a trend toward watchful waiting, as patients often want to avoid invasive procedures.  

For patients diagnosed with high-risk HPV, crucial follow-up testing/monitoring has been declining. 
In those with at least one year of data following a diagnosis of high-risk HPV, 40% had an immediate follow-up procedure (either a Pap test or a colposcopy) within one month, and 18% then had follow-up Pap tests after a year, per recommended guidelines. 

However, the number of patients with high-risk HPV who received a follow-up Pap test after one year decreased by 34% between 2016 and 2023. This is concerning given that retesting is crucial for monitoring the status and possible progression of HPV-related cellular changes and cervical cancer risk and prevention.

White patients were 5% more likely than Black patients to receive a follow-up colposcopy after a high-risk HPV diagnosis. 
While 57% of White patients and 56% of Asian and Pacific Islander patients with a high-risk diagnosis went on to receive a colposcopy within 10 years, rates were slightly lower among both Hispanic/Latino and Black patients at 52%.   

The rising cases of high-risk HPV coupled with declining cervical cancer screening and follow-up rates highlight a critical public health concern. This analysis underscores the essential role of high-fidelity real-world data in shaping preventative public health strategies, particularly in areas with fast-changing, demographic-specific trends like cervical cancer screening and HPV monitoring. Up-to-date tracking of preventative healthcare utilization and outcomes enables healthcare systems and policymakers to identify gaps in care, assess the real-world impact of interventions, and refine guidelines to better serve affected populations. Insights into what is happening on the ground in real time enable adaptive systemic responses that can maintain patient safety, optimize care delivery, and, ultimately, save lives and reduce the burden of disease — Komodo’s primary mission. 

Read our recent analysis on Long COVID and MECFS, two conditions that disproportionately affect women. 

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