Optimizing the Uptake and Completion of the Cervical Cancer Screening Continuum: Opportunity Knocks, Including at Home

Abstract

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening—rather than actual costs—remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions. Optimizing cervical cancer prevention requires attention not only to initial screening uptake but also to completion of the full screening continuum, including timely follow-up after abnormal results. Recent policy developments—including the US Supreme Court affirmation of the ACA preventive services mandate, elimination of cost-sharing for patient navigation beginning in 2026, expansion of coverage for diagnostic follow-up starting in 2027 for insured individuals, and endorsement of self-collected human papillomavirus testing—create an unprecedented opportunity to reduce financial and logistic barriers to completion of cervical cancer screening. However, realizing the population-level and equity benefits of these advances will require deliberate implementation strategies that emphasize transparent communication about patient out-of-pocket costs, integration of navigation services, and follow-up pathways.

See related article by Isaacson et al., p. 1158