Cervical cancer is preventable. So why are rates increasing among women in their 30s and 40s?

Cervical cancer, considered a “highly preventable” disease, has long been declining in the United States — but it’s now on the rise among women in their 30s and 40s.

Rates climbed 1.7 percent among women 30 to 44 years of age between 2012 and 2019, according to recently published data from the American Cancer Society (ACS).

Overall, cervical cancer rates have been dropping in the United States since the early 1990s thanks to more widespread screening and the release of the first HPV vaccine in 2006.

Those vaccinations and routine screenings, coupled with follow-up treatment when needed, can prevent “nearly all” cervical cancers, according to the National Cancer Institute (NCI).

But not all women take those precautionary steps — or are able to. Health experts theorize cervical cancer cases are climbing among 30- and 40-something women due to two things: low HPV vaccination rates among women over 30 and decreasing cervical cancer screening in the United States.

While not all cervical cancer is caused by HPV, several strains of the virus are the leading cause of the disease, according to the NCI.

For that reason, health experts urge anyone who can get the vaccine to do so. A significant majority of adolescents across the country get inoculated: The share who had received at least one dose rose from roughly 56 percent in 2015 to over 75 percent in 2020, according to an analysis of National Immunization Survey-Teen data.

It’s not clear what the HPV vaccination rate among women 30 and older is, but every health expert who spoke with The Hill said it was far lower than the rate among 20-somethings and teens.

This is primarily because most 30- to 44-year-olds were either too old to receive the vaccine when it came out, weren’t offered the immunization in their doctor’s office or refused to get it due to vaccine hesitancy, according to Jennifer Young Pierce, a professor of gynecologic oncology and the director of the Division of Cancer Control and Prevention at the USA Health Mitchell Cancer Institute.

Adults who are now 30 would have been about 12 years old when the Food and Drug Administration approved the first-generation HPV vaccine, Gardasil, in the mid-2000s.

The Centers for Disease Control and Prevention (CDC) recommends that the vaccine be administered to adolescents at about age 11 or 12, with the intention of protectingthem from various strains of HPV before they become sexually active.

Vaccine hesitancy played a major role in Anna Ogo, 36, not receiving the HPV vaccine as a teen or young adult in her native Japan, and possibly in her diagnosis with cervical cancer four years ago.

Japan initially embraced the two HPV vaccines in the early 2010s, and the country’s health ministry added the shots to the national immunization program and began to recommend the vaccine, according to the research journal Science.

But after several girls started reporting adverse side effects like pain and motor impairment, in June 2013 an advisory panel “suggested suspending the recommendation,” which the health ministry did.

As a result, HPV vaccination in the country fell from 70 percent to almost zero that same year.

Ogo didn’t discover what HPV was or its connection to cervical cancer until she moved to the U.S. and her doctor offered to do a pap-smear and HPV test at the same time, she said.

“I had never heard of the HPV test nor was it offered in Japan,” she said. “I didn’t think about it too much, I just thought maybe some procedures and testing are different in the U.S. from those in Japan and I just went with what she suggested.”

Ogo said she was shocked when she eventually learned about the vaccine and how her cancer could have been prevented.

While vaccination rates remain high in the U.S., some people don’t believe it is safe and refuse to give their consent so their children can receive it.

One 2022 study conducted in Maryland found that parents who do not want their children to get the HPV vaccine worry over potential side effects or think it’s an unnecessary vaccination because their children aren’t sexually active.

People who aren’t inoculated in their early teens can still get the vaccine, but it may not prove as effective past a certain age.

The shots provide less protection to adults older than 26 because “more people in this age range have already been exposed to HPV,” the CDC states on its website.

While the agency advises that every adult 26 and younger get the HPV vaccine, it encourages older adultsto talk to their doctor before getting the inoculation.

The vaccine can still benefit adults older than 26 who have already been infected with HPV by providing protection against other strains, but it doesn’t treat existing infections, according to KFF.

Kathleen Schmeler, professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center, agrees with the CDC’s guidelines, believing that administering the vaccine to adults older than 26 would have very little impact.

“We feel pretty strongly that we should use the vaccine on the people it’s going to have the most impact on,” said Schmeler, who is also a member of the White House Moonshot Cervical Cancer Forum.

There is also a worldwide shortage of the HPV vaccine, Schmeler noted, which partially influences who the drug is administered to.

Those who do get the vaccine are far less likely to get cervical cancer.

One 2020 study of HPV vaccination rates among Swedish women and girls published in the New England Journal of Medicine found that the vaccine decreased the likelihood of developing cervical cancer by 63 percent.

The study also showed that women who are vaccinated against HPV can still get cervical cancer from a strain of the virus the inoculation doesn’t protect against, however.

This is why cervical cancer screenings in the form of regular pap smears and HPV tests are vital to preventing the disease, health experts said.

But the share of women who are overdue for such screenings has been on the rise for decades, according to data from the NCI. In 2005, about 14 percent of women in the U.S. were overdue; by 2019, that figure rose to 23 percent.

The COVID-19 pandemic likely exacerbated this trend.  Appointments for cervical cancer screenings fell by 84 percent in April 2020 alone, according to a 2021 study analyzing data from the CDC’s National Breast and Cervical Cancer Early Detection Program.

People with cervixes should receive a pap smear every three years to check for precancerous or cancerous cells when they’re between the ages of 21 and 29, according to the U.S. Preventative Services Task Force. Between the ages of 30 and 65, they should receive a pap smear every three years and an HPV test every five years as part of a cervical cancer screen.

If they test positive for HPV, they should have another pap smear one year later, according to the University of Texas MD Anderson Cancer Center.

The primary reason women said they were not up to date on a pap smear or HPV test was because they didn’t know they needed to undergo either one.

One 2022 study published in JAMA Open Network found that a “lack of knowledge” on when to undergo either type of screening has increased over time. In 2019, about 55 percent of women didn’t know if and when they needed a pap smear or HPV test, up from about 45 percent in 2005, according to the study.

This was the case for Claudia Perez-Favela, who was diagnosed with precancerous cells in her cervix in 2018 due to an HPV infection.

“I had heard of HPV before, but I didn’t know the relationship between it and cervical cancer,” Perez-Favela said in e-mail to The Hill.

Other common reasons why women had fallen behind on cervical cancer screenings: They had not received a recommendation toget screened from a health care professional, or they lacked access.

The JAMA study defined a lack of access as either not having enough money or health insurance to cover the expense of getting a pap smear or HPV test or not having a health care provider to go to for testing.

Most cervical cancer is being diagnosed in older women with about 62 percent of all cases found in women 45 and older, the NCI data.

But cervical cancer is most frequently diagnosed in women between the ages of 35 and 44. This, in part, is leading health experts to theorize that cases of cervical cancer could be rising in the age group not only because of low or falling vaccination and screening rates, but because the cases are being caught earlier.

ACS data shows that most cervical cancer cases — 43 percent —are being diagnosed at a localized stage, meaning that it is limited to the organ or place where it started.

“I think there is a component of this happening in the 30- to 45-year-old population,” Pierce said. “That we are diagnosing disease earlier and therefore at a younger age.”

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