National Outcomes of Increasing Cervical Cancer Screening in Federally Qualified Health Centers.

IMPORTANCE

Federally qualified health centers (FQHCs) deliver health care to more than 30 million people across the US and often face structural constraints that affect their ability to provide cervical cancer screening (CCS).

OBJECTIVES

To estimate the number of underscreened individuals served by FQHCs and the outcomes of improving CCS in FQHCs to meet the Healthy People 2030 goal of 79.2%.

DESIGN, SETTING, AND

PARTICIPANTS

This cross-sectional analysis used data from the Uniform Data System reported in 2023 by 1352 FQHCs across the US, self-reported survey-weighted CCS prevalence from the National Health Interview Survey, and population size estimates from the US Census Bureau American Community Survey 2023. Participants were US adults served by FQHCs who were CCS eligible nested within the estimated 85 364 685 CCS-eligible individuals in the US population. Analyses were conducted between September 2024 and July 2025.

EXPOSURES: Receipt of CCS at an FQHC.

MAIN OUTCOMES AND MEASURES: Percentage of CCS-eligible individuals who were up to date on CCS.

RESULTS

In 2023, a total of 7 757 211 CCS-eligible individuals were served by FQHCs, representing 9.1% (95% uncertainty interval [UI], 9.0%-9.2%) of the estimated 85 364 685 individuals in the CCS-eligible population. FQHCs served 35.9% (95% UI, 32.9%-39.6%) of the underscreened publicly insured population, 26.3% (95% UI, 23.1%-30.1%) of the underscreened rural population, 22.4% (95% UI, 20.9%-24.0%) of the underscreened population living at or below 200% of the poverty level, 19.5% (95% UI, 17.9%-21.4%) of the underscreened uninsured population, and 17.7% (95% UI, 16.7%-18.9%) of the underscreened racial or ethnic minority population. By region, FQHCs served 16.5% (95% UI, 14.6%-18.7%) of the underscreened population in the Northeast, 14.1% (95% UI, 12.7%-15.9%) in the Midwest, 13.5% (95% UI, 12.5%-14.7%) in the South, and 19.1% (95% UI, 17.3%-21.1%) in the West. Increasing CCS in FQHCs from the current estimate of 55.1% to the Healthy People 2030 goal of 79.2% would screen an additional 1 872 367 people and increase CCS among the aforementioned subgroups and regions by 2 to 6 percentage points.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that FQHCs served a large number of underscreened individuals from traditionally underscreened subgroups. These results suggest that improving CCS in FQHCs would result in a substantial increase in national CCS rates.