Mental health of people living in Afghanistan: protocol for a systematic review.

Cervical cancer is one of the most preventable malignancies in women, yet it continues to impose avoidable morbidity and mortality when screening and timely follow-up are missed. Screening programs have historically driven major reductions in incidence and deaths by detecting precancerous lesions before invasion, and U.S. clinical guidance now offers several evidence-based pathways for average-risk individuals with a cervix. The U.S. Preventive Services Task Force (USPSTF) recommends cytology every 3 years for ages 21–29 and, for ages 30–65, cytology every 3 years, primary high-risk HPV testing every 5 years, or co-testing every 5 years. The American Cancer Society (ACS) further updated its guideline to emphasize primary HPV testing where available and to refine initiation and intervals, reflecting the central etiologic role of HPV and the performance of HPV-based testing. In practice—particularly within nursing-led preventive care and community outreach—these recommendations translate into routine opportunities to promote screening completion, address barriers, and ensure appropriate follow-up when results are abnormal, consistent with modern risk-based management approaches. Despite clear recommendations, screening uptake remains uneven, and recent evidence suggests that underscreening has not been eliminated and may be worsening in specific populations. A large, repeated cross-sectional assessment of guideline-concordant screening from 2005–2019 documented declines and highlighted persistent reasons for underscreening across sociodemographic groups. More recent national evidence also underscores geographic inequities, with rural populations experiencing lower screening levels in contemporary years, reinforcing the need for targeted prevention strategies. At the same time, improvements in screening questions and surveillance measurement remain an active area of public health work—important for interpreting trends and comparing estimates across survey years. From a nursing and health services perspective, difficulty obtaining medical care because of cost is a central access concern. In BRFSS, MEDCOST1 captures whether respondents needed to see a doctor during the previous 12 months but could not because of cost; it does not identify cervical screening-specific costs or particular mechanisms such as transportation, scheduling, or lost wages. In a broader preventive-care context, unmet need due to cost remains consequential for receipt of recommended services. Even among people with insurance coverage, out-of-pocket costs or unexpected cost-sharing may discourage preventive service use, indicating that insurance alone does not guarantee affordability.