The aim of this research was to examine the national cohort for under and over-screening for cervical cancer. Elements pertinent to cervical cancer screening among women aged 21–65 with 6 years of continuous enrollment were searched from the MarketScan database, a nationwide administrative database of employee-sponsored insurance (2015–2019). Women were considered to be at average risk if they had no known risk factors, such as pre-existing conditions, aberrant screening histories, or evidence of a hysterectomy with cervix removal for benign indications. 

A screening schedule of Pap tests every 2.5–3.5 years or HPV tests every 4.5-5.5 years was deemed acceptable for women at average risk. The probabilities of under-screening, over-screening, and guideline-adherent screening were predicted using logistic regressions. Nearly 8 in 10 patients (78.5%), or 1,471,063 out of the total 1,872,809, met the criteria for regular screening. About 25.4% were not checked at all during the 6-year period, while only 18.1% had a screening that was in line with guidelines. Overscreening was more common among younger women (ages 21-39) [OR 1.46]. 

During the study period, women aged 50–64 had higher odds of being under-screened or unscreened than younger women (OR 2.54). HPV testing alone (80%), co-testing (44%), and cytology alone (15%) all had the greatest rates of screening that adhered to guidelines. High-risk criteria necessitating more frequent screening were met by 329,062 women (18% of the overall sample). Both low rates of screening and high rates of overscreening point to the need for additional initiatives to increase adherence to guidelines in medical practice.