Background:

Cervical cancer screening is essential for early detection and prevention, particularly among adolescents and young adults (AYAs). Sickle cell disease (SCD) is a hereditary blood disorder characterized by chronic hemolytic anemia and vaso-occlusive complications. As life expectancy increases in individuals with SCD, AYAs face unique challenges during the transition from pediatric to adult care—often including limited access to preventive services and healthcare providers experienced in adult SCD management.

This population is at risk for fragmented care and suboptimal preventive health screening. Although cervical cancer screening has proven beneficial, many women remain unscreened. Despite the importance of routine cervical cancer screening, little is known about screening adherence and outcomes in women with SCD. According to U.S. Preventive Services Task Force (USPSTF) guidelines, women aged 21–29 should undergo cervical cytology (Pap smear) alone every three years, while those aged 30–65 should receive HPV testing alone or co-testing with Pap and HPV testing every five years.

Objective

To evaluate cervical cancer screening outcomes among AYAs aged 21–29 with SCD and to assess associations with clinical factors including hydroxyurea use, HPV vaccination status, STI history, BMI, smoking status, and HPV test results.

Methods:

A retrospective chart review was conducted of 36 individuals with SCD aged 21–29 who had at least one clinical visit between January 2024 and December 2024. Individuals with a history of hematopoietic stem cell transplantation were excluded. Electronic health records (EHRs) were reviewed to assess:

  • Proportion meeting USPSTF cervical cancer screening guidelines

  • Pap smear results and abnormalities

  • HPV vaccination status

  • STI history and HPV testing

  • Hydroxyurea use, BMI, and smoking status

Results

Among the 36 patients included, only 50% (18/36) of the cohort had undergone cervical cancer screening in accordance with USPSTF guidelines. Additionally, 16.7% (6/36) had not received the HPV vaccine, and 11.1% (4/36) had a documented STI. At the time of the Pap smear, 36.1% (13/36) of patients were on hydroxyurea, and the average BMI was 25.13.

Of the six patients with abnormal Pap smears, four were associated with HPV infection. Notably, only one of those four had completed the full HPV vaccination series. Additionally, all but one patient with both an STI and positive HPV test were not receiving hydroxyurea therapy, suggesting a potential link between lack of disease-modifying treatment and inadequate preventive care engagement.

Discussion:

This study reveals substantial gaps in cervical cancer screening adherence among AYAs with SCD. The 50% rate of missed cervical cancer screening among women aged 21–29 with sickle cell disease in our cohort exceeds the 29.1% of women in the general U.S. population in the same age group who were not up to date with screening in 2019, highlighting a disparity in preventive care delivery. Suboptimal HPV vaccination rates and low hydroxyurea utilization among those with abnormal findings further emphasize the need for comprehensive preventive health strategies tailored to this population.

Conclusion:

AYAs with SCD are at risk for inadequate cervical cancer screening and HPV vaccination. Targeted interventions—such as structured transition programs and integrated preventive care services—are critical to improving outcomes in this underserved and vulnerable group.

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2025
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