Community health centers in Washington and Idaho have adopted new methods of screening for cervical cancer at different rates, which a recent study in the journal BMC Primary Care says could point to possible gaps in care and limited resources. 

Researchers looked at three primary care health systems in the two states that are run by federally qualified health centers (FQHCs). These nonprofits receive federal grants to provide medical services in underserved communities, regardless of a patient’s ability to pay. 

The study found that, in 2012, Pap smears were almost exclusively used for a patient's first routine screening for cervical cancer. Using a small brush, a clinician collects cells from the cervix, which are then examined under a microscope for precancerous abnormalities. 

Over the following decade, all the FQHCs began providing co-testing, which is more comprehensive: Cells are not only visually evaluated but also tested for viral strains of human papillomavirus (HPV), which causes cervical cancer. 

Some FQHCs, however, were more likely to provide co-testing than others.

By 2022, 58.8% of patients received co-testing for their first routine screening at FQHC A, the only system that serves rural communities.

FQHC B almost exclusively provided Pap smears in 2022, though in 2019 it was doing co-testing for 63.8% of the first routine cervical cancer screenings. 

In 2022, co-testing at FQHC C was at 76.8%. This organization had the lowest percentage of patients who were publicly insured through programs like Medicaid and Medicare. 

The researchers note that patients living in rural areas, those who lacked insurance, and those with fewer primary care visits were significantly less likely to receive co-testing. 

"These patterns suggest that access to care, visit frequency, and continuity of care may influence whether patients are offered or receive HPV-based screening," the study authors wrote.

The researchers added that potential barriers to HPV-based screening in rural communities are concerning, “given that rural populations already experience lower cervical cancer screening rates and that rural-urban disparities may have widened following the COVID-19 pandemic.”

While the researchers looked only at frequency of co-testing for first routine screening, a March 2026 paper published in JAMA Network Open concluded that, after an initial negative HPV test, co-testing may yield limited benefits while increasing costs.

As FQHCs face growing financial pressures, decisions like when and how often to provide co-testing might become more pressing—especially as the uninsured population in the United States is increasing.