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Cervical cancer is one of the most preventable malignancies. The introduction of HPV tests and the HPV vaccine over the past 20 years, following decades of Pap testing, have contributed to a steady decline in the disease — with one notable exception. In a new study published Thursday in the International Journal of Gynecological Cancer, researchers found the incidence of stage 4 cervical cancer has slowly but steadily increased from 2001 to 2018, a worrying and paradoxical trend that experts believe has only gotten worse with the Covid-19 pandemic.

“Nobody should be presenting with a distant-stage cancer,” said Rebecca Perkins, a professor of obstetrics and gynecology at Boston University School of Medicine who did not work on the study. “It means people are just being missed. It’s a failure of the screening system in terms of, probably, people not being able to access care.”

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