Targeting under-screened women in cervical cancer: combining self-sampling and human papillomavirus testing with a strategic reminder plan.

Abstract

Cervical cancer (CC) screening is essential for reducing its incidence, yet engaging under-screened women remains challenging. Self-sampling has emerged as a promising solution to enhance attendance; however, its integration into programmes has proven difficult. This study evaluated a multimodal approach combining self-sampling, human papillomavirus (HPV) testing, and personalized contact to reach women not attending conventional CC screening. To achieve this, 801 women aged 30-59 who had not participated in Portugal's Central Region CC screening programme for more than 4 years were selected based on specific criteria. Of these, 114 women were excluded for not meeting eligibility criteria, resulting in 687 eligible participants. Using an 'opt-in' approach, women who consented to participate received cervicovaginal self-sampling kits at home. Multiple contact strategies, including phone calls and reminder letters, were employed to encourage participation. Women testing positive for high-risk HPV (hr-HPV) were referred for gynaecological follow-up. Of the eligible women, 307 (44.7%) consented to participate and 198 (28.8%) provided valid samples for hr-HPV testing. Approximately 60.0% of participants were enrolled after the first reminder phone call, while additional contact strategies accounted for one-third of submitted samples. Among 12 hr-HPV positive cases, 11 completed gynaecological follow-up, resulting in the identification of six cervical lesions. This study confirms the feasibility and effectiveness of combining self-sampling, HPV testing, and personalized contact strategies to improve CC screening uptake among under-screened women. The findings highlight the potential of such interventions to address participation gaps and enhance early detection of cervical lesions, ultimately reducing CC incidence.