Addressing Cervical Cancer Screening Through Self-Sampling and HPV Testing Among Under-Screened Women: A Case Study in the Decentralized Portuguese Setting

Abstract

Background: Cervical cancer (CC) screening is crucial for reducing its incidence. However, encouraging participation among under-screened women remains challenging. Portugal's decentralized health regions provide an ideal case study due to a significant proportion of eligible women avoiding regular screening. Globally, self-sampling has emerged as a promising solution to enhance screening attendance. This study aims to assess self-sampling acceptance among under-screened women in central Portugal, contributing to the existing knowledge of self-sampling in CC screening. Methods: 801 women aged 30-59, not participating in the Central Region's CC Screening for 4 or more years, were randomly recruited. Women who accepted to participate in the study received cervicovaginal self-sampling kits at home. Women with a positive high-risk human papillomavirus (hr-HPV) test result were invited for gynaecological follow-up. Results: Among the 687 eligible women, 307 (44.7%) accepted, and 198 (28.8%) provided specimens for hr-HPV testing. Out of twelve positive cases, eleven underwent gynaecological follow-up, identifying six cervical lesions. Conclusions: The study highlights the potential of self-sampling and HPV testing to enhance CC screening in Portugal, with encouraging acceptance and effective detection of cervical lesions. These findings offer a promising solution for addressing under-screening among eligible women in the decentralized health regions of Portugal.