Breaking barriers, building bridges: How collaboration and innovation can overcome barriers to cervical cancer screening

It’s astonishing that cervical cancer is so deadly because we know so much about it. Almost all cases of cervical cancer are caused by the human papillomavirus (HPV), a common virus. Cervical cancer progresses slowly, offering ample opportunity for prevention through early detection and screening. Yet millions of people miss out on screening tests and follow-up care that could save their lives. Even in the United States, 20% to 50% of women diagnosed with cervical cancer were not screened during the five years before their diagnosis.2

Why is this happening? The reasons are complex, from poor access, knowledge gaps and fear among patients to staff shortages and limited resources for healthcare professionals.3 This web of obstacles stands in the way of the World Health Organization’s ambitious goal to eliminatecervical cancer by 2030.4

Yet there’s hope on the horizon. Recent innovations and collaborations show new ways to overcome barriers, such as embarrassment, anxiety and access.

A web of obstacles

Barriers to cervical cancer screening create a complex and often interconnected web of obstacles that can prevent patients from accessing preventive care.4

Barrier 1: Embarrassment and shame

Bridge: Collaboration, technology and self-collection

It goes without saying that most women don’t eagerly anticipate pelvic exams. Who feels at ease lying naked on an examining table, feet in stirrups, speculum inserted? It’s a vulnerable place to be, and it’s one of the reasons many women delay cervical screenings.5 

For some, trauma, gender dysphoria6 or religious beliefs further heighten discomfort. In Malaysia, where modesty is a significant cultural consideration to the majority Muslim population, cervical screening uptake was as low as 12.8%.7 Program ROSE(Removing Obstacles to Cervical ScrEening) directly addressed this by offering women the opportunity to self-collect their own vaginal sample for a high-precision HPV test followed by quick delivery of results and follow-up via mobile phone.8

The 2018 pilot screened 4,188 women, achieving 89% follow-up for those who tested positive. Program ROSE tripled daily screening and was widely accepted by patients and healthcare professionals alike, with more than 95% of women saying they would recommend self-sampling. It’s important to note that 35% of the women in the Project ROSE pilot had never had a Pap Smear before.8

Barrier 2: Fear and anxiety

Bridge: Knowledge, education and more frequent screenings

Fear is also a significant deterrent to screening: fear of the procedure, pain, judgment or the diagnosis itself.

A study in Shenzhen, China, found that nearly three quarters of participants suffered from pre-procedural anxiety.9 However, women who had been screened three times or more felt less anxious about their screenings, suggesting that familiarity and knowledge reduce fear. (See Figure 2.) The interval and results of past screenings influenced anxiety as well. For example, women who didn’t know their past screening results felt less confident and more worried about engaging in a new round of screening.

Knowledge gaps about HPV are common, and educating patients about the screening process and results can significantly ease anxiety. Explaining what will happen and answering questions ahead of the procedure, coupled with more regular screening, could help demystify the screening process and help patients feel more at ease.

Barrier 3: Access to care

Bridge: Bringing care to the patients

Connecting patients with care is a fundamental challenge, whether for uninsured women in the United States, immigrants in Europe10 or women in rural Africa.8

In the Rio Grande Valley of Texas, a region with high poverty and high cervical cancer rates, mobile clinics have proven transformative. These fully-equipped clinics traveled to communities, offering education, HPV vaccination, screening and colposcopy services for women who hadn’t had a Pap smear in more than three years.8

A study showed that the mobile clinic program increased the proportion of women with cervical dysplasia who underwent Loop Electrosurgical Excision Procedure (LEEP) within 90 days of colposcopy, significantly accelerating treatment. This highlights the power of innovative outreach to overcome geographical and logistical hurdles.11

Barrier 4: Embarrassment, access and fear

Bridge: Self-collection

To improve cervical cancer outcomes, it’s crucial that we recognize the range of barriers that impede early detection and screening efforts. It’s equally important that we stay up-to-date on new ideas and technologies that could overcome those barriers — and consider them for our own communities and practice.

Self collection has the potential to overcome multiple barriers simultaneously — embarrassment, fear and access. A 2024 survey conducted in 12 countries found that more than 70% of women have an interest in using a self-collection vaginal swab test at the doctor’s office.5

While recently approved for use in U.S. healthcare settings, countries like Australia, Canada and several in Europe are already exploring home-based screening options. In England, a recent trial showed that home test kits, including self-collection for HPV screening, could increase screening rates to 77% over three years.12

Wherever screening happens, healthcare providers remain central to the process. Self-collection is not a replacement for clinical expertise; it’s just a way to meet women where they are, using the same highly sensitive Roche technology as a clinician-collected sample. When a patient tests positive for HPV via self-collection, the OB/GYN still guides the crucial follow-up care, including colposcopy, biopsy and treatment, maintaining their indispensable role in the patient’s journey.

Ultimately, self-collection is a value-add, not a takeaway, for both clinicians and patients. It expands access, empowers individuals and allows OB/GYNs to focus their expertise on guiding complex care pathways, all contributing to our collective goal of eliminating cervical cancer worldwide. Continued efforts to educate women about cervical cancer screening, in combination with providing different options that meet them where they are and what they are comfortable with, will help overcome barriers and improve access to screening.

If you’d like to learn more about HPV self-collection and how it could help you reach more patients, tap into these resources. For inspiration, watch this documentary about conquering cervical cancer in the USA.