María Besó Delgado

Optimisation of a Cervical Cancer Screening Model Based on Self-Sampling for Human Papillomavirus Testing

Introduction Cervical cancer remains a significant cause of morbidity and mortality among women globally, despite the availability of effective prevention tools. The use of self-sampling devices for human papillomavirus (HPV) testing is a promising strategy to increase screening participation, particularly in settings dominated by opportunistic models. Understanding women’s preferences regarding invitation methods and device design is essential to ensure effective and equitable programme implementation. This study explored the expectations, preferences, and perceived barriers of women aged 35 to 65 in the Valencian Community (VC), Spain, in anticipation of launching a population-based cervical screening program. Methods A qualitative study was conducted using four face-to-face focus groups involving 29 women, selected from the target population of the screening programme (healthy women aged 35-65 residing in the VC). The session combined an individual assessment (questionnaire and electronic response system of five self-sampling devices) with a structured group discussion. Preferences regarding invitation channels, test communication, and device usability were analyzed through descriptive statistics and thematic content analysis. Results Self-sampling was highly accepted, with 96.4% of women stating they would perform it at home. Preferred channels for both invitations and results were SMS and local health centers. Simplicity and ease of use were the key features of the device accepted by the largest number of women—FLOQSwab. Evalyn Brush was also positively valued for its attractive design and was the preferred option for some women. Participants expressed concerns about reliability and proper use, particularly among older women or those with limited body awareness. Familiarity with colorectal screening supported acceptance. Importantly, device selection emerged as a key factor in facilitating participation. The integration of digital technologies (SMS, health apps) was positively valued as a means of increasing accessibility, improving communication, and supporting equity in outreach efforts. Conclusion Self-sampling is a feasible and widely accepted strategy for cervical cancer screening. Effective implementation requires validated devices, culturally adapted information campaigns, and digital engagement tools to maximize participation and reduce inequalities.

Implantación del cribado poblacional de cáncer de cérvix con autotoma. Estudio piloto en la Comunidad Valenciana

To evaluate the processes and outcomes of a pilot study designed for the implementation of the Population-Based Cervical Cancer Prevention Program in the Valencian Community, based on human papillomavirus (HPV) detection through self-sampling, conducted between November 2022 and June 2023. A pilot study was conducted, inviting 4293 women aged 35-65 years through direct mailing of self-sampling kits (FlowSWAB®, Copan). To encourage participation, reminder SMS messages were sent, including a survey on reasons for non-participation. Women with incorrect addresses were contacted by phone. Exclusion criteria identified through the survey or follow-up led to the exclusion of some participants, resulting in a final sample of 4170 women. A descriptive and rate-based analysis was conducted on participation and pathology, assessing process and outcome indicators. The overall prevalence of HPV was 7.01% (2.0% for genotype 16 and 5.17% for other genotypes). Colposcopies detected 9 cases of CIN1 (0.42%), 3 cases of CIN2+(0.16%), and 2 adenocarcinomas (0.11%). The highest proportion of detected pathology was associated with genotype 16. Participation was 45.49%, lower among younger age groups, foreign-born individuals, employed women, those with chronic diseases, those without a residential unit, and those with lower income levels, with statistically significant differences observed. SMS reminders increased participation by 10.84% after the first SMS, with a greater effect among women aged 55-65 years. The most common reason for non-participation was lack of information (13.3%). Contacting a healthcare professional significantly improved participation among women with incorrect addresses (71.42% participation rate). The study results confirm the proper functioning of screening procedures, supporting the feasibility of the pilot model, although participation was lower than expected. Key deficiencies were identified, including challenges in reaching the eligible population, inefficient processes, and data management complexities. Implementing an interoperable information system could optimize these aspects. To improve participation, raising awareness of the program and screening techniques is crucial. Strategies such as reminder SMS messages and direct contact with healthcare professionals have proven effective.