While most American women still prefer to have their cervical cancer screenings performed in a clinical setting, new national data reveals a significant preference for at-home human papillomavirus (HPV) self-sampling among women who have experienced discrimination in healthcare. This finding raises important questions about trust, access, and equity in cervical cancer prevention strategies.
Declining Screening Rates and Rising Cervical Cancer Incidence
Cervical cancer screening programs have been remarkably successful in reducing the incidence and mortality of the disease over the past five decades. However, recent trends are concerning. Screening coverage in the United States has declined from 86.5% in 2000 to 75.8% in 2023. Concurrently, the incidence of cervical cancer has begun to increase, particularly among women aged 30 to 44, with an annual increase of 1.7% between 2012 and 2019.
Projections from the National Cancer Institute estimate nearly 13,500 new cases and 4,500 deaths in 2025. This burden disproportionately affects socioeconomically disadvantaged women and minorities who often face barriers to regular screening.
The Potential of At-Home HPV Testing
Cervical cancer is most often caused by persistent infection with high-risk types of human papillomavirus (HPV), a common sexually transmitted virus. While most HPV infections resolve on their own, some can lead to precancerous changes and, cancer. HPV testing is now recognized as a more sensitive method for detecting these precancerous lesions compared to traditional Pap cytology.
The U.S. Preventive Services Task Force (USPSTF) endorsed HPV testing using clinician-collected samples as a preferred screening strategy in 2018, and the American Cancer Society followed suit in 2020. Importantly, HPV tests can be accurately performed on samples that women collect themselves at home.
At-home self-sampling has the potential to overcome several barriers to screening, including feelings of embarrassment, distrust of the healthcare system, difficulties with scheduling appointments, transportation challenges, and geographical distance from medical facilities. Clinical trials have demonstrated the feasibility of mailing self-collection kits and have shown increased screening rates among women who are typically underscreened.
Despite these promising results, the USPSTF has not yet formally endorsed self-sampling in its official guidelines. However, a significant step forward occurred on , when the Food and Drug Administration (FDA) approved the first at-home self-sampling device for cervical cancer screening in the United States.
A New Study Reveals Key Preferences
A recent study published in JAMA Network Open sought to understand women’s preferences for at-home versus clinic-based cervical cancer screening. Researchers analyzed data from the 2024 Health Information National Trends Survey (HINTS 7), a nationally representative survey of U.S. Women aged 21 to 65. The survey, conducted between March and September 2024, included responses from 4,224 eligible participants.
The study focused on women eligible for cervical cancer screening according to USPSTF guidelines. Researchers considered a range of factors that might influence screening preferences, including sociodemographic characteristics, experiences of discrimination, access to healthcare, and trust in the healthcare system.
Key Findings: Discrimination and Preference for At-Home Testing
The study revealed that 20.4% of women preferred at-home self-sampling, while 60.8% preferred traditional clinic-based testing, and 18.8% were unsure. A particularly noteworthy finding was that women who reported experiencing discrimination in healthcare settings were nearly twice as likely to prefer at-home testing.
While descriptive analyses showed White respondents were more likely to prefer at-home testing, regression analysis revealed that Black women were less inclined to prefer at-home self-sampling compared to White women. Age, income, education, marital status, location, insurance coverage, and sexual orientation did not significantly influence preference after statistical adjustment.
Women with lower incomes, less trust in the healthcare system, and uncertain sexual orientation were more likely to be undecided about their screening preferences. Frequent healthcare visits were associated with greater confidence in screening choices. Common reasons cited for considering at-home HPV tests included privacy concerns, time constraints related to work schedules, a desire to avoid embarrassment, and the need to reduce transportation costs.
Implications for Future Screening Guidelines
These findings suggest that incorporating at-home self-sampling as an alternative option in national cervical cancer screening guidelines could help address persistent disparities in prevention. The study authors argue that offering a wider range of screening options may improve equity and access, particularly for women who have experienced discrimination or face other barriers to care.
Moving forward, policymakers should consider formally endorsing self-sampling as an acceptable screening method. Healthcare providers and public health organizations should also develop targeted educational campaigns to address the specific concerns and preferences of underscreened populations, ensuring that all women have access to the information and resources they need to make informed decisions about their health.
