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2022-RA-1116-ESGO Barriers in the cervical cancer screening program and how self-sampling for HPV-testing is experienced as a solution to them
  1. Eva Maria Payrich,
  2. Anna Sophie Skof,
  3. Maja Struck,
  4. Sarah Thies,
  5. Carola Schreckenberger,
  6. Jalid Sehouli and
  7. Andreas Martin Kaufmann
  1. Klinik für Gynäkologie, Charité – Universitätsmedizin Berlin – corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany


Introduction/Background In 2019, 47.7% of all eligible women in Germany participated in cervical cancer screening. Since 2020 screening includes HPV/cytology co-testing from age 35 onwards. Self-sampling for HPV detection could reduce screening barriers and increase participation.

Methodology This mixed-methods sub-study of the FACTS-project aimed to focus on experiences of affected women on screening barriers and the potential use of self-sampling in Germany. All women included in the FACTS project (n=696) were asked to perform self-sampling (Evalyn-Brush) in addition to a physician-taken specimen and to fill a questionnaire (n=613). Additionally, 25 semi-structured interviews with different groups of participants were performed.

Results 536 women (87.4%) with median age 40 (20–79) had participated in the screening program several times. Most of the interviewed women (n=14) reported that they often do not know what happens at screening or which tests are done. In addition, they experienced structural barriers (i.e. long waiting times, appointment difficulties). 16.3% of all women over 35 years stated they had not yet had an HPV test or could not remember having one. The performance of self-sampling and self-sampling in comparison to a physician-taken smear was described as good or very good by 88.6% and 83.1%, respectively. Importantly, all women interviewed indicated that they would not generally prefer self-sampling to a visit at the gynaecologist. However, self-sampling could provide additional security and a way of not having to extend screening intervals due to time constraints.

Conclusion Cervical cancer screening is associated with many barriers. Not knowing which tests will be done and a lack of comprehensible explanations is most likely to lead to uncertainty and seems avoidable. Self-sampling as an option in addition to office-based screening is well accepted among German women and can reduce structural barriers. However, women would not want to replace a visit to the gynaecologist by self-sampling.

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