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.