Self-Sampling as a Plausible Alternative to Screen Cervical Cancer Precursor Lesions in a Population with Low Adherence to Screening: A Systematic Review

Acta Cytol. 2020;64(4):332-343. doi: 10.1159/000505121. Epub 2020 Jan 20.


Background: Cervical cancer is the fourth most common cancer in the world. A raised incidence and mortality parallel a low participation rate in screening, namely screening in poor countries and among specific populations of developed countries. Cervical or vaginal self-sampling may increase adherence to screening due to its low costs and elevated sensibility and specificity. Our main goal was to compare self-sampling with physician sampling and to evaluate the participation rate of women formerly non-adherent to cervical cancer screening.

Study design: We identified relevant studies from PubMed. Studies were eligible for inclusion if they fulfilled the following criteria: women aged between 16 and 80 years, poor and developed countries that use self-sampling, women with a low participation rate in screening and studies published since 2013. After fully reading the articles, data were extracted to an Excel sheet to -display all relevant information in an organized manner. -Results: We identified 18 studies, which altogether enrolled 22,118 women. Self-sampling and physician sampling are quite similar regarding the HPV detection rate. Women have a low participation rate mainly because of limited access to health services, religious and culture beliefs, and lack of time due to several demanding tasks in daily life. Self-sampling shows a significant increase in acceptability and preference compared to physician sampling.

Conclusion: Self-sampling is a reliable method to involve women in opportunistic or organized screening programs for cervical cancer prevention.

Keywords: Cervical cancer screening; HPV; Screening adherence; Self-sampling.

Publication types

  • Systematic Review

MeSH terms

  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Mass Screening / methods*
  • Papillomavirus Infections / diagnostic imaging
  • Papillomavirus Infections / pathology
  • Self Care / methods*
  • Specimen Handling / methods
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears / methods