IARC 60th Anniversary - 19-21 May 2026
Session : 21/05/26 - Posters
Definition and piloting of strategies to increase participation to HPV-based screening among vulnerable populations in three countries (CBIG-SCREEN)
MOSQUERA METCALFE I. 1, RAMIREZ PINEDA A. 1, MENSAH K. 2, TISLER A. 3, UUSKÜLA A. 3, FIRMINO MACHADO J. 4,5, TEIXEIRA M. 5, FERNANDES A. 5, LUNET N. 5, NICOARA D. 6, GAVRILA I. 6, BURC? R. 6, T?UT D. 7, BABAN A. 7, GREENLEY R. 8, MCKEE M. 9, KIRKEGAARD P. 10, BASU P. 1
1 IARC, Lyon, France; 2 INSERM, Paris, France; 3 University of Tartu, Tartu, Estonia; 4 Universidade de Aveiro, Aveiro, Portugal; 5 Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal; 6 Oncologic din Cluj-Napoca (IOCN), Cluj, Romania; 7 Institutul Universitatea Babes Bolyai, Cluj, Romania; 8 Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; 9 Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom; 10 Randers at Aarhus University, Aarhus, Denmark
Background
Cervical cancer causes around 27,000 deaths annually in Europe, though it is largely preventable. This can be partly explained by low cervical cancer screening (CCS) rates among vulnerable women.
Objectives
The CBIG-SCREEN project aims to implement strategies to increase CCS participation among vulnerable populations in Estonia, Portugal, and Romania, and compare results with the standard of care. Targeted populations included women living with HIV (WLHIV) in Estonia, women living in socioeconomically deprived areas in Portugal, and socioeconomically disadvantaged women in Romania.
Methods
In Estonia, the routine CCS programme offers a choice of screening by provider-collected sample or opt-in self-sampling. In Portugal providers perform HPV-based screening. In Romania there is no organised CCS programme, and at the time of the study relied on facility and mobile unit-based approach. The standard of care (phase I) was compared with the results from the implementation of tailored strategies based on HPV self-sampling (phase II), planned to be offered to 700 women in each country.
Strategies for increasing CCS participation among vulnerable women were based on the triangulation of findings from: 1) a scoping review on CCS participation barriers and facilitators, 2) perspectives from micro, meso and macro level stakeholders obtained through collaborative user boards, and 3) structured capacity assessment of CCS services in the three intervention countries.
Results
Strategies tested in phase II were HPV-based self-sampling through a mailed opt out approach (Estonia and Portugal) or distributed at pharmacies (Romania), paired with 1-2 reminders (Estonia and Portugal), return of samples by post (all countries), at pharmacies (Romania) or at primary care centres (Portugal), study materials developed with community representatives (Estonia) and a helpline (Portugal). Romania also provided health facility-based provider collected HPV sampling. Estonia and Portugal nested a randomized trial in the study to assess the impact of adding a deadline to the opt-out approach.
In Estonia, it was found that the participation to screening among those invited to the organised screening programme and phase II increased as compared to phase I (42.4% vs 32.9%). Adding a deadline to the invitation to opt out HPV self-sampling had no impact on participation. Women reported the sampling device to be easy to use (91%).
In Portugal preliminary findings from phase II show a lower participation rate than in phase I (29.7% vs 55.7%) and a lower HPV positivity rate (5.9% vs 11.7%).
Phase II is still ongoing in Romania, but preliminary results show a higher HPV positivity than in phase I (12.8% vs 3.7%).
Conclusions
The opt out approach of mailed HPV self-sampling was effective in increasing participation in Estonia, but not in Portugal. Further analyses are required to understand the reasons behind this. The results will be useful to identify optimal approaches to increase participation and ensure care compliance for CCS in Europe.