Self-collection enables rapid and more equitable screening of cervical cancer

In settings with established cervical screening programmes, most cervical cancer cases occur among women who do not attend screening (1). Many programmes take years to implement fully and often reach underserved populations only slowly (2). If HPV-based screening is difficult to roll out, cervical cancer elimination may be delayed for decades. Self-collection enables rapid and more equitable implementation of HPV screening (3,4), thereby accelerating progress toward cervical cancer elimination. Australia aims to achieve elimination between 2028 and 2035, and widespread adoption of self-collection may allow this goal to be reached earlier.

Evidence from systematic reviews shows that self-collected and clinician-collected samples detect high-grade cervical precursors at comparable rates (3). Protection against invasive cancer is also similar between the two methods (5). A retrospective cohort study using data from Australia’s National Cancer Screening Register demonstrated that offering self-collection to all eligible women improves outreach, equity, acceptability, and convenience (4). These findings indicate that self-collection not only supports faster elimination but also enhances population coverage and equity.

Self-collection is also cost-effective. A European survey estimated that clinician-based sampling fees in the UK (£92 million annually) were 2·5 times higher than laboratory analysis costs (6). Eliminating clinician sampling fees could therefore yield substantial savings. Targeted distribution of self-collection kits to under-screened women is efficient, as this approach detects high rates of precancerous lesions and invasive cancers (4,7). Predictive values for invasive cancer among HPV-positive under-screened women using self-collection have reached up to 12% (7).

More than 1000 studies have evaluated the self-collection strategy for HPV screening. It was also included in WHO’s 2020 global cervical cancer elimination strategy. As such, concerns about insufficient real-world evidence are no longer justified. An increasing number of countries are now integrating self-collection into routine screening. Importantly, offering self-collection to all women resulted in higher participation among under-screened groups than restricting it to those overdue, highlighting that limited targeting is insufficient to achieve optimal equity and coverage.

Among self-collection delivery models, dispense-and-collect strategies are the most effective, achieving near-complete kit return rates (3). Attendance appears similar regardless of whether kits are provided by community workers or clinicians, although costs may differ. Mail-to-all approaches also increase participation compared with clinic-based invitations (3), though uptake remains lower than dispense-and-collect models. Together, these data indicate that HPV self-collection is a key strategy for faster, more equitable, and more cost-effective elimination of cervical cancer.

Ref:

1. Int J Cancer. 2020; 146:1230-1240
2. Int J Cancer. 2018; 142:44-56
3. Br J Cancer. 2023; 128:805-813
4. Lancet Public Health. 2026; 11:e101-e110
5. J Natl Cancer Inst. 2025;
6. Eur J Cancer. 2015; 51:950-968
7. Int J Cancer. 2025;