TOPLINE:

One fifth of women prefer home-based self-sampling for cervical cancer screening, with marginalized populations and those experiencing healthcare discrimination showing higher preference for this option. Privacy concerns, time constraints, and fear of embarrassment are primary drivers for considering home-based screening.

METHODOLOGY:

• Screening coverage in the US has declined from 86.5% in 2000 to 75.8% in 2023, leading to a reversal in cervical cancer incidence reduction. The FDA approved the first at-home self-sampling device for cervical cancer screening last year.
• Researchers conducted a population-based cross-sectional analysis of 2300 women aged 21-65 years (mean age, 45.5 years) who meet the US Preventive Services Task Force eligibility guidelines for cervical cancer screening.
• Data were collected from the 2024 Health Interview National Trends Survey, a nationally representative survey of civilian, noninstitutionalized US adults, conducted between March and September 2024.
• Researchers examined factors including age, race, income, education, sexual orientation, marital status, health insurance, urbanicity, trust in healthcare, past-year practitioner visits, and discrimination experiences.
• Primary outcome measured preference for at-home vaginal self-sampling vs clinic-based testing, with responses categorized as preference for either method or uncertainty about choice.

TAKEAWAY:

• Among participants, 20.4% (95% CI, 17.4%-23.4%) preferred at-home self-sampling, 60.8% (95% CI, 57.2%-64.4%) preferred clinic-based testing, and 18.8% (95% CI, 15.5%-22.1%) were uncertain about their choice.
• Non-Hispanic Black respondents showed lower odds of preferring at-home self-sampling than non-Hispanic White individuals (odds ratio [OR], 0.45; 95% CI, 0.21-0.96; P = .04).
• Women who experienced prejudice or discrimination when getting medical care had higher odds of preferring at-home self-sampling (OR, 1.94; 95% CI, 1.16-3.22; P = .01).
• The most commonly reported reasons for considering at-home self-sampling were privacy (54.9%; 95% CI, 49.8%-60.0%), time constraints (35.1%; 95% CI, 29.0%-41.2%), and fear of embarrassment (33.4%; 95% CI, 28.0%-38.8%).

IN PRACTICE:

“To address cervical cancer inequities and increase screening uptake, the findings suggest US guidelines should incorporate home-based self-sampling as an alternative to clinic-based testing, women’s education and empowerment should be enhanced, and tailored interventions focusing on high-risk groups are needed to increase awareness and self-confidence in performing home-based self-sampling,” the authors of the study wrote.

SOURCE:

The study was led by Joél Fokom Domgue, MD, MPH, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center in Houston. It was published online on February 6 in JAMA Network Open.

LIMITATIONS:

The cross-sectional design of the survey prevented establishing causal relationships between women’s preferences and associated factors. Many respondents were likely unfamiliar with home-based self-sampling as it was not endorsed by US screening guidelines at the time of the survey. The study population showed potential underrepresentation of gender minority individuals, uninsured individuals, and rural dwellers, as most participants were health-insured (91.9%), heterosexual (87.2%), and residing in urban areas (85.6%). Additionally, data on prior screening history and experiences were not collected, limiting the ability to account for this potential confounder in the analysis.

DISCLOSURES:

The study was funded by grant P30CA016672 from the National Cancer Institute, the Betty B. Marcus Chair in Cancer Prevention, and the Duncan Family Institute for Cancer Prevention and Risk Assessment. The funders had no role in the design, conduct, analysis, interpretation, manuscript preparation, or publication decisions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.