Home-Based Self-Sampling in Cervical Cancer Screening: A National Analysis

Cervical cancer screening coverage in the United States has declined significantly over the past 2 decades, falling from 86.5% in 2000 to 75.8% in 2023.¹ This decline has contributed to a reversal in the long-term reduction of cervical cancer incidence, particularly among women aged 30 to 44. While the FDA approved the first at-home self-sampling device for cervical cancer screening in May 2025,² national guidelines have yet to formally incorporate this modality.

A comprehensive population-based study of 2300 screening-eligible women, published in JAMA Network Open, reveals a complex landscape of preferences:

• Clinic-based testing remains the majority preference (60.8%), largely due to established medical standards and potential lack of familiarity with new alternatives.
• Home-based self-sampling is preferred by 20.4% of respondents, driven by needs for privacy (54.9%) and the elimination of time and embarrassment barriers.
• Uncertainty is high (18.8%), particularly among low-income individuals and those with low trust in the healthcare system.

The study indicates that at-home self-sampling is a critical tool for reaching marginalized and underscreened populations. Specifically, individuals who have experienced prejudice or discrimination in medical settings are nearly twice as likely to prefer at-home sampling. To address cervical cancer inequities, the findings suggest that at-home self-sampling must be incorporated into national guidelines and supported by tailored educational interventions to build self-confidence in the method among high-risk groups.

Current Landscape of Cervical Cancer Screening

Despite the efficacy of cytology and human papillomavirus (HPV) testing, cervical cancer continues to cause approximately 4500 deaths annually in the US.

• Diagnostic accuracy: HPV tests are more sensitive and specific than cytology in detecting precancerous lesions.
• Self-collection feasibility: Unlike cytology, HPV testing can be performed on self-collected vaginal specimens without a loss of diagnostic accuracy.
• Regulatory milestone: On May 9, 2025, the FDA approved the first at-home self-sampling device, representing a major step toward increasing access for high-risk populations.

Analysis of Patient Preferences

The study categorized women’s perspectives on screening modalities into 3 distinct groups: those preferring clinic-based testing, those preferring at-home self-sampling, and those who remain uncertain.

Among women who preferred at-home sampling or were uncertain, the following reasons were cited for considering the alternative:

• Privacy: 54.9%
• Time constraints: 35.1% (e.g., preferring not to take time off work)
• Avoiding embarrassment: 33.4%
• Transportation costs: 26.5%
• Proximity: Living far from a healthcare provider.

The adoption of at-home self-sampling is heavily influenced by individual experiences with the healthcare system and sociodemographic background. Women who reported experiencing prejudice or discrimination while receiving medical care had significantly higher odds (adjusted odds ratio, 1.94) of preferring at-home self-sampling over clinic-based testing. Individuals with "a little" or "no trust at all" in the healthcare system were 1.80 times more likely to be uncertain about their choice, suggesting a hesitancy to engage with standard medical protocols.

Conclusions and Recommendations

The study concludes that at-home self-sampling is a "people-centered" approach that can reduce the burden on strained healthcare systems and address deep-seated barriers like mistrust and discrimination. To reverse declining screening trends, the following actions are suggested by the authors:

• Policy integration: Incorporate home-based self-sampling into national screening guidelines as a recommended alternative to clinic-based testing.
• Targeted education: Develop culturally adapted interventions to educate women on the safety and effectiveness of self-sampling. These should specifically target high-risk groups, such as non-Hispanic Black and low-income women, to build self-confidence in the method.
• Empowerment and awareness: Enhance women’s education and empowerment to ensure they are aware of all available options for cervical cancer screening.
• Addressing inequities: Prioritize the mailing of self-sampling kits to underscreened and hard-to-reach populations, a strategy already proven to increase participation in pilot trials.

“Since women who reported preference for at-home self-sampling were more likely to be overdue for cervical cancer screening, offering this alternative screening option to the general population could help close the screening gap in women who are hesitant to receive conventional (clinic-based) cervical cancer screening due to the various access barriers to health care services, thereby reducing disparities in cervical cancer screening uptake in the US,” said Domgue et al, authors of the study.

REFERENCES

1.Domgue J, Chandra M, Oladoyin O, et al. Women’s preferences for home-based self-sampling or clinic-based testing for cervical cancer screening. JAMA Netw Open. Published February 6, 2026. Accessed February 17, 2026. 2026;9;(2):e2558841.doi:10.1001/jamanetworkopen.2025.58841

2.FDA approves at-home self-collection device for cervical cancer screening. News release. The ASCO Post. Published May 12, 2025. Accessed February 17, 2026. https://tinyurl.com/44bn6vfk