While most women still choose clinic-based screening, new national data reveal that those who experience discrimination in healthcare are far more likely to favor at-home HPV self-sampling. This raises urgent questions about how US screening guidelines can better address trust, access, and equity.
Study: Women’s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. Image credit: Anastasiya Tsiasemnikava/Shutterstock.com
A recent study in JAMA Network Open investigated women’s preference for home-based or clinic-based approaches for cervical cancer screening. The research revealed that although most women still prefer clinic-based screening, women who reported discrimination in healthcare and those facing certain access barriers showed greater interest in at-home cervical cancer screening, an observation that could inform ongoing discussions about future updates to US screening guidelines.
Declining Screening Rates Fuel Rise in Cervical Cancer
In the last five decades, organized cervical cancer screening programs have significantly led to declines in cases and deaths across high-income countries. Despite this success, a recent study has recorded a decline in screening coverage in the US from 86.5 % in 2000 to 75.8 % in 2023. Furthermore, cervical cancer incidence has started to increase, particularly among women aged 30 to 44, whose rates increased 1.7 % annually between 2012 and 2019.
The US National Cancer Institute projected nearly 13,500 new cases and 4,500 deaths in 2025. It must be noted that the burden falls disproportionately on socioeconomically disadvantaged women and minorities who lack access to regular screening.
The Promise of At-Home HPV Testing
Human papillomavirus (HPV) is a highly contagious virus transmitted through skin-to-skin contact. Even though most infections are harmless and may clear up within two years, some cause genital warts or may lead to cervical cancer.
HPV testing is more sensitive than traditional cytology in detecting precancerous lesions, a finding supported by prior clinical studies rather than evaluated directly in this survey. Given this effectiveness, the US Preventive Services Task Force in 2018 and the American Cancer Society in 2020 endorsed HPV testing of clinician-collected samples as a preferred screening strategy. Interestingly, HPV tests can be accurately performed on samples that women collect themselves at home.
At-home self-sampling could help overcome many barriers that keep women from getting screened, including embarrassment, distrust of the healthcare system, scheduling difficulties, transportation challenges, and distance from medical facilities.
Clinical trials have shown that mailing self-collection kits to women is feasible and can increase screening rates among underscreened women. Yet the US Preventive Services Task Force (USPSTF) has not endorsed self-sampling in its official guidelines. On May 9, 2025, the FDA approved the first at-home self-sampling device for cervical cancer screening in the US. This approach is considered a major step toward incorporating home-based tests into national guidelines and improving access for high-risk populations.
Despite the clinical validity and cost-effectiveness of at-home self-sampling, its adoption depends on women's preferences. A few US studies have examined preferences for self-sampling among specific groups, with low-income and underscreened women preferring home-based testing. But these studies had several limitations, including focusing on women who did not follow screening guidelines, evaluating perceptions in controlled settings, and not using nationally representative samples.
Assessing Women’s Perspectives on At-Home HPV Testing
The current cross-sectional study used nationally representative US-based data from the 2024 Health Information National Trends Survey (HINTS 7) to examine who prefers at-home cervical cancer screening and why. The survey was offered in English and Spanish between March and September 2024, with a response rate of 27.3 %.
The study included women who were eligible for cervical cancer screening per USPSTF guidelines and responded to the screening preferences question, excluding respondents who selected “not applicable,” which likely included individuals without a cervix. The socioecological model guided the researchers’ variable selection, integrating factors at individual, interpersonal, organizational, community, and policy levels that influence screening decisions. These included sociodemographic characteristics, experiences of discrimination, number of follow-up visits needed, place of residence, and trust in the healthcare system.
The primary outcome was preference for at-home self-sampling over clinician-collected sampling. Sociodemographic variables were considered along with information on healthcare-related factors, including trust in the healthcare system, the number of medical visits in the past year, and experience with discrimination.
Factors Influencing Cervical Screening Preference
Of the 7,278 participants in HINTS 7, 4,224 individuals aged 21 to 65 were included. A total of 2,300 women met all eligibility criteria, with a mean age of 45.5 years. The sample was racially diverse with 62.2 % White, 11.1 % Black, 4.3 % Asian, 18.0 % Hispanic, and 4.4 % other non-Hispanic race.
The majority of participants in the study cohort were heterosexual, married or partnered, had household incomes above $50,000, had at least some college education, lived in urban areas, and had health insurance. Most participants reported multiple healthcare visits in the past year, trust in the healthcare system, and no experience of discrimination in medical settings.
Overall, 20.4 % of women preferred at-home self-sampling, 60.8 % preferred traditional clinic-based testing, and 18.8 % were unsure. Notably, preference for at-home testing was higher among White respondents in descriptive analyses, rural dwellers in unadjusted comparisons, those with less trust in healthcare, and those who had experienced discrimination in medical settings.
Regression analysis revealed that Black women were less inclined than White women to prefer at-home self-sampling. However, women who had experienced discrimination in healthcare were nearly twice as likely to prefer at-home testing. Age, income, education, marital status, location, insurance, and sexual orientation were not associated with this preference after statistical adjustment.
Women with lower incomes, less trust in healthcare, and uncertain sexual orientation remained more undecided about screening preferences, although lower trust was not significantly associated with preferring at-home testing after adjustment. In contrast, those with frequent healthcare visits showed greater confidence in their screening preferences. The most commonly cited reasons for considering at-home HPV tests among women who preferred at-home testing or were unsure were privacy concerns, time constraints related to work schedules, desire to avoid embarrassment associated with clinical examinations, and the need to reduce transportation costs to healthcare facilities.
Equity concerns shape future screening policy debates
A national survey reveals that one in five women favor at-home self-sampling, while a majority continue to prefer clinic-based testing. Women who reported discrimination in healthcare showed stronger interest in this option. These findings suggest that incorporating at-home self-sampling as an alternative option in national screening guidelines could help close persistent gaps in cervical cancer prevention, though the study itself assessed preferences rather than clinical outcomes or screening uptake.
In the future, policymakers should formally endorse self-sampling as an alternative screening method in national guidelines, as the study authors argue this approach may improve equity and access. In addition, healthcare providers and public health organizations must develop targeted education campaigns that address the specific concerns and preferences of underscreened populations.
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