Improving Accessibility of Cervical Cancer Screening: A Global Perspective on Self-Sampling and Digital Innovation

Cervical cancer causes 350,000 deaths annually, with 90% occurring in low and middle-income countries (LMICs), despite being largely preventable through vaccination and screening. This review examines innovative approaches to address screening coverage gaps worldwide, analysing both established programs in high-income countries and implementation strategies for LMICs. Self-sampling technologies demonstrate significant potential to increase screening participation by 1.5 to 2.5 times compared to traditional methods, particularly benefiting underserved populations across all healthcare settings. Vaginal brushes achieve the highest sensitivity (94.6%, 95% CI: 92.4-96.8) for HPV detection, while novel approaches like tampon sampling show promising acceptability and performance metrics. Implementation strategies vary by healthcare context, with high-income countries achieving success through integrated screening programs and digital solutions, while LMICs demonstrate effective adaptation through community-based distribution (20-35% uptake) and innovative delivery methods. In resource-limited settings, self-sampling increases participation through enhanced patient comfort and cultural acceptability, while reducing costs by 32-48%. Progress toward the WHO's cervical cancer elimination goals require careful consideration of local healthcare infrastructure, cultural contexts, and sustainable financing mechanisms. Future research priorities include optimising self-sampling technologies for sustainability and scalability, developing context-specific implementation strategies, and validating artificial intelligence applications to enhance screening efficiency across diverse healthcare settings.