Willingness for cervical cancer screening among socially vulnerable and underserved women in Portugal: a cross-sectional study

Background Cervical cancer screening (CCS) programs are crucial for the early detection and timely treatment of cervical cancer (CC), thus reducing disease mortality and morbidity. However, Europe is still experiencing disparities in screening coverage, particularly among the most vulnerable and underserved populations, who generally face difficulties in accessing healthcare services. In Portugal, several women remain at heightened risk of CC due to lower screening participation. This study aimed to assess the willingness of socially vulnerable women to participate in CCS and determine the associated factors. Methods: A community-based cross-sectional study was conducted in the Lisbon Metropolitan Area. Participants aged 30–65 years were identified through organizations serving vulnerable populations. Data were collected via a self-administered questionnaire covering sociodemographic characteristics, awareness and knowledge of CC, history of screening and willingness to participate in the CCS. Poisson regression with robust variance was used to assess factors associated with screening willingness. Results: A total of 246 women were included in the study. Of these, 218 (90.1%) reported being willing to be screened, but 35.8% (n = 88) had never received CCS. A lower age at first sexual intercourse (aPR = 1.076, 95% CI = [1.017; 1.138]), greater number of pregnancies (aPR = 1.048, 95% CI = [1.009; 1.089]) and perception that the CCS is advantageous (aPR = 1.303, 95% CI = [1.126; 1.508]) were factors significantly associated with willingness to undergo a Pap smear test. Conclusions: These findings suggest that the willingness for cervical cancer screening among socially vulnerable and underserved women may be linked to factors such as earlier sexual debut and a greater number of pregnancies, which might reflect increased contact with healthcare services. This highlights the need for alternative strategies to improve healthcare access and utilization, as well as targeted outreach efforts to raise awareness about cervical cancer and screening in this population.