[Emerging role of primary care health visitors in population-based cervical screening]

Introduction: Cervical screening policy update with primary human papillomavirus detection should cover women who rarely visit gynecologists. Education of registered health visitors in Hungary has incorporated cervical sampling since 2015. Objective: Analysis of data from a geographically representative high-risk human papillomavirus prevalence survey to explore target population characteristics and results of samples collected by health visitors (n = 905) compared to gynecologists (n = 3826). Method: Cervical sampling with Rovers Cervex-Brush Combi device into ThinPrep containers followed by an anonymous questionnaire of demographic and anamnestic data by randomly appointed competent 40 health visitors and 169 gynecologists all over Hungary. Laboratory detection of high-risk human papillomavirus genotypes with Neumann Confidence and Roche Linear Array clinically validated tests. Results: Women enrolled by health visitors were significantly less educated, older, and last screened a longer time ago on average than those who visited gynecologists. Age distribution of women screened by health visitors matched more proportionally the target population above 55 years. Rate of invalid samples was similar by health visitors and gynecologists. Patients of gynecologists showed higher virus prevalence despite higher human papillomavirus vaccination rate. Discussion: Lower age-standardized virus prevalence in rural samples was potentially mediated by the health professional who performed the screening because a patient with pathological anamnesis may prefer going to gynecologists rather than waiting for health visitor contact. Conclusion: Calculating with the onset and beneficial coverage of school vaccination program and the age distribution of cervical, vulvar and vaginal cancer incidence, screening keeps its importance for another 20–30 years minimum. Inclusion of risk target group of women with lower education, rural residence, 50+ years of age in the screening was more effective through health visitors than through gynecologists. Health visitors are comparable in sampling competence and have a practice in actively approaching and involving women, playing a unique part in achieving prevention objectives. Orv Hetil. 2025; 166(7): 263–271.