[Implementation of population-based self-sampling cervical cancer screening. Pilot study in the Valencian Community]

To evaluate the processes and outcomes of a pilot study designed for the implementation of the Population-Based Cervical Cancer Prevention Program in the Valencian Community, based on human papillomavirus (HPV) detection through self-sampling, conducted between November 2022 and June 2023.

A pilot study was conducted, inviting 4293 women aged 35-65 years through direct mailing of self-sampling kits (FlowSWAB®, Copan). To encourage participation, reminder SMS messages were sent, including a survey on reasons for non-participation. Women with incorrect addresses were contacted by phone. Exclusion criteria identified through the survey or follow-up led to the exclusion of some participants, resulting in a final sample of 4170 women. A descriptive and rate-based analysis was conducted on participation and pathology, assessing process and outcome indicators.

The overall prevalence of HPV was 7.01% (2.0% for genotype 16 and 5.17% for other genotypes). Colposcopies detected 9 cases of CIN1 (0.42%), 3 cases of CIN2+(0.16%), and 2 adenocarcinomas (0.11%). The highest proportion of detected pathology was associated with genotype 16. Participation was 45.49%, lower among younger age groups, foreign-born individuals, employed women, those with chronic diseases, those without a residential unit, and those with lower income levels, with statistically significant differences observed. SMS reminders increased participation by 10.84% after the first SMS, with a greater effect among women aged 55-65 years. The most common reason for non-participation was lack of information (13.3%). Contacting a healthcare professional significantly improved participation among women with incorrect addresses (71.42% participation rate).

The study results confirm the proper functioning of screening procedures, supporting the feasibility of the pilot model, although participation was lower than expected. Key deficiencies were identified, including challenges in reaching the eligible population, inefficient processes, and data management complexities. Implementing an interoperable information system could optimize these aspects. To improve participation, raising awareness of the program and screening techniques is crucial. Strategies such as reminder SMS messages and direct contact with healthcare professionals have proven effective.