A new model for cervical cancer screening in Cambodian garment workers

Cervical cancer remains a major health concern in low-resource settings, with Cambodian women experiencing some of the highest rates due to limited screening access. 15% of all Cambodian women work in the garment industry; very few of which have ever been screened for cervical cancer. Achieving the WHO's 90-70-90 cervical cancer elimination target will require new service-delivery models capable of reaching large numbers of women in high-risk or underserved populations.

A cross-sectional feasibility study was conducted, screening 2690 female garment workers aged 25-49 across nine factories in Cambodia. Mobile clinics were set up in factories to facilitate the screening and treatment process. Participants self-collected swabs for human papillomavirus (HPV) testing and results were communicated directly to participants via text message. Women with positive results were scheduled for digital colposcopy and concurrent treatment with thermal ablation or large loop excision of the transformation zone.

Of the 2690 workers screened, 341 (12.7%) tested positive for HPV, of whom 314 (92%) underwent colposcopy and 311 had biopsies. Only seven of the 2690 self-swab specimens were found to be inadequate (ie, insufficient DNA) for testing (0.26%). There were 17 cases of CIN2+ lesions (cervical intraepithelial neoplasia), including one adenocarcinoma.

This study demonstrates that implementing HPV-based cervical cancer screening with mobile clinics in garment factories is feasible and highly accepted among workers. Such programmes not only enhance early detection and treatment of cervical lesions but also improve workforce stability and could serve as a model for other industrial sectors in low-resource settings. This screening model, which facilitates large numbers of women to be efficiently screened with self-swab HPV testing, may help Cambodia progress toward achieving the WHO's 70% screening target. Integration of workplace-based models with national referral systems for more advanced treatment (when necessary) may reduce loss-to-follow-up and strengthen continuity of care.