Barriers to Cervical Cancer Screening Uptake Among Women in Low-Resource Settings

Abstract

Cervical cancer remains disproportionately fatal in low-resource settings, where roughly 90% of the disease's global deaths now occur despite the availability of effective, low-cost screening and precancer treatment. This short communication synthesizes recent evidence on why screening uptake stays low across these settings, drawing on cross-national coverage data, primary surveys from Ethiopia and Uganda, a regional meta-analysis among HIV-positive women in sub-Saharan Africa, and the trial literature on HPV-based screen-and-treat and self-sampling. Average effective screening coverage in developing countries is roughly a third of that in developed countries, with the poorest women screened at less than a sixth the rate of the richest. Individual-level barriers, especially the belief that screening is unnecessary without symptoms and outright lack of awareness that screening exists, recur across every setting studied, compounded by structural obstacles such as distance to services and, among HIV-positive women, a distinct fear of an additional stigmatized diagnosis. HPV self-sampling and single-visit screen-and-treat protocols directly address several of these structural barriers and show measurable gains in test performance and participation, but their integration with the trust-building and awareness mechanisms shown to drive uptake remains underdeveloped. Closing the screening gap will likely require pairing these two strands of evidence rather than treating either alone as sufficient.