{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:46:09Z","timestamp":1776091569297,"version":"3.50.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Portuguese Institute of Oncology at Coimbra"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Cervical cancer (CC) screening is essential for reducing its incidence, yet engaging under-screened women remains challenging. Self-sampling has emerged as a promising solution to enhance attendance; however, its integration into programmes has proven difficult. This study evaluated a multimodal approach combining self-sampling, human papillomavirus (HPV) testing, and personalized contact to reach women not attending conventional CC screening. To achieve this, 801 women aged 30\u201359 who had not participated in Portugal\u2019s Central Region CC screening programme for more than 4 years were selected based on specific criteria. Of these, 114 women were excluded for not meeting eligibility criteria, resulting in 687 eligible participants. Using an \u2018opt-in\u2019 approach, women who consented to participate received cervicovaginal self-sampling kits at home. Multiple contact strategies, including phone calls and reminder letters, were employed to encourage participation. Women testing positive for high-risk HPV (hr-HPV) were referred for gynaecological follow-up. Of the eligible women, 307 (44.7%) consented to participate and 198 (28.8%) provided valid samples for hr-HPV testing. Approximately 60.0% of participants were enrolled after the first reminder phone call, while additional contact strategies accounted for one-third of submitted samples. Among 12\u2009hr-HPV positive cases, 11 completed gynaecological follow-up, resulting in the identification of six cervical lesions. This study confirms the feasibility and effectiveness of combining self-sampling, HPV testing, and personalized contact strategies to improve CC screening uptake among under-screened women. The findings highlight the potential of such interventions to address participation gaps and enhance early detection of cervical lesions, ultimately reducing CC incidence.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf122","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T09:22:05Z","timestamp":1753780925000},"page":"984-991","source":"Crossref","is-referenced-by-count":1,"title":["Targeting under-screened women in cervical cancer: combining self-sampling and human papillomavirus testing with a strategic reminder plan"],"prefix":"10.1093","volume":"35","author":[{"given":"Sara da Gra\u00e7a","family":"Pereira","sequence":"first","affiliation":[{"name":"Infogene, IPN Aceleradora , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu\u00eds","family":"Nobre","sequence":"additional","affiliation":[{"name":"Infogene, IPN Aceleradora , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Infogene, IPN Aceleradora , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patr\u00edcia","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Department of Public Health, Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Morais","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Salinas Family Health Unit, Pra\u00e7a Manuel Dami\u00e3o , Cacia,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Sousa","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Gynaecology, Portuguese Institute of Oncology of Coimbra , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Paula","family":"Moniz","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Histopathology, Portuguese Institute of Oncology of Coimbra , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Matos","sequence":"additional","affiliation":[{"name":"Department of Public Health, Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gra\u00e7a","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Histopathology, Coimbra Hospital and University Centre (CHUC) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Pedro","family":"Pimentel","sequence":"additional","affiliation":[{"name":"Department of Public Health, Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Carlos","family":"Marinho","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Santa Joana Family Health Unit , Aveiro,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Lu\u00eds","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Gynaecology, Portuguese Institute of Oncology of Coimbra , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Ilh\u00e9u","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Histopathology, Portuguese Institute of Oncology of Coimbra , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Rebelo","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Department of Gynaecology, Coimbra Hospital and University Centre (CHUC) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9","family":"Fonseca-Moutinho","sequence":"additional","affiliation":[{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Health Sciences Research Centre (CICS-UBI), Beira Interior University , Covilh\u00e3,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"Prazeres","sequence":"additional","affiliation":[{"name":"Infogene, IPN Aceleradora , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5816-2051","authenticated-orcid":false,"given":"Rui Jorge","family":"Nobre","sequence":"additional","affiliation":[{"name":"Center for Neuroscience and Cell Biology (CNC), Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra , Coimbra,","place":["Portugal"]},{"name":"Institute for Interdisciplinary Research (III), University of Coimbra , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Loureiro","sequence":"additional","affiliation":[{"name":"Department of Public Health, Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]},{"name":"Working Group on Cervical Cancer in the Central Region of Portugal (GTCCU), Central Regional Health Administration (ARS Centro) , Coimbra,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"2025101607022854400_ckaf122-B1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J 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Americas"},{"key":"2025101607022854400_ckaf122-B13","first-page":"524","article-title":"Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials","volume":"383","author":"Ronco","year":"2014","journal-title":"Lancet"},{"key":"2025101607022854400_ckaf122-B14","first-page":"805","article-title":"Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening","volume":"128","author":"Costa","year":"2023","journal-title":"Br J Cancer"},{"key":"2025101607022854400_ckaf122-B15","first-page":"729","article-title":"Cervical cancer screening programs in Europe: the transition towards HPV vaccination and population-based HPV testing","volume":"10","author":"Chrysostomou","year":"2018","journal-title":"Viruses"},{"key":"2025101607022854400_ckaf122-B16","volume-title":"Evaluation and Monitoring of Organized Population-Based Cancer 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An updated meta-analysis of observational studies and randomized clinical trials","volume":"10","author":"Di Gennaro","year":"2022","journal-title":"Front Public Health"},{"key":"2025101607022854400_ckaf122-B26","first-page":"k4823","article-title":"Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses","volume":"363","author":"Arbyn","year":"2018","journal-title":"BMJ"},{"key":"2025101607022854400_ckaf122-B27","first-page":"100235","article-title":"Clinical performance of high-risk HPV testing on self-samples versus clinician samples in routine primary HPV screening in the Netherlands: an observational study","volume":"11","author":"Inturrisi","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"2025101607022854400_ckaf122-B28","first-page":"577","article-title":"Picturing prevalence and inequalities in cancer screening attendance to population-based programs in 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