90% of Women in Low-Income Countries Have Never Been Screened for Cervical Cancer Because Screening Was Designed Around the Clinician, Not the Woman

Cervical cancer is the fourth most common cancer in women worldwide, killing over 348,000 women in 2022 — nearly 90% of them in low- and middle-income countries. The cancer is preventable through screening and treatable when caught early, yet 90% of women in low-income countries have never been screened. The WHO 90-70-90 elimination strategy requires 70% screening coverage by 2030, but current coverage in low-income countries is under 10%. The fundamental problem is not the absence of screening technology — it's that the screening model was designed around the provider (requiring clinic visits, trained clinicians, speculum exams, and laboratory infrastructure) rather than around the woman who needs to be screened.

WHO's Global Strategy defines cervical cancer elimination as fewer than 4 cases per 100,000 women per year. At current trajectories, most low-income countries will not achieve this within the century. The inequity is stark: screening coverage is 7 times higher in high-income than in low-income countries. An estimated 1.6 billion women aged 20–70 globally have never been screened, including 804 million in lower-middle-income countries and 152 million in low-income countries. The disease burden falls disproportionately on women who are poor, rural, uninsured, and from marginalized communities — the same women for whom clinic-based screening is least accessible. 61% of low-income countries still lack official screening recommendations.

Clinic-based screening programs using Pap smears or visual inspection with acetic acid (VIA) have been the standard approach for decades. These require trained providers, laboratory infrastructure, and multiple clinic visits — women must attend for sampling, return for results, and return again for treatment if positive. Each step loses patients: studies in LMICs show 30–50% dropout between screening and treatment. The provider-collected sample requirement is the primary structural barrier: it requires women to travel to a facility, take time off work (wage loss that the poorest cannot afford), undergo an intimate examination by a stranger (culturally unacceptable in many contexts), and return repeatedly. In one study, 90% of women knew that early detection could prevent cervical cancer but only 9% had been screened — demonstrating that the problem is access, not awareness. Cultural and religious barriers (partner prohibition, modesty norms), fear of the exam, cost of transport, and lack of childcare compound the problem. Over 250 HPV tests are commercially available, but few are validated, affordable, and suitable for point-of-care use in low-resource settings. The research base itself reflects the inequity: only 3 of 72 studies in a major systematic review of self-sampling preferences were conducted in low-income countries.

HPV self-sampling — where women collect their own vaginal sample at home or in a community setting — eliminates the need for clinic attendance, trained providers, and speculum exams. Studies show it increases screening participation by 32–48% and reaches women who have never been screened. Vaginal brushes achieve 94.6% sensitivity for HPV detection. However, self-sampling only solves half the problem. What's still needed is: (1) a low-cost, accurate, point-of-care HPV test that can process self-collected samples without laboratory infrastructure — current isothermal amplification and lateral flow approaches are promising but not yet at the price and performance point needed; (2) a "screen-and-treat" workflow where a positive result leads to immediate treatment in the same visit, eliminating the dropout between screening and treatment; and (3) integration with existing community health systems (community health workers, mobile health platforms) so that screening reaches women rather than waiting for women to reach screening.

A student team could design a community-based cervical cancer screening workflow that integrates self-sampling with a low-cost point-of-care HPV test and a decision-support tool for community health workers. The deliverable would be a service design prototype (workflow, logistics, communication materials, data tracking) tested with a specific population segment — for example, women in a peri-urban community who have never been screened. A more technically oriented team could work on the sample-to-answer challenge: designing a low-cost sample processing method that bridges the gap between self-collected samples and affordable HPV detection, potentially using paper-based microfluidics or isothermal amplification. Skills in public health, service design, biomedical engineering, or behavioral science would be most relevant.