Date of Award


Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Kara Roman, PA-C

Second Advisor

Jennifer Christiansen, PA-C

Third Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA



Cervical cancer is a striking women's health problem worldwide. It is the fourth most common cancer in women and the seventh most common cancer worldwide1. There were roughly 604,000 new cases of cervical cancer and 342,000 deaths in 20202. Most of these cases occur in developing countries due to ineffective screening initiatives2. Screening essentially allows pre-cancerous lesions to be identified at stages where they can easily be treated; screening methods include cytology and HPV testing (Human Papillomavirus)1. HPV has over 100 strains and is one of the most common risk factors for cervical cancer. HPV testing is more sensitive than cytology which has been successfully used to reduce the burden of cervical cancer in high- income countries1. Compared to cytology pap smear testing, HPV testing can be done by a specimen collected by the woman-self-sampling3 and removes the need for a pelvic exam and a provider1. Scientifically, HPV testing is more sensitive than traditional cervical cancer screening cytology, which has been successfully utilized to decrease the cervical cancer rate in high- income countries1. This empowers women by letting them be in control and collect their own specimens in private, at a time and place of their choosing3. This strategy is been designed to be utilized in low-income and rural communities with limited resources and options to travel to distant health facilities for screening3. As a result, it has shown results to improve access to increase screening, particularly among under-screened women in rural populations3. When diagnosed, cervical cancer can be successfully treated as long as it is detected early and managed effectively3. It takes 15 to 20 years for cervical cancer to develop in women with healthy immune systems, and 5 to 10 years in women who are immunocompromised, such as those with cancer, autoimmune diseases, and untreated HIV infection3. WHO Global Strategy has a goal to achieve Running Head: The Role of Self-Sampling for HPV in the Primary Prevention of Cervical 4 Cancer the “90-70-90” targets by 2030 and this states that 90% of girls should be fully vaccinated with the HPV vaccine by age 25, 70% of women screened twice by age 35, and then by age 45, and 90% of women with cervical dysplasia should receive treatment1. Increasing screening can allow women to know if they are at risk for cervical cancer but some issues revolve around the next steps of what exactly can be done with the results that are received. The overall goal of increasing cervical cancer screening can be achieved by respecting women’s privacy through self-sampling to encourage screening participation in under-screened rural populations. With a holistic approach to preventing, screening, and treatment for cervical cancer, there is a high likelihood that it can be eliminated as a global public health issue within this generation.