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Cited by 83Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

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Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review

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Kirubarajan, Abirami, Leung, Shannon, Li, Xinglin, Yau, Matthew, Sobel, Mara·2021·BMC Women's Health
DOI 10.1186/s12905-021-01264-xPMC PMC7989022

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Abstract

Background: Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. Methods: We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Results: Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusion: There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.

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  • A gap remains regarding understanding the full range of factors associated with screening attendance in women aged 30 or under, including socio-demographic or psychological factors.

    “However, a gap remains regarding understanding the full range of factors associated with screening attendance in this age group, including socio-demographic or psychological factors, as well as the identified perceived barriers/facilitators themselves.”

    From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [17]

    The Discussion (Main findings; page not available) says it has been difficult to characterize the breadth of young people’s perspectives on screening, supporting a gap in understanding barriers and facilitators. But the review concerns people under 35, not specifically women aged 30 or under, and it does not explicitly identify a gap in the full range of socio-demographic and psychological factors associated with screening attendance. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Psychological barriers were far more prevalent in the current review in comparison to a previous review.

    “Psychological barriers were far more prevalent in the current review in comparison to a previous review. 17”

    From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [17]

    The Results (Analysis of notable barriers; page unavailable) report psychological barriers to screening, including fear of pain in ten studies and embarrassment in 13 of 36 studies. The source does not compare those findings with the citing authors’ current review, so it cannot establish that psychological barriers were far more prevalent there. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In alignment with an earlier review, perceptions and screening behaviours of the LGBTQ+ group are underrepresented in research.

    “In alignment with an earlier review, 17 perceptions and screening behaviours of this group are underrepresented in research.”

    From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [17]

    The Discussion (‘Next steps and implications for care’) says none of the included studies specifically targeted the beliefs of non-heterosexual or non-cisnormative participants, and that the search found no studies of transgender men specific to young people. This supports underrepresentation in research on cervical cancer screening among young people, but not the broader, unqualified claim about LGBTQ+ screening behaviours in research generally. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The previous review only included studies that explicitly mentioned an age cut-off in the title/abstract, which may have resulted in the exclusion of potentially relevant studies.

    “The previous review 17 also only included studies that explicitly mentioned an age cut-off in the title/abstract, which may have resulted in the exclusion of potentially relevant studies.”

    From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [17]

  • The current review implemented a stricter age limit of under 30 compared to under 35.

    “Alongside these factors, the current review also implemented a stricter age limit of under 30 compared to under 35. 17”

    From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [17]

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Metadata

Authors
Kirubarajan, A., Leung, S., Li, X., Yau, M., & Sobel, M.
Affiliations
  • University of Toronto (CA)
  • Sinai Health System (CA)
Corresponding author
Kirubarajan, Abirami
ORCID
Venue
BMC Women's Health
Publisher
Springer Science and Business Media LLC
Published
2021-03-23
Volume
21
Issue
1
Pages
122-122
ISSN
1472-6874 (ISSN-L)
DOI
10.1186/s12905-021-01264-x
PMC
PMC7989022
OpenAlex
W3138308112
Cited by
83
References
1
Citations by year
2026: 16 · 2025: 19 · 2024: 14 · 2023: 16 · 2022: 16 · 2021: 2
FWCI
1.83
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Women s Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer screening, adolescents, youth, barriers to screening, facilitators of screening, Pap smear, HPV testing, self-sampling, health knowledge awareness, social norms, family support, self-efficacy, underscreening
MeSH terms
Adolescent, Uterine Cervical Neoplasms, Cross-Sectional Studies, Female, Health Personnel, Humans, Mass Screening, Early Detection of Cancer

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