ACCESS Consensus Group expert report urges action to improve cervical cancer screening participation and equity across Spain

RECOMMENDATIONS ON CERVICAL CANCER SCREENING IN SPAINExpert views from different autonomous communities

Cervical cancer remains a preventable yet persistent health burden in Spain despite scientific and technological advances. In response to declines in cervical cancer screening uptake across high-income countries, the ACCESS International Consensus Group developed the “Turning the Tide” White Paper, which outlines six key recommendations to improve screening participation, equity, and accessibility. A new exploratory analysis in Spain led by leading experts in the field was undertaken to identify good practices that can serve as examples for other regions and pinpoint policy gaps hindering implementation of the six recommendations. The analysis includes a RAG (red/amber/green) rating model to reflect current implementation levels and help prioritise areas for improvement.

Key recommendations include: 

National level:

  1. Strengthen the Ministry of Health’s strategic role via an ambitious, coordinated roadmap for screening implementation, with defined timelines, targets exceeding WHO minimums, and an equity-centred approach.
  2. Improve equity and data quality through standardised systems that enable comparable monitoring of invitations, participation, follow-up, and outcomes across regions, age groups, and vulnerable populations.
  3. Standardise and link key registries—including population, cancer, primary care, screening, and vaccination—to assess territorial inequities, ensure interoperability and enable comprehensive, data-driven decisions.
  4. Promote culturally adapted national information and awareness campaigns targeted at under-screened women, coordinating traditional, digital, and community channels with regional health services.
  5. Integrate economic evaluation into the national indicator framework, promoting cost-effectiveness analyses that compare screening strategies to inform investment decisions and assess health and budget impacts.
  6. Promote partnerships with key social stakeholders—such as patient groups, community organizations, and women’s health entities—by implementing funding mechanisms, technical support, and educational campaigns to boost screening uptake and address cultural and social barriers.
  7. Create permanent mechanisms for interregional learning to enable systematic exchange of experiences, best practices, and lessons learned, to reduce implementation gaps and increase screening uptake across the country.
  8. Strengthen multilevel coordination by aligning efforts between the Ministry of Health, regional health services, and civil society stakeholders to reduce implementation disparities and ensure nationwide coverage.
  9. Mobilise European and national resources, prioritising allocation to autonomous communities facing greater technical and institutional challenges, in order to accelerate the rollout of population-based screening and promote innovative measures.

Regional Level:

  1. Align regional plans with the national framework, including coverage targets, quality standards, and equity priorities, with the Ministry of Health’s technical support where operational or budgetary constraints exist.
  2. Deploy effective accessibility strategies, especially in regions with lower screening coverage, prioritising optimised invitation systems (SMS, mail, and digital channels), extended screening appointments, and offering screening in settings beyond primary healthcare centres.
  3. Consider the gradual implementation of HPV self-sampling an additional tool to improve screening participation, ensuring its deployment is subject to evaluation, appropriate mechanisms for quality control and traceability. Implementation should be progressive and evaluated, ensuring device validation, analysis of screening coverage and outcomes, traceability of samples, and the existence of clear clinical follow-up protocols.
  4. Incorporate economic evaluation into the design and monitoring of screening programmes, considering cost-effectiveness analyses, selection of the primary test, screening intervals, and follow-up strategies. This approach would help optimise resources, support evidence-based decision-making, and strengthen the long-term sustainability of the programme.
  5. Ensure continuous training and support for healthcare professionals, providing tools to strengthen communication with under-screened women. Explore non-financial incentives such as harmonised criteria for professional accreditation, institutional recognition, or including screening promotion in performance evaluation systems.
  6. Strengthen technical coordination between regional health services and scientific societies to harmonise quality standards, training, and professional accreditation in cervical cancer screening and follow-up.

READ THE FULL REPORT (SPANISH)

Project Team

National Expert Group – provided both regional and national perspectives

Project Coordinators – ACCESS members responsible for overseeing the project methodology in Spain and ensuring alignment of the analysis with the study objectives

  • Dr Rosario Granados, Head of the Pathology Department at Hospital Universitario de Getafe (Madrid Regional Health Service), Former President of the European Federation of Cytology Societies and of the Spanish Society of Cytology, Spain. Member, ACCESS Consensus Group
  • Dr Xavier Bosch, Clinical oncologist and epidemiologist, co-founder of the HPV Information Centre (ICO and IARC), Director of HPV World (HPW), Spain. Member, ACCESS Consensus Group

Report Contributors – provided technical and context-specific insights on the implementation of screening programmes in participating regions, and contributed to the report review through comments and observations

  • Dr Elena Bartolomé, Head of Cancer Screening Programs at the Regional Office for Oncology Coordination, Community of Madrid. Board Member, Spanish Society for Healthcare Quality
  • Dr Elena Rodríguez Camacho, MD, PhD, Specialist in Preventive Medicine and Public Health, Technical Officer at the Early Disease Detection Service of the Directorate-General of Public Health, Ministry of Health, Xunta de Galicia
  • Dr María José Macías, Head of Health Promotion and Disease Prevention Programmes at the Directorate-General for Public Health, Extremadura Health Service (SES), Spain
  • Dr Marta del Pino, Consultant at the Gynecologic Oncology Unit, Hospital Clínic de Barcelona, and Associate Professor of Medicine at the University of Barcelona

Other Contributors – provided data specific to their respective regional screening programmes 

  • David del Valle Peña, Cervical Cancer Early Detection Screening Program, Osakidetza. Gynecologist at the Cervical Pathology Unit, Donostia University Hospital.
  • Generalitat Valenciana (Regional Government of Valencia), Screening Programs Service, Deputy Directorate-General for Health Promotion and Prevention, Directorate-General for Public Health 

International Steering Group – led the overall methodological design and strategy of the RAG report project to their respective regional screening programmes

  • Dr Mairead O’Connor, Research Officer, National Screening Service Ireland, behavioural scientist, Member, ACCESS Consensus Group, Ireland
  • Philippe Descamps, Professor and Head of the Department of Obstetrics and Gynecology, Angers University Hospital. Former Vice-President of the International Federation of Gynecology and Obstetrics (FIGO), Co-chair, ACCESS Consensus Group
  • Dr Rosario Granados, Head of the Pathology Department at Hospital Universitario de Getafe (Madrid Regional Health Service), Former President of the European Federation of Cytology Societies and of the Spanish Society of Cytology, Spain. Member, ACCESS Consensus Group