Bridging the Gap: Inclusive Cervical Screening for Women with Disabilities

Cervical cancer is one of the most preventable cancers, yet nearly nine women are diagnosed with it every day in the UK¹, leading to hundreds of unnecessary deaths and many more suffering from long-term health complications each year. Although regular screening can significantly reduce the risk of cervical cancer, women with certain disabilities face greater barriers to accessing this life-saving procedure, putting their health at higher risk. To address this issue, the UK’s Royal College of Nursing has introduced a new resource to help healthcare professionals improve the cervical screening experience for this underserved group.

The Importance of Cervical Screening

Almost all cases of cervical cancer are caused by high-risk strains of human papillomavirus (HPV), a very common sexually transmitted infection². The challenge is that most HPV infections show no symptoms, so regular cervical screening (or smear test) is essential, which detects high-risk HPV early, preventing the possible development of cervical cancer.

In the UK, the NHS Cervical Screening Programme (CSP) provides free cervical screening to women and individuals assigned female at birth (AFAB) aged 25 to 64. Invitations are sent every 3 to 5 years, depending on age and previous screening results³. However, while early detection is crucial for reducing cervical cancer cases, screening uptake in the UK remains not high enough due to certain barriers that many women face when accessing this potentially life-saving test⁴. This is particularly true for women with disabilities who often encounter unique challenges, highlighting the need for greater support from the healthcare community.

Barriers to Cervical Screening

Despite widespread campaigns encouraging cervical screening, many women still face barriers that prevent them from attending these essential appointments. These challenges are even greater for some groups, such as women with a physical disability or autism—a condition that affects a person’s communication, social interaction, and behaviour.

For women with a physical disability, logistical challenges can be a major barrier. Inaccessible facilities, a lack of specialised equipment, and limited understanding from clinical staff often deter women from attending screenings⁵. Fear of discomfort, heightened by physical limitations, may further discourage participation.

For women with autism, the barriers might be less obvious but just as challenging. Sensory sensitivities, difficulties with communication, and anxiety about unfamiliar settings or procedures can make cervical screening feel overwhelming. Without tailored support or accommodations, many women struggle to access this vital service. The impact of these barriers is concerning, as evidence shows that women with disabilities are much less likely to attend cervical screening compared to the general population⁶^,⁷. This increases their risk of being diagnosed at later stages, receiving less treatment, and generally experiencing worse outcomes⁶, highlighting the urgent need to address these issues and reduce healthcare disparities.

Addressing Specialised Needs

Fortunately, the UK’s Royal College of Nursing (RCN) has taken a significant step by publishing a resource to help clinical staff better support women with a physical disability and/ or autism during cervical screening⁸. By providing healthcare staff with this guide, the RCN aims to create a more inclusive healthcare environment where every woman feels supported and can access essential care.

The clinical guidance emphasises the importance of understanding and addressing the individual needs of women with disabilities. One of its key messages is the critical need to effectively listen to patients and work collaboratively to provide personalised care.

For women with a physical disability, this may involve practical adjustments such as ensuring wheelchair accessibility, using adjustable examination tables, or offering alternative screening techniques where appropriate. For women with autism, the focus may be on creating a calm and predictable environment, providing clear explanations of the procedure, and allowing extra time for the appointment.

The guide includes a good practice checklist and practical advice on how to approach conversations with women who may have concerns about cervical screening⁸. For example, asking open-ended questions to understand the patient’s fears or barriers can help create a supportive and respectful dialogue.

It also highlights available resources, such as accessible leaflets and visual aids, to help women with autism better understand what to expect during cervical screening. This includes targeted campaigns that address their specific needs and concerns, which are particularly important in encouraging them to attend.

The guide additionally underscores the importance of continuity of care. Building trust through consistent interactions with the same healthcare professional can make a significant difference for women who may feel anxious about the process. Nurses are encouraged to take the time to interpret verbal and non-verbal cues, acknowledge the patient’s expertise in their own needs, and provide reassurance every step of the way.

Summary

Cervical screening can prevent most cases of cervical cancer, but many women face significant barriers to accessing this life-saving service. For women with a physical disability or autism, these challenges are often made worse by a lack of adequate understanding and tailored support. The RCN’s new clinical guidance is a welcome step toward addressing these disparities and ensuring that every woman, regardless of her circumstances, has access to the care she needs. By empowering clinical staff with the knowledge and resources to support women through the cervical screening process, a more inclusive healthcare system can be created, one where no woman is left behind in the effort to eliminate cervical cancer.

10zyme: Advancing women’s health

We’re developing a groundbreaking self-test with instant results to detect the main cause of cervical cancer: high-risk HPV. Detecting infections early prevents cancer ever developing.

By enabling self-testing, we aim to empower women, overcome stigma and anxiety, and help eliminate a disease killing hundreds of thousands a year globally. See our Education Section to find out more.

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References:

Cancer Research UK (CRUK). (2017-2019). Cervical cancer statistics. (Online). Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer [Accessed 25/01/2025]
National Health Service (NHS). (2024). Causes of cervical cancer. (Online). Available at: https://www.nhs.uk/conditions/cervical-cancer/causes/ [Accessed 25/01/2025]
NHS England. (2024). Cervical screening: programme overview. (Online). Available at: https://www.gov.uk/guidance/cervical-screening-programme-overview
Choi, S. Ismail, A. Pappas-Gogos, G. Boussios, S. (2023). HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens. 12(2):298. (Online). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9960303/ [Accessed 25/01/2025]
Chan, DNS. Law, BMH. So, WKW, Fan, N. (2022). Factors associated with cervical cancer screening utilisation by people with physical disabilities: A systematic review, Health Policy, 126 (10), pp. 1039-1050. (Online). Available at: https://pubmed.ncbi.nlm.nih.gov/35948497/ [Accessed 26/01/2025]
Choi, JY. Yeob, KE. Hong, SH. Kim, SY. Jeong, EH. Shin, DW. Park, JH. Kang, GW. Kim HS. Park, JH. Kawachi, I. (2021) Disparities in the Diagnosis, Treatment, and Survival Rate of Cervical Cancer among Women with and without Disabilities, Cancer Control (28). (Online). Available at: https://pubmed.ncbi.nlm.nih.gov/35042390/ [Accessed 26/01/2025]
Baruch, L. Bilitzky-Kopit, A. Rosen, K. Adler, L. (2022). Cervical Cancer Screening Among Patients with Physical Disability. Journal of Women’s Health. 31(8), 1173–1178. (Online). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419959/ [Accessed 26/01/2025]
Royal College of Nursing (RCN). (2024). Cervical Screening for Physically Disabled Women and Autistic Women. (Online). Available at: https://www.rcn.org.uk/Professional-Development/publications/rcn-cervical-screening-for-physically-disabled-women-and-autistic-women-uk-pub-011-821 [Accessed 26/01/2025]