Female allogeneic hematopoietic cell transplant survivors' perspectives on cervical cancer screening: a retrospective study

PURPOSE: Female allogeneic hematopoietic cell transplantation (AlloHCT) survivors are at increased risk for human papillomavirus (HPV)-related malignancies due to immunosuppression. Guidelines recommend annual cervical cancer screening for AlloHCT survivors with a cervix aged 21-65. This study explored cervical cancer screening knowledge, behaviors, attitudes, experiences, and preferences-specifically provider-collected versus self-collected methods-and identified adherence barriers and facilitators. METHODS: We conducted a mixed-methods observational study of female AlloHCT survivors aged 21-65 who received AlloHCT at Oregon Health & Science University between 2012 and 2023. Participants completed demographic surveys and participated in focus groups exploring screening adherence, perceptions, and preferences. RESULTS: Twenty-three survivors completed the survey, and 16 joined focus groups in fall 2024. The median participant age was 49 years (range 32-61); most were white (87%) and privately insured (91%). Median age at bone marrow transplantation (BMT) was 41 years (range 19-56). Primary diagnosis included acute myeloid leukemia or myelodysplastic syndrome (65%). Reported complications included graft versus host disease (GVHD) (44%), chronic GVHD (39%), and vaginal GVHD (22%). Awareness of increased cervical cancer risk facilitated screening adherence, while limited access to in-network providers was a barrier. All participants preferred provider-collected screening due to confidence in test accuracy and reassurance from clinician involvement. Psychological factors, particularly worrying about recurrence or secondary cancers, strongly influenced screening preferences. CONCLUSION: Cervical cancer screening preferences among AlloHCT survivors were shaped by physical and psychological treatment-related factors. HPV self-collection may be a supplemental option before BMT, between annual clinic visits, or when access barriers arise.