| Summary: | Background <br/>HPV-test is more effective than Pap test in preventing cervical cancer. HPV-based screening will imply longer intervals and a triage test for HPV positive women. It will also permit the use of self-sampling devices. <br/>These innovations may affect population coverage, participation, and compliance to protocols, and likely in a different way for less educated, poorer, and disadvantaged women. <br/>Aim <br/>To describe the impact on inequalities, actual or presumed, of the introduction of HPV-based screening. <br/>Methods <br/>The putative HPV-based screening algorithm has been analysed to identify critical points for inequalities. A systematic review of the literature has been conducted searching PubMed on HPV screening coverage, participation, and compliance. Results were summarised in a narrative synthesis. <br/>Results <br/>Knowledge about HPV and cervical cancer was lower in women with low Socio-economic status and in disadvantaged groups. A correct communication can reduce differences. <br/>Longer intervals will make it easier to achieve high-population coverage, but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women. <br/>There are some evidences that inviting for HPV test instead of Pap increases participation, but there are no data on social differences. <br/>Self-sampling devices are effective in increasing participation and coverage. Some studies showed that the acceptability of self-sampling is higher in more educated women, but there is also an effect on hard-to-reach women. <br/>Communication of HPV positivity may increase anxiety and impact on sexual behaviours, the effect is stronger in low educated and disadvantaged women. <br/>Many studies found indirect evidence that unvaccinated women are or will be more probably under-screened. <br/>Conclusions <br/>The introduction of HPV test may increase population coverage, but non-compliance to protocols and interaction with opportunistic screening can increase existing inequalities.
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