For Virgine Umuhoza, the warning signs came gradually.

She noticed abnormal bleeding and unusual vaginal discharge but initially thought the bleeding could be part of her normal menstrual cycle or a sign that her period was approaching.

Even when the symptoms persisted, she did not immediately seek medical attention. Part of the hesitation came from fear of what a medical examination might reveal.

By the time the pain became difficult to ignore and she finally went to hospital, she was diagnosed with advanced cervical cancer. She is now undergoing treatment at Butaro Teaching Hospital in Burera District.

Umuhoza’s experience reflects some of the barriers the government is trying to address as it works to increase cervical cancer screening among women.

Health officials say fear, misinformation, privacy concerns, transport costs, lack of time and uncertainty about where to access services can discourage women from getting screened.

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Rwanda is responding by bringing screening closer to communities, expanding HPV DNA testing, introducing self-collection and using community health workers and other trusted health professionals to explain why screening matters.

The measures are part of a wider effort to close the gap between Rwanda’s strong HPV vaccination coverage and the much lower proportion of adult women who have undergone cervical cancer screening.

Bringing screening closer to women

Dr Theoneste Maniragaba, Director of the Cancer Programme at Rwanda Biomedical Centre (RBC), says increasing screening requires more than waiting for women to visit health facilities on their own.

Community mobilisation, involvement of Community Health Workers (CHWs), integration of screening into primary healthcare and bringing services closer to communities are becoming increasingly important.

The approach is intended to make screening easier to access and less intimidating.

One of the changes is greater use of HPV DNA testing, which Rwanda’s latest guidelines recommend as the primary screening method for women aged 30 to 49. Women living with HIV are advised to begin screening earlier, from age 25.

Rwanda is also introducing self-collection, under which an eligible woman can collect her own vaginal sample using a provided device before the sample is processed through the health system.

For women who may be uncomfortable with an initial pelvic examination, self-collection offers another way to access screening.

The World Health Organisation also recognises HPV self-collection as an option that can help increase screening coverage where HPV testing is available.

The approach can be particularly useful for women who may feel embarrassed discussing an intimate examination or being examined by a healthcare provider.

ALSO READ: Cervical cancer: Rwanda rolls out new HPV vaccine

Tackling fear and misinformation

Making screening services available is only part of the challenge.

Fear and misinformation remain important reasons some women delay or avoid screening.

Maniragaba says some women fear that screening will be painful, damage their reproductive organs or affect their fertility. Others wrongly assume that a positive screening result automatically means they have cancer.

"Some women are afraid that screening will be painful, that the procedure will damage their reproductive organs, or that a positive result automatically means they have cancer,” he says.

There are also rumours that screening may involve removing the cervix or interfere with a woman’s ability to have children.

For health officials, addressing those fears requires clear information delivered by people women trust.

"We need trusted people, particularly CHWs, nurses, midwives and local leaders, to explain what screening actually involves,” Maniragaba says.

Such conversations can help women understand what happens during screening, why it is important and what different results mean.

Privacy and dignity are also important in overcoming reluctance to screen.

Women need to feel safe during examinations, have access to appropriate examination rooms and be confident that their personal information will remain confidential.

The same applies to women using self-collection, who need clear instructions and reassurance that their samples and results will be handled appropriately.

Encouraging screening before symptoms appear

Another barrier is the belief that screening is necessary only when someone feels sick.

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Cervical cancer can develop without obvious symptoms, meaning a woman may feel healthy while precancerous changes are developing.

"The greatest danger is that precancerous changes can develop without symptoms and may eventually progress to invasive cervical cancer,” Maniragaba says.

Cervical cancer generally develops slowly. Rwanda’s national guidelines note that it can take more than 10 years for the disease to develop, creating an opportunity to detect and treat HPV-related precancerous lesions before they become invasive cancer.

"Screening therefore should not be viewed as a test for women who are sick. It is primarily a preventive service for women who feel healthy,” Maniragaba says.

Waiting for symptoms can be dangerous.

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By the time a woman experiences abnormal vaginal bleeding, bleeding after sexual intercourse, unusual vaginal discharge or pelvic pain, the disease may already have progressed.

At that stage, treatment may become more complicated, more expensive and potentially less successful.

Closing the screening gap

Rwanda has already made significant progress in preventing cervical cancer through HPV vaccination.

The country introduced a national HPV vaccination programme in 2011 and has maintained coverage of more than 90 per cent among eligible girls.

Screening among adult women, however, remains a major challenge.

In February 2026, RBC reported that more than 90 per cent of girls were fully vaccinated against HPV by age 15, while only 31 per cent of women aged 30 to 49 had been screened using high-performance tests.

RBC described screening as the country’s "greatest challenge and most urgent priority.”

ALSO READ: Inside Rwanda’s push to eliminate cervical cancer ahead of WHO targets

Closing that gap has become increasingly important as Rwanda pursues its cervical cancer elimination target.

Under Mission 2027, the country wants to eliminate cervical cancer as a public health problem by 2027, three years ahead of the global target.

The national strategy aims to have 70 per cent of women aged 30 to 49 screened using high-performance HPV DNA testing and 90 per cent of women identified with precancerous lesions or invasive cancer receiving timely treatment.

Achieving those targets will require more than simply increasing the number of facilities providing screening.

Women also need to know where screening is available, be able to reach those services and trust that they will be treated with privacy and dignity.

Reducing distance and indirect costs

Access can also be affected by distance and the indirect costs of seeking care.

Even where screening is free or subsidised through public health services, women may still have to pay for transport, take time away from work or arrange childcare.

These costs can discourage women from seeking preventive care, particularly when they do not have symptoms.

Rwanda’s strategy therefore includes community mobilisation, mobile screening campaigns and integration of screening into existing health services.

The national elimination plan provides for facility-based, mass and mobile screening to reach eligible women.

Bringing services closer to communities can reduce unnecessary journeys and make screening easier to fit into women’s daily lives.

ALSO READ: Rwanda to introduce vaccine against six cancers

But screening alone is not enough.

For women who require further assessment or treatment, referral systems are equally important. Identifying women who need additional care has limited value if they cannot easily move through the health system and receive appropriate treatment.

Reducing fear around a positive result

Another barrier is uncertainty about what happens after an HPV test.

For a woman already worried about screening, fear of receiving a positive result may itself become a reason to avoid testing.

Health officials stress, however, that an HPV-positive result does not mean a woman has cervical cancer.

"An HPV-positive result does not mean that a woman has cervical cancer,” Maniragaba says.

Instead, it means a high-risk HPV infection has been detected and that further assessment is needed.

ALSO READ: Women can now self test for cervical cancer

Depending on the result and clinical assessment, women may undergo additional testing and, where appropriate, treatment for precancerous lesions.

Rwanda’s guidelines provide for treatment methods including thermal ablation and LEEP, while women suspected of having cancer are referred for diagnostic and oncology services.

Clear communication about what happens after testing can therefore help reduce fear.

Screening is not simply about receiving a potentially frightening diagnosis; it provides an opportunity to identify risk early and, where necessary, treat precancerous disease before it progresses.

When fear leads to delayed care

Thérèse Nyiramahoro, a resident of Remera who is receiving treatment at University Teaching Hospital of Kigali (CHUK), also knows what can happen when symptoms are repeatedly explained away.

She began experiencing pelvic and back pain but initially relied on painkillers to manage it.

Her husband repeatedly encouraged her to go to hospital, but she was afraid.

Instead, she tried to explain the pain in other ways. At times, she wondered whether it was connected to her menstrual period or even the chair she used at work.

When her husband asked about the pain, she sometimes told him that it had stopped.

Eventually, the pain became unbearable.

She called her husband and asked him to take her to a clinic in Kigali. She was later transferred to CHUK, where she was diagnosed with advanced cervical cancer.

She is now undergoing treatment.

Looking back, Nyiramahoro says fear contributed to the delay.

Her experience has changed the advice she gives other women. She encourages them not to ignore changes in their bodies and not to wait until symptoms become severe before seeking medical attention.

Her story reinforces the reason Rwanda is placing greater emphasis on prevention and early detection.

The objective is to reach women before they arrive at hospital with advanced disease.

Turning screening into routine preventive care

Umuhoza and Nyiramahoro eventually sought medical attention when their symptoms became difficult to ignore.

Rwanda’s cervical cancer strategy is intended to move that point of intervention much earlier.

The country is building on its success with HPV vaccination by expanding screening among adult women and changing how those services reach them.

Self-collection can make testing more acceptable to women who may be uncomfortable with an examination.

HPV DNA testing can identify high-risk infections before cancer develops.

CHWs, nurses, midwives and local leaders can help address fear and misinformation, while mobile and community-based screening can reduce the burden of distance and indirect costs.

Stronger referral and follow-up systems can also help ensure that women who need further assessment or treatment are not left on their own after receiving a result.

For Maniragaba, the broader challenge is changing the perception that screening is something women should seek only when they feel unwell.

A woman does not need to have symptoms before seeking cervical cancer screening. Screening is a preventive service intended to detect risk early and help women remain healthy.

For Nyiramahoro, that lesson came after her diagnosis.

She now wants other women to listen to changes in their bodies, seek medical help early and make cervical cancer screening part of their regular healthcare.

For Rwanda, tackling the barriers to cervical cancer screening means ensuring that more women can access services, understand the importance of early testing and act before symptoms and advanced disease force them into the health system.