Cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in four US-Affiliated Pacific Islands between 2007 and 2015 |
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| Institution: | 1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States;2. Department of Family Medicine and Community Health, Pacific Regional Cancer Programs, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States;1. Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain;2. Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, L''Hospitalet de Llobregat, Barcelona, Spain;3. Cancer Prevention and Control Group, Institut d''Investigació Biomèdica de Bellvitge – IDIBELL, L''Hospitalet de Llobregat, Barcelona, Spain;4. Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain;5. Group of Integrative Pharmacology and Systems Neuroscience, Neurosciences Programme, IMIM (Hospital del Mar Medical Research Institute), Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain;6. Catalan Network of Smoke-free Hospitals, L’Hospitalet de Llobregat, Barcelona, Spain;7. Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain;8. Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain;1. Faculty of Health Sciences of the University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal;2. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden;3. Department of Statistics, Örebro University, 701 82, Örebro, Sweden;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE 171 77, Stockholm, Sweden;5. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, SE 171 76 Stockholm, Sweden;6. Department of Epidemiology and Public Health, University College, WC1E 6BT London, UK;1. Department of Oncology, Queen’s University, Kingston, Canada;2. Department of Surgery, Queen’s University, Kingston, Canada;3. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Canada;1. Registre des cancers du Bas-Rhin, U1113, FMTS, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France;2. Service de santé publique, Hôpitaux Universitaires de Strasbourg, 1 place de l’hôpital, 67091 Strasbourg, France;3. Registre des cancers de la Manche, Centre Hospitalier Public du Cotentin, 46 rue du Val de Saire, 50102 Cherbourg-Octeville, France;4. Registre des tumeurs de l''Hérault, Centre de Recherche, 208 rue des Apothicaires, 34298 Montpellier, France;5. Registre général des tumeurs du Calvados, Cancers & Préventions – U1086 Inserm, Centre François Baclesse, Avenue du Général Harris BP 5026, 14076 Caen, France;6. Registre des tumeurs du Doubs et du Territoire de Belfort, EA3181, Centre Hospitalier Régional Universitaire, 25030 Besançon, France;7. Registre des cancers du Tarn, 1, rue Lavazière, BP 37, 81001 Albi cedex, France;8. Institut Claudius Regaud, Centre régional de lutte contre le cancer, IUCT-O, Registre des cancers du Tarn, 31059 Toulouse, France;9. Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n°0350, Centre Hospitalier Universitaire, Avenue de la Côte de Nacre, 14033 Caen, France;10. Registre des cancers de l’Isère, CHU de Grenoble, Pavillon E BP 217, 38043 Grenoble 9, France;11. Registre du cancer de la Somme, Service Épidémiologie Hygiène et Santé Publique, CHU Nord, 80054 Amiens, France;12. Service d’épidémiologie et de biostatistique, Centre Paul Strauss, 3 rue de la Porte de l’hôpital, 67065 Strasbourg, France;1. University of Guam, College of Natural & Applied Sciences, 303 University Drive, Mangilao, 96923, Guam;2. University of Hawaii At Manoa, 1955 East West Road, Agricultural Science 216, Honolulu, HI 96822, United States;3. University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, United States;4. AB Consulting, LLC, P. O. Box 5588 CHRB, Saipan, MP CNMI 96950, Northern Mariana Islands;1. Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland;2. Royal College of Surgeons in Ireland, Dublin 2, Ireland |
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| Abstract: | BackgroundCervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC.Materials and methodsWe examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed.ResultsA total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007–2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse) was 2.4% for first program screens and 1.8% for subsequent program screens. Histology results showed a high proportion of cervical intraepithelial neoplasia grade 2 or worse (57%) among women with precancers and cancers. Roughly one-third (32%) of Pap test results warranting follow-up had no data recorded on diagnostic tests or follow-up done.ConclusionThis is the first report of cervical cancer screening and outcomes of women served in the USAPI through the NBCCEDP with similar results for abnormal Pap tests, but higher proportion of precancers and cancers, when compared to national NBCCEDP data. The USAPI face significant challenges in implementing cervical cancer screening, particularly in providing and recording data on diagnostic tests and follow-up. The screening programs in the USAPI should further examine specific barriers to follow-up of women with abnormal Pap results and possible solutions to address them. |
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| Keywords: | US-Affiliated Pacific Islands Cervical cancer Screening NBCCEDP US territories |
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