Senkomago Virginia, Royalty Janet, Miller Jacqueline W, Buenconsejo-Lum Lee E, Benard Vicki B, Saraiya Mona
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Cancer Epidemiol. 2017 Oct;50(Pt B):260-267. doi: 10.1016/j.canep.2017.04.011.
Cervical 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.
We 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.
A 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.
This 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.
美属太平洋岛屿（USAPIs）的宫颈癌发病率是美国本土的两倍。美属萨摩亚、北马里亚纳群岛联邦（CNMI）、关岛和帕劳共和国从疾病控制中心（CDC）的国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）获得资金，为低收入、未参保或参保不足的女性实施宫颈癌筛查。USAPI的受资助者向CDC报告筛查和后续活动的数据。
我们检查了2007年至2015年四个USAPI地区NBCCEDP项目的宫颈癌筛查和后续数据。我们总结了通过巴氏（Pap）检查和致癌性人乳头瘤病毒（HPV）检测进行的筛查、提供的后续和诊断检测以及观察到的组织学结果。
2007 - 2015年，四个USAPI项目对14,206名女性进行了总共22,249次Pap检查。首次项目筛查中异常Pap结果（低级别鳞状上皮内病变或更严重）的总体百分比为2.4%，后续项目筛查为1.8%。组织学结果显示，癌前病变和癌症女性中宫颈上皮内瘤变2级或更严重的比例较高（57%）。大约三分之一（32%）需要后续跟进的Pap检查结果在诊断检测或后续跟进方面没有记录数据。
这是关于通过NBCCEDP在美国API地区接受服务的女性宫颈癌筛查及结果的首份报告，与国家NBCCEDP数据相比，异常Pap检查结果相似，但癌前病变和癌症比例更高。USAPI在实施宫颈癌筛查方面面临重大挑战，特别是在提供和记录诊断检测及后续跟进数据方面。USAPI的筛查项目应进一步研究对异常Pap结果女性进行后续跟进的具体障碍以及可能的解决办法。
