title: Cervical Cancer Screening in the United States-Affiliated Pacific Islands: Options and Opportunities.
abstract: OBJECTIVE
  Successful cervical cancer screening in the United States-Affiliated Pacific Islands (USAPI) is limited by geographic, political, economic, and logistic factors. An expert panel convened to examine screening in each of the 6 island jurisdictions and to explore options beyond cytology-based screening.
  
  
  METHODS
  Forty-one representatives of American Congress of Obstetrics and Gynecology, American Society for Colposcopy and Cervical Pathology, government agencies, the World Health Organization, Pan American Health Organization, health representatives of the 6 Pacific island jurisdictions, Puerto Rico, and several academic institutions met in a 2-day meeting to explore options to improve access and coverage of cervical cancer screening in the USAPI.
  
  
  RESULTS
  Cytology-based screening is less widely accessed and less successful in the USAPI than in the United States in general. Barriers include geographic isolation, cultural factors, and lack of resources. Cytology-based screening requires multiple visits to complete the process from screening to treatment. Screen-and-treat regimens based on visual inspection with acetic acid or human papillomavirus requiring 1 or 2 visits have the potential to improve cervical cancer prevention in the USAPI.
  
  
  CONCLUSIONS
  The standard US algorithm of cytology screening followed by colposcopy and treatment is less effective in geographically and culturally isolated regions such as the USAPI. Alternate technologies, both high tech, such as primary human papillomavirus screening, and low tech, such as visual inspection with acetic acid, have shown promise in resource-poor countries and may have applicability in these US jurisdictions.
authors.affiliation: 1Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM; 2Department of Family Medicine and Community Health, Pacific Regional Cancer Programs, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; 3Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland OH; 4Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; 5Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS; 6Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; and 7Molina Healthcare of Florida, Doral, FL.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Waxman
authors.forename: Lee E
authors.initials: LE
authors.lastname: Buenconsejo-Lum
authors.forename: Miriam
authors.initials: M
authors.lastname: Cremer
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ault
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Cain
authors.forename: Maria Lina
authors.initials: ML
authors.lastname: Diaz
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006298:Health Services Administration; D006801:Humans; D011114:Polynesia; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*