Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project.

The U.S.-affiliated Pacific Islands (USAPI) have higher cervical cancer incidence and mortality rates and lower screening coverage compared with the United States. This is likely because of economic, geographical, health care delivery, and cultural barriers for women living in these resource-constrained, isolated regions. The most recent U.S. and World Health Organization cervical cancer screening guidelines recommended primary human papillomavirus (HPV) testing as one screening option or the preferred screening modality. Primary HPV screening-based strategies offer several advantages over current screening methods in the USAPI. However, adoption of this newer screening modality has been slow in the United States and not yet incorporated into USAPI screening programs. The U.S. Centers for Disease Control and Prevention and partners initiated the Pacific Against Cervical Cancer (PACe) project in 2019 to evaluate the feasibility, acceptability, and cost-effectiveness of primary HPV testing-based strategies in Guam and in Yap, Federated States of Micronesia. This report provides an overview of the PACe project and outlines the approaches we took in implementing primary HPV testing as a new cervical cancer screening strategy (including the option of self-sampling in Yap), encompassing four core components: (1) community engagement and education, (2) medical and laboratory capacity building, (3) health information and system improvement, and (4) modeling and cost-effectiveness analysis. The PACe project provides examples of systematic implementation and resource appropriate technologies to the USAPI, with broader implications for never screened and under-screened populations in the United States and Pacific as they face similar barriers to accessing cervical cancer screening services.

Factors associated with success or failure in trials of vacuum extraction.

Failure rates for vacuum extraction of between one in 16 and one in 600 have been reported. Most studies report that unexpected failure carries a greater risk to both mother and fetus. The aim of this study was to determine factors that were likely to predict success or failure in trials of vacuum extraction. At the Port Moresby General Hospital, 59 trials of vacuum extraction were performed between 1 December 1997 and 30 November 1999. These cases were analysed according to whether vacuum extraction was achieved with more than or less than three pulls, or an alternative method of delivery was required to effect delivery Factors that were predictive of failure were: (i) Highlands origin of the mother; (ii) longer duration of the second stage of labour; (iii) severe moulding of the fetal head; (iv) cup detachments and deflexing cup applications; and (v) operator persisting with the procedure after three pulls. The cervix being less than fully dilated when the trial was commenced was not associated with a higher risk of failure, nor was it associated with a significantly higher risk of cervical trauma. Perinatal death and serious fetal scalp trauma were associated with deflexing cup applications, making more than three pulls and failed vacuum extractions.