Abstract A043: Pacific Against Cervical Cancer (PACe) project: Implementation of a cervical cancer screening and treatment program in Yap, Federated States of Micronesia

Abstract

Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPI) is among the highest in the world, with more than half of cases diagnosed at an advanced stage. Limited healthcare resources, geographic isolation, and sociocultural barriers reduce access to cervical cancer screening for many Pacific Islander women. To address these challenges, the Pacific Against Cervical Cancer (PACe) Project developed a locally tailored cervical cancer prevention program that piloted and translated a novel high-risk human papillomavirus (hrHPV) self-collection screening approach for the island state of Yap, Federated States of Micronesia (FSM). In partnership with the Yap State Department of Health Services, a multidisciplinary team—including experts in cervical cancer prevention and treatment, laboratory sciences, community engagement, and data systems—co-designed and implemented a community-engaged cervical cancer screening and treatment program across Yap's main island and 22 remote outer islands spanning more than 100,000 square miles of ocean. In addition to standard provider-collected screening for women aged 30-50 years, the program offered primary hrHPV self-collection screening and incorporated comprehensive capacity building through clinical and community health worker training. Screening was integrated with WHO-aligned visual assessment for treatment (VAT) and thermal ablation protocols to provide timely management of precancerous lesions. Over a 4-year period, the PACe Project established local capacity by training 6 physicians and 5 nurses in cervical cancer screening and treatment, 16 community health workers in hrHPV education and motivational interviewing, and 15 clinic staff in the canSCREEN digital registry platform. The program expanded services to Yap's main island and 18 of its 22 outer islands, including atolls located more than 700 miles from the state capital. Screening exceeded the target goal of 1,600 women, reaching 1,892 women, of whom 86% chose hrHPV self-collection. The project also established electronic specimen tracking and local laboratory processing to improve continuity of care. 306 women tested positive for hrHPV (16% positivity rate), of which 87% completed VAT follow-up for evaluation and precancer treatment. 67% of the women screened had never been screened for cervical cancer. The PACe Project successfully implemented a locally tailored cervical cancer screening and treatment program in Yap, FSM, demonstrating that hrHPV self-collection can be effectively integrated into geographically dispersed, resource-limited island settings. Through community engagement, workforce development, and strengthened clinical infrastructure, the program substantially increased screening uptake and access to follow-up care. The implementation strategies developed in Yap, FSM through PACe provide a scalable model for expanding cervical cancer prevention, notably hrHPV screening with self-collection, across other USAPI jurisdictions and similarly rural and underserved populations in the U.S. Neal A. Palafox, Martina Reichhardt, James Edilyong, Kassandra Lelman, Mavis Nitta, Isabel Scarinci, Kathryn Maxwell, Enriquito Lu, Komal Soin, Rica Dela Cruz, Cerina Mariano, Emi Chutaro. Pacific Against Cervical Cancer (PACe) project: Implementation of a cervical cancer screening and treatment program in Yap, Federated States of Micronesia [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A043.