Jacqueline W. Miller

Breast, cervical, and colorectal cancer screening prevalence in the US-Affiliated Pacific Islands

Breast, cervical, and colorectal cancer screening are recommended and can reduce mortality from these cancers, yet information on screening prevalence in the US-Affiliated Pacific Islands (USAPI) is limited. We analyzed data from population-based cross-sectional surveys undertaken at different time points from 2016 to 2019 in American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia states of Pohnpei and Kosrae. We estimated the age-standardized percentage of never screened and up-to-date screening for breast, cervical, and colorectal cancer among eligible adults by select sociodemographic and health characteristics. In the USAPI overall, 20.6 % (95 % confidence interval [CI]: 18.6, 22.8) of participants were up-to-date with breast cancer screening, 38.6 % (95 % CI: 37.1, 40.2) with cervical cancer screening, and 15.1 % (95 % CI: 13.8, 16.4) with colorectal cancer screening. Screening in the USAPI overall was lower for all three cancers among participants who reported having a high school education or less compared to those with more than a high school education. Cervical cancer screening was lower among participants with diabetes compared to those without diabetes, and colorectal cancer screening was lower among participants who reported tobacco use than among those without tobacco use. Cancer screening was suboptimal across all three cancer types in the USAPI. Developing, implementing, or expanding culturally tailored and effective cancer screening strategies may address barriers to screening and improve access and utilization.

Are National Breast and Cervical Cancer Early Detection Program Recipients Providing Services in Counties Heavily Burdened by Breast and Cervical Cancer?

Introduction: Alignment of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) clinical services with the spatial distribution of breast and cervical cancer burden is essential to maximizing programmatic impact and addressing cancer disparities. This study identified spatial clustering of breast and cervical cancer burden scores and assessed whether and to what extent NBCCEDP clinical services were associated with clusters for the 5-year period, 2015–2019. Methods: We examined burden scores for spatial clustering using Local Indicators of Spatial Association (LISA) tests in GeoDA. We then used t-tests to compare the NBCCEDP 5-year average percentage of eligible women served clinical breast and cervical cancer services between hotspot (high burden) and coolspot clusters. Results: There was statistically significant spatial clustering in the pattern of breast and cervical cancer burden scores across counties, with hotspot clusters mostly observed in the Southern region, Idaho and Nevada. For both breast and cervical cancer, higher percentages of eligible women received breast and cervical cancer clinical services in coolspot clusters compared to hotspot clusters during each year from 2015–2019. Conclusion: NBCCEDP clinical services can help reduce breast and cervical cancer burden. Yet, during 2015–2019, increased service delivery was not aligned with the spatial distribution of counties with greater breast and cervical cancer burdens. NBCCEDP recipients may improve their impact on breast and cervical cancer burden by prioritizing and consistently increasing service delivery in cancer burden hotspot clusters if they have not already maximized their resources in these areas.