The state of cervical cancer screening in Vanuatu: A retrospective analysis (2015–2020)

Abstract

Aims

Vanuatu is a lower- and middle-income country in the Pacific with a cervical cancer incidence of 100 per 100,000 women. An opportunistic screening program has existed since 2008, with continuous data collection related to this since 2015.

Methods

We analysed all cervical cancer screening data for Vanuatu over 6 years, and conducted a descriptive analysis of number of women screened, the results of screening, the treatment rates of human papillomavirus (HPV) positivity or cytological abnormalities detected through screening, and the incidence of cervical cancer. The challenges encountered during the implementation of the screening program are also described.

Results

Data were available from 01/01/2015 to 31/12/2020. Based on census data, 70,081 women were eligible for screening, and 15,696 (22.4%) women underwent screening at least once. Screening coverage included 13.2% of individuals under 30 years, 33.2% of individuals in the 30−50 age group, and 15.8% of people over 50 years. A total of 8910 HPV tests were conducted, of which 876 (9.8%) were positive. Among the HPV-positive cases, 316 received large loop excision of the transformation zone (LLETZ) treatment, 156 (49.4%) of which were high grade and 2 (0.6%) of which were cancer. A total of 13,396 Pap smear tests were conducted, with 315 (2.4%) showing high-grade results and 226 (1.7%) indicating possible high-grade results. Overall, 119 cancers were diagnosed from 15,696 women screened (0.8%), including 6/3297 (0.2%) of < 30 years, 75/10,089 (0.7%) of 30−50 years, 38/2310 (1.6%) of > 50 years.

Conclusion

One in five eligible Ni-Vanuatu women have undergone cervical cancer screening since 2015, with 7.6 per 1000 women having malignant results and 40.4 per 1000 women having high-grade or possible high-grade results.