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Cancer Epidemiol. 2017 Oct;50(Pt B):283-288. doi: 10.1016/j.canep.2017.07.008.

Acceptability and feasibility of a community based participatory research project comparing cytology and urine HPV DNA testing for cervical cancer screening in Yap, Federated States of Micronesia.

Author information

Pacific Cancer Projects, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd #815, Honolulu, HI, 96813, United States. Electronic address:
Cancer Research Center of Hawaii, University of Hawaii, 701 Ilalo Street, Honolulu, HI, 96813, United States.
Yap State Department of Health Services, PO Box 148, Colonia, Yap, 96943, Federated States of Micronesia.
Pacific Cancer Projects, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd #815, Honolulu, HI, 96813, United States.


Non-invasive, self-collected sampling methods for HPV DNA detection in women, which are reliable, efficient, and acceptable have the potential to address barriers to cervical cancer screening in underserved communities, including low-middle income countries (LMIC) such as the island nation of the Federated States of Micronesia (FSM). Urine-based HPV testing has not been rigorously evaluated in clinical trials. A pilot community-based participatory randomized control research project evaluated use of urine HPV testing as a more culturally- and human resource appropriate method of cervical cancer screening in Yap State, FSM. Women participated in a cervical screening intervention using pap vs. urine test (N=217). This manuscript described attitudes about screening feasibility and preferences. Stakeholders and women participants were interviewed (N=23), and a survey also evaluated women's screening preferences (N=217). Qualitative content thematic analysis with multiple coders identified themes from interviews on acceptability and feasibility of screening tests. Women research participants were comfortable with the urine test (95%), despite limitations in some to provide samples. While 82.0% indicated that they felt comfortable with Pap smear, they also preferred a clinician (42%) to do the Pap smear, explaining that they preferred having a trained worker instead of themselves to do tests. Women want to be screened but accessibility remains a challenge. Education and training of professionals and community members alike will improve clinical skills, research capacity, knowledge of screening tests and behaviors including prioritizing HPV screening and testing.


Cancer screening; Community based participatory research; Early detection of cancer; Female; Human papillomavirus; Pacific Islands; Papillomavirus infections; Prevention and control; Translational research

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