PICCSi: Pacific Island Cervical Cancer Screening Initiative

Project Leaders: Dr Nicola Fitzgerald and Dr Amanda Hill

Project Partner: Fiji National University, Department of Obstetrics and Gynaecology @ Lautoka Hospital, Hospital Rd, Lautoka, Fiji.

Location: This project is a pilot program for the Pacific Islands and will operate in Fiji. 



Fiji, along with other Pacific countries, has a high burden of cervical cancer.

The annual mortality rate per 100,000 people from cervical cancer in Fiji has increased by 44.1% since 1990, an average of 1.9% a year.

This is in part due to the high prevalence of the human papilloma virus (HPV) and the low rate of cervical screening across the region.

There are economic and social/logistical reasons for this, however a large barrier to screening in the Pacific is the long delay in the time taken to obtain results, and a high loss to follow up rate of women screened.


Defining the Problem:

1) Currently there is not the financial support from the Ministry of Health (MOH) in Fiji to fund a national cervical cancer screening program. Further recognition of the importance of cervical screening, and also further funding is needed.

2) Currently there is not the workforce amongst the local pathologist community to perform the number of cervical cytology and histology specimens that are required for a functioning national cervical cancer screening program. There are also quality control issues in this group. An increase in workforce, and improved training within that area of the workforce is needed.

3) The small medical/pathology work force means that women are not able to access the results of their cervical screening test in a timely fashion. In Fiji it takes up to 8 weeks for results to be obtained. Together with transport and family issues, this ensures a large rate of women lost to follow up, and who don’t receive treatment for abnormal results.

4) Women are being screened for cervix cancer opportunistically in Fiji ie when presenting for another issue to a hospital gynaecology outpatient appointment, rather than routinely. This means that only a small number (around 8%) of Fijian women have cervical screening. The number of women screened for cervix cancer in Fiji needs to increase to have an effect on the overall cervical cancer mortality rate in Fiji.

5) Women in Fiji have very limited health literacy, and are unaware they would benefit from screening for cervical cancer. Further education of the population is needed.

6) Information regarding the prevalence and incidence of HPV and cervical cancer in the western part of Fiji has not been collected in the past. Previous studies have looked only at health centres near the capital city of Suva. These regions of Fiji are quite separate geographically, as they are divided by a long mountain range.

 This Pilot Program:

The plan for this pilot study would be to perform point-of-care HPV testing for women presenting for screening at local health centres, and to invite women to wait for their results (expected to be around 60 minutes) and have access to treatment on the same day.

Treatment would be performed by a specialised gynaecologist, or a gynaecology registrar being supervised by a specialist. 

Ideally all screening and treatment would involve training of local clinicians – general practitioners, health centre nurses and specialist registrars – so that the program could be run by local staff in the future. 

If the pilot successfully shows that large numbers of women can be screened and treated for cervical dysplasia in an acceptable and safe manner in Fiji, the aim of the PICCSI would be to roll out the program to other areas in the Pacific.

Overall objectives:

1)Improve access to accurate and timely screening and treatment for cervical dysplasia (precancerous cell changes on the cervix) to Fijian women

2) Improve awareness of cervical cancer amongst Fijian women and encourage screening

3) Encourage local medical practitioners to become involved in the project so that it is sustainable in the long term

4) Provide data about acceptability and cost effectiveness of screening to the Fiji Ministry of Health, so that serious consideration is given to a nationwide screening program.

5) Start to develop a longer term project that will involve screening for cervical cancer throughout the Pacific.

6) Start to collect long term outcome data through Lautoka Hospital regarding incidence of cervical cancer, as well as rates of preterm birth amongst women treated for cervical dysplasia.

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We are interested in projects that involve:

Rural community health clinics, special units in hospitals where patients lack access to such facilities

Training of all kinds of health workers with an emphasis on community health

 Scholarships for Post-graduate training and professional development of healthcare graduates 

The provision of multimedia resources for health education

Community health development in dentistry

Health education of school teachers, students and community leaders