Reducing Cancer Health Disparities in the US-associated Pacific

Abstract

Purpose-To assess cancer prevention and control capacity in the US-associated Pacific Islands (USAPI, including American Samoa, Northern Mariana Islands, Micronesia, Guam, Marshall Islands, and Palau) and to support indigenous leadership in reducing cancer health disparities.Methods-Jurisdiction-specific needs assessments were conducted to assess cancer prevention and control capacity and challenges, The Cancer Council of the Pacific islands (CCPI), an indigenous health leadership team from public health and medicine, was supported to review assessment findings, develop priorities, and build capacity to address recommendations.Results-Capacity varied across jurisdictions, but generally there is limited ability to measure cancer burden and a lack of programs, equipment, and trained personnel to detect and treat cancer. Most cancers are diagnosed in late stages when survival is compromised and care is most costly. Jurisdictions also are challenged by geographic, social, and political constraints and multiple incountry demands for funding. Based on findings, strategies were developed by the CCPI to guide efforts, including fund seeking, to expand cancer prevention and control capacity in regionally appropriate ways.Conclusions-Concerted planning, training, and funding efforts are needed to overcome challenges and upgrade capacity in cancer education, prevention, detection, and treatment in the USAPI. Indigenous leadership and local capacity building are essential to this process. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript health crisis occurring in the United States-associated Pacific Islands (USAPI). The region's limited ability to detect, diagnose, and treat cancer is believed to contribute to late detection, when survival is compromised and care is most costly. The cancer prevention and control capacity of the USAPI also is challenged by geographic, social, and political constraints and multiple in-country demands for sparse funding. [1][2][3] The USAPI refers to six separate and distinct island-based jurisdictions in the Pacific that have formal relationships with the US government: American Samoa, Guam, Inherent in these political relationships is conflict over the extent of the responsibility of the United States to provide for health, education, and welfare of these jurisdictions. 1,6,8 Despite economic aid, most jurisdictions are economically unstable with only marginal health and educational systems. They have experienced rapid cultural upheaval and are heavily dependent on the US as well as other foreign aid. 5,6 Most jurisdictions are burdened with health conditions found in both developing countries (eg, malnutrition, filariasis, and dengue fever), and diseases associated with developed countries (eg, diabetes, heart disease, and cancer). 8Cancer in this region has gained US attention in the past decade because of newly released information associated with US thermonuclear weapons testing. For the CCPI, the assessment of cancer prevention and control capacity prov...

Common Determinant and Prevention Strategies of Cancer in the Pacific Countries: A Systematic Review

“…In addition, developing countries have limited resources allocated toward prevention of cancer and treatment of cancer [12]. In PICs, cancer patients received better treatment and services when referred to the US and the other developed countries when compared to the patients receiving treatment and services within their own PICs [13].…”

Eyes on the Pacific: Cancer Issues of Native Hawaiians and Pacific Islanders in Hawai`i and the US-Associated Pacific

“…More than half are Samoans, and most others are from the RMI (Republic of the Marshall Islands) and the FSM (Federated States of Micronesia) 4,5. There are no reliable population-based estimates of breast and cervical cancer prevalence or screening utilization in these populations, either in their home countries (due to lack of tracking infrastructure) or in the US (due to small population numbers) 4–6. Although American Samoa, RMI, and FSM have Centers for Disease Control and Prevention (CDC)-funded Breast and Cervical Cancer Control Programs (BCCCP), capacity and reach are limited 6.…”

“…There are no reliable population-based estimates of breast and cervical cancer prevalence or screening utilization in these populations, either in their home countries (due to lack of tracking infrastructure) or in the US (due to small population numbers) 4–6. Although American Samoa, RMI, and FSM have Centers for Disease Control and Prevention (CDC)-funded Breast and Cervical Cancer Control Programs (BCCCP), capacity and reach are limited 6. Once in Hawai'i, these groups underutilize BCCCP services, likely due to lack of awareness about the importance of screening and the recommended screening guidelines, lack of awareness about BCCCP, lack of financial resources for copayments, and lack of transportation to mammography units 4,5.…”

“…These groups are more likely than other ethnic groups in the US to be diagnosed at late stages of disease and to die from cancer. They also are less likely to be up-to-date with cancer screening, and they are more likely to engage in lifestyle practices that increase their risk of cancer, eg, they are more likely to be overweight and less likely to engage in physical activity than many other ethnic groups 1–6…”

Identifying the Causes of Cancer Health Disparities

“…The causes of cancer health disparities in underserved populations such as Pacific Islanders are multifactorial and complex (Palafox, Buenconsejo-Lum et al 2002; Tsark and Braun 2007; Tanjasiri and Tran 2008). Medical advancements that have been made in the early detection, diagnosis, and treatment of cancer have not been realized by all racial/ethnic groups in our society (Brawley and Berger 2008; Goss, Lopez et al 2009).…”