Cancer Control in the U.S. Affiliated Pacific Islands

The U.S. Affiliated Pacific Islands (USAPI), funded by CDC to implement cancer control programs, consists of Flag Territories and Freely Associated States (FAS). The Flag Territories include American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands (CNMI). The Freely Associated States include the Federated States of Micronesia (FSM), which consists of Yap, Pohnpei, Kosrae, and Chuuk; the Republic of the Marshall Islands (RMI); and the Republic of Belau (ROB) (also known as Palau) for a total of 10 USAPI jurisdictions. The population of the USAPI is about 510,000 people, with nearly 200,000 of the inhabitants living in the FAS. The USAPI is twice the size of the continental United States and crosses five time zones and the International Date Line.

Challenges Related to the Cancer Burden and Related Health Disparities

Cancer is the second most common cause of death in nearly all USAPI jurisdictions. The availability of supplies and money to ship and process Pap tests varies tremendously: in the FSM, less than 15% of women receive Pap tests; in the outer atolls of the RMI and the one urban area of the RMI, Ebeye, no screening services are available. There is no mammography unit in the FSM. Four of the USAPI receive CDC funding to provide breast and cervical cancer screening and diagnostic services.

A working colposcope for diagnosis and early treatment of cervical cancer is non-existent in several areas of the FAS. The availability of fecal occult blood testing or prostate-specific antigen testing varies. The FSM has no pathologist or radiologist, and most countries do not have an oncologist. No radiation oncology is available in the region, and most areas are unable to do maintenance chemotherapy. Medications for palliation are often in short supply, and health personnel need more training in this area. Traditional medicine and healing practices are used in most jurisdictions. Religion and spirituality play important roles in the lives of the people.

Comprehensive Cancer Control and Surveillance Plans

CDC’s Division of Cancer Prevention and Control provides National Comprehensive Cancer Control Program (NCCCP) funding to all six USAPI to develop and implement comprehensive cancer control plans. Guam, CNMI, American Samoa, and the Republic of Palau also receive funding through the National Breast and Cervical Cancer Early Detection Program to provide breast and cervical cancer screening and diagnostic services. The University of Hawaii receives CDC funding through REACH U.S. to develop a Pacific Centers for Excellence in Eliminating Health Disparities (Pacific CEED), focused on breast and cervical cancers.

Beginning in 2007, the University of Hawaii also received funding on behalf of the USAPI to develop a regional Pacific Cancer Registry. For the first time, the USAPI will have population-based cancer incidence data available for analysis and cancer control activities. With funding from the National Program of Cancer Registries, the USAPI are planning for implementation of the Pacific Regional Central Cancer Registry (PRCCR). PRCCR’s “official” reference date is January 1, 2007, but will include cases from 2000 forward. PRCCR has identified and established several data variables, including information about many chronic diseases; risk factors, such as being born in a radiation-affected atoll; screening and prevention, such as human papillomavirus vaccination; and more detailed information about ethnicity.

The USAPI worked with a variety of partners from 2004 through 2007 to build local cancer coalitions and develop individual jurisdiction comprehensive cancer control plans that address their unique situation. The development of a regional plan [PDF-613KB] that focuses on objectives and strategies best coordinated at a regional level to build capacity for early detection, treatment, and high-quality data was led by the Cancer Council of the Pacific Islands (CCPI), an indigenous advisory body comprised of two representatives appointed by the Ministers, Secretaries, and Directors of Health of the 10 USAPI jurisdictions.