SEARCHNARRATIVE_REVIEWoncology, public_health

narrative_review·oncology, public_health, epidemiology, radiation_oncology, head_and_neck_oncology, gynecologic_oncology, gastroenterology, endocrinology·PMC10000177

Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region

Cancers · 5 authors, 4 centres

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FIDELITY 88%

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

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TL;DR

This narrative review examines the sociocultural determinants driving cancer disparities among indigenous Pacific Islanders in Micronesia, where cancer is the second leading cause of death. Key factors include transitions from traditional diets, high rates of betel nut chewing, historical radiation exposure from nuclear testing, limited healthcare infrastructure, and climate change threats. The authors underscore that these interconnected factors produce some of the world's highest rates of obesity, cervical cancer (up to 8 times US rates), and oral cavity cancers, while severely limited oncology services and physician shortages delay diagnosis and treatment.

Full summary

3,721 CHARS

**Background:** Micronesia is an ethnogeographic region within Oceania comprising over 2,000 islands and atolls, including the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Palau, the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), Nauru, and Kiribati. Cancer is the second leading cause of death in nearly all US-Affiliated Pacific Island (USAPI) nations. This narrative review comprehensively examines the sociocultural determinants of health that contribute to cancer disparities in this underserved region.

**Methods:** The authors conducted a keyword-based literature review using PubMed Advanced Search on or before December 1, 2022, for studies with terms including "Micronesia," "Guam," "Mariana," "risk factors," "social determinants of health," "healthcare," "diet," "radiation," "cancer," and "oncology." They limited the review to research on human subjects, English-language peer-reviewed articles, online reports, electronic books, and press releases, focusing on studies from the US, Micronesia, Australia, and New Zealand.

**Key Results:** Cancer incidence data from the Pacific Regional Central Cancer Registry (2007–2018) reveal stark disparities. Cervical cancer incidence reaches 65.8 per 100,000 in RMI and 40.7 in Pohnpei—5–8 times higher than US rates. Oral cavity and pharynx cancer incidence is 4 times higher in Yap (53 per 100,000) compared to the US (12.0 per 100,000). Liver cancer incidence is 2–3 times higher in Palau (23.8) and Yap (20.5) versus the US (8.1). Lung cancer 5-year survival rates range from 4% in Yap to 30% in Guam. Breast cancers are frequently detected at stage 3 or later in RMI and Pohnpei.

MAJOR CONTRIBUTING FACTORS INCLUDE

(1) Dietary transitions—96% of Pohnpeian women eat rice frequently (3–7 days/week) while only 75% consume locally grown carbohydrates; over 80% of Pohnpei's population consumes less than five servings of fruits and vegetables daily. (2) Obesity—the top 10 countries with highest obesity rates are all Pacific Island nations; over 80% of adults in Pohnpei and Kosrae are obese. (3) Betel nut use—over half of Micronesia's adult population chews betel nut (world average 20%); 75% of Palauan high school students have tried it; 90% of chewers in Pohnpei and 80% in Palau co-consume tobacco. (4) Radiation exposure—nuclear testing from 1946–1958 deposited radioactive materials; some studies suggest increased risk of thyroid and hematological cancers by 20% and 5% respectively. (5) Healthcare infrastructure—only Guam has MRI/PET imaging, chemotherapy, and radiation therapy; many islands lack pathologists, radiologists, and oncologists; off-island referrals cost an estimated $125 million as of 2017.

CLIMATE CHANGE COMPOUNDS THESE ISSUES

low-lying islands face sea level rise, and a 2007 sea level rise event in two atoll islands caused complete loss of farmed produce in one-third of households. COFA migrants were excluded from Medicaid until 2020, and mortality rates for COFA migrants increased 21% from 2015–2018. Pacific Islanders are among the least represented groups in US medical schools, with virtually no oncology representation.

**Clinical Implications:** Addressing cancer disparities in Micronesia requires culturally informed interventions targeting diet, betel nut use, and healthcare access. Strengthening the physician workforce pipeline, expanding telehealth, improving cancer surveillance infrastructure, and building climate-resilient health systems are critical. The Pacific Regional Comprehensive Cancer Control Program (established 2002) and its regional cancer registry represent important coalition-building efforts that have already informed policy decisions.

STUDY TYPE

narrative_review

SPECIALTY

oncology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

88% · B

ORIGINAL PAPER

PMC10000177

Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region

Cancers

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ABSTRACT

Abstract Simple Summary Micronesia is an ethnogeographic region within the continent of Oceania that represents an underserved area of the world. Cancer is the second leading cause of death among the people of Micronesia and indigenous Pacific Islanders share an unequal burden of the disease. Many factors come into play when discussing the adverse health outcomes of Micronesian people. Our paper intends to review these factors that have led to the ongoing health crisis among indigenous Pacific Islanders. Abstract It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia. Keywords: cancer disparities, Micronesia, Palau, Nauru, Kiribati, Mariana Islands, Guam, Pacific Islands, health disparities, Oceania

CITATION EXPORT

Eric Pineda, Ryan Benavente, Megan Y Gimmen et al.. Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region. Cancers. (2023). https://doi.org/10.3390/cancers15051392

AUTHORS

5 · 4 CENTRES

Eric Pineda, Ryan Benavente, Megan Y Gimmen, Nicole V DeVille, Kekoa Taparra

1Tulane University School of Medicine, New Orleans, LA 70112, USA
2Harvard Medical School, Boston, MA 02115, USA
3Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
4Department of Radiation Oncology, Stanford University, Palo Alto, CA 94305, USA

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3,721 CHARS

MAJOR CONTRIBUTING FACTORS INCLUDE

CLIMATE CHANGE COMPOUNDS THESE ISSUES

Eric Pineda, Ryan Benavente, Megan Y Gimmen et al.. Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region. Cancers. (2023). https://doi.org/10.3390/cancers15051392