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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TL;DR

This narrative review synthesizes evidence on the sociocultural determinants of health contributing to high cancer incidence and poor outcomes among indigenous Pacific Islanders in Micronesia. Key factors include transitions to a Western diet, high betel nut consumption, historical radiation exposure, limited healthcare infrastructure, and climate change threats, but the review does not establish causal links between these factors and specific cancer outcomes.

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BACKGROUND

This narrative review addresses the significant cancer health disparities faced by indigenous populations in the Micronesian region of Oceania, an underserved area where cancer is the second leading cause of death. Methods: The authors conducted a qualitative literature search of peer-reviewed articles, reports, and other sources published in English on or before December 1, 2022, focusing on studies from the US, Micronesia, Australia, and New Zealand. Key Results: The review identifies several sociocultural determinants of health contributing to cancer disparities. These include a dietary shift from traditional foods to imported processed meats and refined grains, which are linked to increased colorectal and gastric cancer risk. Historical US nuclear testing in the Marshall Islands has left a legacy of radiation exposure linked to thyroid and hematological cancers. Furthermore, extremely limited healthcare infrastructure, with severe shortages of specialists, screening tools, and treatment options like chemotherapy and radiation, leads to late-stage diagnoses and reliance on costly off-island referrals. Climate change, causing sea-level rise and severe weather, threatens to further disrupt food security, displace populations, and compromise fragile health systems. Limitations: As a narrative review, it synthesizes existing literature without a systematic meta-analysis, so findings represent associations observed in primary studies rather than confirmed causal relationships. Implications: The findings underscore the urgent need for multifaceted interventions, including culturally informed dietary and substance-use programs, investment in local healthcare infrastructure and physician workforce diversity, and climate-resilient health planning to address the complex web of factors driving cancer inequities in Micronesia.

STUDY TYPE

narrative_review

SPECIALTY

oncology

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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

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