Dealing With Cancer

A newly formed Cancer Council of the Pacific Islands (CCPI) representing United States-affiliated islands in the region is aiming to step up prevention programs and develop a region-wide cancer registry.

Dr. Kamal Gunawardane, who heads the Council, says that cancer data and screening programs in the U.S.-affiliated islands are generally very poor, there have been few studies and what data does exist often can't be compared from island to island because of different collection styles.

"It's obvious we have a higher cancer rate in the Marshall Islands," he says. A study of cancer trends in the Marshall Islands from 1984 to 1994 showed that the rate for a majority of cancers checked was three-to-four times higher than in the U.S. There are a variety of reasons, including radiation exposure from American nuclear weapons tests, smoking, sexually transmitted diseases, hepatitis B and other factors that cause the cancers, he adds.

And what Gunawardane, who has worked as a surgeon at Majuro Hospital and other medical officials see is the general lack of systematic cancer screening and prevention programs that would reduce both the mortality rate and the high cost of treating late stage cancers at off-island hospitals, costs that eat up large portions of island health care budgets. With the exception of Palau-which Gunawardane says is more advanced in cancer prevention than any of the other islands-there is little in the way of early cancer screening, he says.

In the Marshall Islands, only pregnant women who come to prenatal clinics at the hospital receive cancer screening. But few other women who are "at-risk" receive annual screening for cervical and breast cancer, he says, adding that it's a similar situation in most islands.

The CCPI also hopes to address the absence of standardized cancer data collection in the region, which makes it impossible for islands to compare notes. "The first goal is of the CCPI is to establish a central database and for each island to have its own," Gunawardane says.

The organization includes medical officials from the Marshall Islands, Federated States of Micronesia, Palau, Guam, Commonwealth of the Northern Marianas and American Samoa.

It is asking the U.S. Center for Disease Control for funding to develop a comprehensive cancer control plan for this region. Gunawardane's hopeful that it will be approved because it is a regional effort. "If we applied as an individual jurisdiction, there's only a small chance of getting approval," he says. "But we applied as six islands together."

The goal of the new Cancer Council is to identify priority issues in each island, then develop prevention and control programs.