U.S.-Affiliated Pacific Island (USAPI) Jurisdictions

American Samoa – CNMI – Guam – Palau – RMI - FSM

On behalf of the Cancer Council of the Pacific Islands (CCPI) and the Pacific Comprehensive Cancer Control Coalition, we are pleased to present the updated Pacific Regional Comprehensive Cancer Control (RCCC) Plan for 2022-2027. This document is a work in progress, as the CCPI will continually refine strategic priorities and activities based on changing resources and health system infrastructures in each of the six USAPI.

Cancer places a particularly heavy burden on our individual small countries and states; chronic disease places an even bigger burden, such that the Pacific Islands Health Officer Association (PIHOA) declared a Regional State of Emergency due to Non-Communicable Diseases (NCD) on May 25, 2010. Our populations and absolute numbers of cancer are relatively small compared to the United States, but because of the many challenges that exist in our jurisdictions' economic and health care infrastructure, the burden is high. Given the high rates of obesity in children and adults and tobacco use among youth, we anticipate that the NCD and cancer burden will increase drastically while our health systems remain inadequately prepared to address this NCD burden.

Awareness and advocacy about cancer-related issues were brought to U.S. Affiliated Pacific Island (USAPI) Regional and U.S. National attention starting in the mid-1990s. After several years of advocacy by dedicated physicians and public health leaders in the USAPI and Hawaii, the Pacific Cancer Initiative was started in 2002. With funding from the NCI National Center to Reduce Cancer Health Disparities and the NIH National Center on Minority Health and Health Disparities, assistance from Papa Ola Lokahi and 'Imi Hale (who held an NCI Special Populations Network grant) and under the leadership of Dr. Neal Palafox, an indigenous advisory council was formed, The Cancer Council of the Pacific Islands (CCPI). Together with the University of Hawaii Department of Family Medicine and Community Health, also under the direction of Dr. Neal Palafox, Cancer Needs Assessments were performed in 2002. From there, preliminary regional and jurisdiction-specific priorities were formed. In 2004, the University of Hawaii, designated as the bonafide agent for 5 of 6 USAPI, received a National Comprehensive Cancer Control Planning grant; Palau received its own NCCCP grant. In 2005, a feasibility study for a regional cancer registry was conducted. In 2007, the CCPI developed the first RCCC plan, designed as an adjunct to each jurisdictions' NCCCP implementation funding. As part of the RCCC plan, in 2011, a region-wide assessment on cervical cancer prevention (immunization, screening) was conducted to evaluate and improve cervical cancer control efforts throughout the Region.

The original Pacific Regional CCC Plan was developed in conjunction with the individual CCC plans for the three Flag Territories and the three Freely Associated States (FAS). The Flag Territories are American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands (CNMI). The Freely Associated States include the Republic of the Marshall Islands (RMI), and the Republic of Belau (also known as Palau) and the Federated States of Micronesia (FSM), which consists of Yap, Pohnpei, Kosrae, and Chuuk States. Each of these jurisdictions has developed its own CCC plan – 9 in total – to address their specific needs. With the increased NCD burden and emphasis on collaboration with other NCD programs, the 2012-2017 RCCC Plan was updated and developed with several regional NCD partners and initiatives (tobacco, diabetes, regional surveillance, quality assurance) and includes collaborative objectives and strategies in several goal areas. The 2017–2022 RCCC plan narrowed the focus to four main areas, namely Prevention, Screening, and Early Detection, Treatment and Quality of Life, as well as continues to focus on local capacity building, which is critical for successful and sustained efforts in CCC.

Pacific-Regional-CCC-Plan-2022-27-final-on-03142022.pdf