Tackling the Hidden Toll of Breast Cancer in the Pacific Islands

In Hela Province, in the distant interior of the PNG mainland, rural women would need to travel considerable distances by road or air to reach a hospital that provides breast screening mammograms. Credit: Catherine Wilson/IPS.

The burden of breast cancer, the most common cancer among women, is global, and the projected increase in cases in the coming decades will affect women in both high- and low-income countries in every region.

That includes the Pacific Islands, where it is the top cause of female cancer mortality. Now, during Breast Cancer Awareness Month, islanders talk about tackling the disparities they face and reversing the trend.

“Breast cancer is a significant health concern in Madang Province,” said Tabitha Waka of the Country Women’s Association in Madang Province on the northeast coast of Papua New Guinea. “Most of our women residing in urban centres have access to enough information and facts about cancer, but at least half who live in rural areas don’t.”

Current global trends indicate that new breast cancer cases could reach 3.2 million every year by 2050, reports the World Health Organization (WHO). In the Pacific Islands, which comprise 22 island nations and territories and 14 million people, more than 15,500 cases of cancer in general and 9,000 related deaths were recorded in 2022. But experts warn that the true numbers are unknown.

“It is currently not possible to accurately estimate the true burden of breast cancer in the Pacific Islands due to significant challenges in cancer data collection and the incomplete coverage of population-based cancer registries,” said Dr Berlin Kafoa, Director of the Pacific Community’s Public Health Division in Noumea, New Caledonia, adding that it was an issue that countries were working to rectify.

Lack of cancer data is one sign of the funding and resource constraints experienced by national health services. And women are being affected, especially in rural communities where they have less access to knowledge about breast cancer and live far from urban-based health clinics and hospitals. These are major factors in global disparities. While 83 percent of women in high-income countries are likely to survive following a breast cancer diagnosis, the likelihood of survival declines to 50 percent in low-income countries.

Breast cancer occurs when cells in the breast change, multiply, and form tumours. Symptoms can include unusual lumps or physical changes in the breasts. If the cancer is detected early, the chances of successful surgery and treatment are high. At a more advanced stage, it can spread to other parts of the body. The risk of breast cancer increases after 40 years and with a family history of the disease, as well as lifestyle factors such as tobacco and alcohol use and lack of physical exercise. However, this is not prescriptive, and about half of all breast cancers are diagnosed in women with no significant risk criteria apart from their age.

Importantly, being diagnosed with breast cancer today is not fatal, and many women can enjoy long and productive lives. The key to this outcome is early detection, but one of the hurdles for women in the Pacific is that specialist services are centralised in main cities. In Papua New Guinea (PNG), women can seek mammograms, the main method of breast screening, in hospitals in the capital, Port Moresby, and the cities of Lae and Kimbe on the northeast coast of the mainland. But most of the 5.6 million women, who make up 47 percent of the population, live in rural areas—whether densely forested mountains or far-flung islands—and it could entail a long and costly journey by road, air, or boat for many to reach a hospital with a mammogram machine.

It is also not uncommon for women to hold back from seeking medical advice or proceeding with treatment because of cultural and community taboos.

“There is evidence to suggest that cultural and community taboos, personal inhibitions, and fears surrounding medical examinations are significant factors contributing to the low levels of early breast cancer diagnosis and treatment among women in Pacific Island societies,” Kafoa said.

Modesty and privacy are important to many women in traditional Melanesian societies. In Palau, for example, a study published by Australia’s Griffith University in 2021 revealed that “low screening rates were, at least in part, explained as being due to women feeling uncomfortable during examinations due to its personal nature.”

There can also be pressure from families that may encourage or dissuade women from taking treatment. “If the family disagrees with the treatment, women might comply due to cultural norms,” and concerns about mastectomy and how it changes women’s bodies “can cause resistance to surgical procedures,” reports a breast cancer study in Fiji published last year.

Taking action now is imperative to save women’s lives across the region and, globally, achieve Sustainable Development Goal No. 3 of good health and well-being. The International Agency for Research on Cancer (IARC) predicts that breast cancer cases could increase globally by 38 percent and mortality by 68 percent by 2050. Experts project that cancer incidence in the Pacific Islands could rise by 84 percent between 2018 and 2040. Kafoa says that “Pacific Island governments are not yet sufficiently prepared to confront the projected surge in breast cancer by mid-century.”

The PNG government’s national health plan includes strengthening health services to reduce cancer morbidity and mortality, but a population-wide breast screening programme is yet to be rolled out. Waka says there is a need for more investment in breast cancer services. “One or two facilities are not enough to cater for the large numbers of women living with breast cancer,” she stressed.

Efforts to transform the quality and outreach of healthcare in the country, through the ‘glocal’ approach of combining global technology and local pathways to action, have begun. “This process is already underway,” said Dr Grant R. Muddle, a global healthcare expert who has worked to assist health system transformation in Australia, the Pacific, and other regions. He is now working with health services in PNG.

Two years ago, a collaborative project was set up with an Australian health agency that “is providing PNG with proven cancer registry software and technical support, while local officials adapt it to PNG’s context. The result is a win-win: PNG quickly gains a modern data system and trained personnel, rather than building from scratch,” Muddle explained.

Mobile technology could also be used to help expand the recording of cancer cases. “Village health workers or clinic nurses, even in isolated areas, could be trained to input basic patient and tumour details into tablets or smartphones,” he continued.

A major step in improving rural health services occurred this year when a new public hospital opened in the remote Highlands province of Enga. It is expected to have an operational mammography unit by the end of this year. But there is also a need to “take the screening technology to women, rather than expecting women to travel to the technology,” Muddle emphasised. “Globally, mobile mammography clinics in vans or portable units have been used to bring breast cancer screening to underserved communities… these could be truck-mounted clinics or portable equipment that can be flown by small plane or ferried by boat to regions with no road access.”

And telemedicine, another proven strategy, can link isolated clinics to specialist doctors at provincial hospitals via video consultations.

As PNG celebrates its 50th anniversary of Independence this year, these initiatives support better outcomes for women’s breast cancer survival and the long journey ahead of meeting the nation’s healthcare goals.

“What needs to be done, we must do. Let us not compromise basic healthcare but, at the same time, provide specialist care. Together, let us secure a functioning health system for the 10 million people of PNG,” Prime Minister James Marape advocated to the Medical Society of PNG in September.