BACKGROUND: We have established and/or upgraded cancer registries in four Pacific countries, a region where few cancer registries exist. We report age-standardised cancer incidence in Tonga (2000-2005), Fiji (2002-2005), Cook Islands (2000-2005) and Niue (2000-2005), and in Pacific people in New Zealand (2000-2005).
METHODS: In each country we identified incident cancer cases by reviewing hospital discharge, death registration, cancer registration records, and pathology reports. The primary site and morphology data were coded using ICD-0, and age-standardised incidence rates were calculated.
RESULTS: Age-standardised cancer incidence rates for Pacific people in New Zealand (315 per 100,000 person-years in females, 379 in males) were similar to those for New Zealand overall (322 in females, 404 in males); incidence rates were lower in the Pacific, with rates of 195 and 151 per 100,000 person-years for females and males respectively in Tonga, 231 and 126 in Fiji, 165 and 142 in the Cook Islands, and 228 and 131 in Niue. However, some specific cancers were elevated in the Pacific including cervical cancer (16 per 100,000 in Tonga, 51 in Fiji, 17 in Cook Islands, and 26 in Niue compared with 10 in Pacific people in New Zealand, and 8 in New Zealand overall), liver cancer (rates of 8, 5, 19, 0, 7, and 2 respectively) and uterine cancer (rates of 24, 18, 47, 19 and 12 respectively).
CONCLUSIONS: Cancer incidence in the Pacific is lower than for Pacific people living in New Zealand. Environmental rather than genetic factors are most likely to explain these patterns, and cancer incidence in the Pacific is likely to increase to rates similar to those in New Zealand as the region becomes more 'westernised' The high rates of cervical cancer and liver cancer in the Pacific indicate an important role of

Polynesia consists of several islands that are scattered across a vast triangle in the Pacific, and include New Zealand, Hawaii, and the Pacific islands. There are reported differences in the types of cancer and epidemiologies seen among communities in these islands, the reasons for which are diverse and complex. In this Review, we describe patterns of cancer incidence, mortality, and survival in indigenous populations compared with populations of European origin in Polynesia, and highlight the limited available data for Pacific populations. Additionally, we document the current knowledge of the underlying biology of cancers in these populations, and report risk factors that differ between ethnicities, including smoking, viral infections, and obesity. Disparities in measures of health are highlighted, as are evident differences in knowledge of tumour biology and cancer management between majority and minority populations.

BACKGROUND: There is little published information about cancer-related knowledge, attitudes, and preventive behaviors of Tongans in the United States. The purpose of this study was to evaluate answers to the following questions: What is cancer? What causes cancer? And what can you do to prevent cancer?
METHODS: We completed face-to-face, semi-structured interviews with 48 self-reported Tongans (16 men and 32 women) over the age of 18 years, selected through non-probability purposive sampling with help from Tongan community-based organizations. The questions regarded demographic characteristics, and cancer-related knowledge, attitudes and preventive behaviors. The research settings were San Mateo, California and Salt Lake City, Utah. We analyzed the data using qualitative content analysis of individual interviews to identify themes.
RESULTS: All but one of the 48 participants had migrated to the U.S. from Tonga. The average income was approximately $3100 per month and average household size was six. Fewer than half of participants had health insurance. The theme that cancer was equivalent to death was pervasive through all the responses. Weaknesses in the body and exposure to toxins in the environment were dominant themes in the causation of cancer. Leading a healthy life and prayer were among the preventive measures cited by the respondents.
CONCLUSION: The association of cancer with death is a strong indication that cancer information is not reaching this community. Interventions must take this into account and include Tongan cancer survivors in order to enhance the effectiveness of early screening efforts.

The groundwork for the Pacific Islander cancer control network (PICCN) began in the early 1990s with a study of the cancer control needs of American Samoans. The necessity for similar studies among other Pacific Islander populations led to the development of PICCN. The project's principal objectives were to increase cancer awareness and to enhance cancer control research among American Samoans, Tongans, and Chamorros. PICCN was organized around a steering committee and 6 community advisory boards, 2 from each of the targeted populations. Membership included community leaders, cancer control experts, and various academic and technical organizations involved with cancer control. Through this infrastructure, the investigators developed new culturally sensitive cancer education materials and distributed them in a culturally appropriate manner. They also initiated a cancer control research training program, educated Pacific Islander students in this field, and conducted pilot research projects. PICCN conducted nearly 200 cancer awareness activities in its 6 study sites and developed cancer educational materials on prostate, colorectal, lung, breast, and cervical cancer and tobacco control in the Samoan, Tongan, and Chamorro languages. PICCN trained 9 students who conducted 7 pilot research projects designed to answer important questions regarding the cancer control needs of Pacific Islanders and to inform interventions targeting those needs. The legacy of PICCN lies in its advancement of improving cancer control among Pacific Islanders and setting the stage for interventions that will help to eliminate cancer-related health disparities. Cancer 2006. (c) 2006 American Cancer Society.

The Pacific Island countries are geographically scattered, with contrasting environmental, social, and political systems, and in varying stages of economic development, but all are going through a rapid epidemiological transition. Processes that took place over thousands of years in Western countries have been very much compacted in time in the Pacific. These processes have produced major changes in environment and lifestyle, which have produced epidemics of non-communicable disease. While it is important to consider non-communicable diseases as a group, it is also important to conduct research into their specific causes. There has been a great deal of research into cardiovascular disease and diabetes in the Pacific, but it is only recently that the importance of cancer as a major source of mortality and morbidity in the Pacific has been recognised, even though it appears to carry a similar burden of morbidity and mortality. It is therefore important that research into the causes and control of cancer in the Pacific is conducted. However, it is also crucially important that this research both learns from the successes and avoids the mistakes of the past. In particular, it is crucial that cancer research in the Pacific is not another opportunity for "research colonialism," but instead provides opportunities for Pacific-training of Pacific health researchers and the conduct of Pacific-led research.

Non-Maori Pacific people constitute a significant and rapidly growing population in New Zealand. An accompanying change in lifestyle associated with changing socio-economic environments results in a change in disease patterns including cancer. The paucity of reliable data on cancer necessitates our effort to contribute to the control of cancer by reviewing the available information. Our study indicates a high incidence among non-Maori Pacific people of some cancers of public health importance as well as a disproportionately high mortality rate compared to non-Maori, non-Pacific people in New Zealand. In addition, we challenge previous documentation of a significant and high incidence of cervical cancer among Pacific women compared to non-Pacific people in New Zealand. We also identified the need to remedy the inadequacy in data quality as part of any strategy to prevent and control the rising incidence and mortality attributed to cancer among non-Maori Pacific people. In addition we have commenced regional training on cancer epidemiology and propose further cancer studies in both New Zealand and the Pacific Islands.

OBJECTIVE: Breast cancer is the most common cancer for many Pacific Islander American populations, but virtually nothing is known about the cancer risks and screening behaviors of many specific ethnic subgroups. This paper examines the breast cancer risk, knowledge, attitudes, and screening behaviors of Tongan-American women.
DESIGN: Research activities were conducted in 3 phases: determination of cancer proportional ratios using data from the California Cancer Registry, exploratory focus groups conducted with 22 women, and self-administered surveys from 303 women (for a response rate of 92%).
SETTING AND PARTICIPANTS: Survey respondents were Tongan-American women aged 40 years and older, residing in Los Angeles and Orange Counties.
RESULTS: The breast is the most common cancer site for Tongan women, followed by the cervix and uterus, lung and bronchus, and stomach. The proportion of all cancers accounted for by breast cancer is lower among Tongan women (0.8) compared to White women. We found low rates for all types of breast cancer screening: only 40% of respondents had ever performed a breast self-examination (BSE); 26% ever received a clinical breast exam (CBE); and 25% ever received a mammogram. Many misperceptions existed about breast cancer causes, signs, and symptoms as well as the role of screening in detecting pre-symptomatic cancers.
CONCLUSIONS: Much emphasis needs to be placed on improving early breast cancer screenings among Tongan-American women, including comprehensive community education, culturally tailored and linguistically appropriate materials, and improved access to low-cost screening sites.