Contents lists available at ScienceDirect Cancer Epidemiology journal homepage: www.elsevier.com/locate/canep Cancer epidemiology in the small nations of Pacific Islands Hanna Tervonen a, ⁎ , Sunia Foliaki b , Freddie Bray c , David Roder a,d a School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia b Centre for Public Health Research, Massey University, Wellington Campus, PO Box 756, Wellington 6140, New Zealand c Section of Cancer Surveillance, International Agency for Research on Cancer, 69372 Lyon Cedex 08, France d South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, 5000, Australia ARTICLE INFO Keywords: Pacific islands Epidemiology Neoplasms Incidence Mortality Indigenous ABSTRACT Background: Pacific island countries and territories (PICTs) comprise 20,000–30,000 islands in the Pacific Ocean. PICTs face challenges in relation to small population sizes, geographic dispersion, increasing adoption of unhealthy life-styles and the burden of both communicable and non-communicable diseases, including cancer. This study reviews data on cancer incidence and mortality in the PICTs, with special focus on indigenous po- pulations. Methods: PICTs with populations of < 1.5 million (‘small nations’) were included in this study. Information on cancer incidence and mortality was extracted from the GLOBOCAN 2012 database. Scientific and grey literature was narratively reviewed for publications published after 2000. Results: Of the 21 PICTs, seven countries were included in the GLOBOCAN 2012 (Fiji, French Polynesia, Guam, New Caledonia, Samoa, Solomon Islands, Vanuatu). The highest cancer incidence and mortality rates were reported in New Caledonia (age-standardized incidence and mortality rates 297.9 and 127.3 per 100.000) and French Polynesia (age-standardized incidence and mortality rates 255.0 and 134.4 per 100.000), with relatively low rates in other countries. Literature indicated that cancer was among the leading causes of deaths in most PICTs; thus they now experience a double burden of cancers linked to infections and life-style and reproductive factors. Further, ethnic differences in cancer incidence and mortality have been reported in some PICTs, in- cluding Fiji, Guam, New Caledonia and Northern Mariana Islands. Conclusion: Cancer incidence in the PICTs was recorded to be relatively low, with New Caledonia and French Polynesia being exceptions. Low recorded incidence is likely to be explained by incomplete cancer registration as cancer had an important contribution to mortality. Further endeavors are needed to develop and strengthen cancer registration infrastructure and practices and to improve data quality and registration coverage in the PICTs. 1. Introduction Pacific island countries and territories (PICTs) comprise 20,000–30,000 islands in the Pacific Ocean [1]. They are small nations in terms of both population sizes and geographic land areas. Popula- tions in the PICTs are relatively young and multi-ethnic, including na- tive (indigenous) people, migrants from other PICTs and migrants outside the Pacific region [2]. PICTs are at different stages of economic development but they all face similar challenges in relation to small populations, geographic dispersion, long distances and the triple burden of communicable diseases, non-communicable diseases (NCDs) and the health impact of climate change [1]. The prevalence of common risk factors for NCDs, such as obesity, physical inactivity, poor diet and tobacco and alcohol consumption, is high. NCDs are the leading cause of mortality in the PICTs comprising 75% of all deaths in 2011. In addition to other NCDs, the burden of cancer is increasing in the PICTs; however, evidence is limited due to low coverage and sub- optimal quality of cancer registration and paucity of reliable mortality data, especially data on causes of deaths [3,4]. Since the report on cancer incidence in the Pacific region published in 1985 [5], cancer epidemiology in the PICTs has been reviewed by several authors [3,4,6–9]. Dachs et al. examined cancer disparities in indigenous Polynesian populations and found disproportionately higher cancer mortality in Polynesian people compared with Europeans living in New Zealand and Hawaii, whereas data were limited on indigenous dis- parities in Polynesian people living in Pacific Islands [3]. The most recent review by Varghese et al. focused on cancer burden and control http://dx.doi.org/10.1016/j.canep.2017.09.002 Received 15 July 2017; Received in revised form 18 September 2017; Accepted 19 September 2017 ⁎ Corresponding author. E-mail addresses: hanna.tervonen@unisa.edu.au, hanna.e.tervonen@gmail.com (H. Tervonen). Cancer Epidemiology 50 (2017) 184–192 1877-7821/ © 2017 Elsevier Ltd. All rights reserved. MARK