A $5.5 million federal grant will aid the University of Hawaii Cancer Center’s research into why cervical cancer rates are so high among certain Pacific Island populations.

The grant supports an 11-year-old partnership between the cancer center and the University of Guam. It will help fund increased cervical cancer screening among Micronesian women in Hawaii and Guam, and also provide services in Guam to help chronic betel nut chewers who want to quit and identify what components in the betel nut cause cancer.

“We wanted to work on areas that are very important to the Pacific, meaning they have a disparity between cancer rates in their population compared to our populations here in Hawaii,” said Dr. Neal Palafox, one of three senior investigators at the cancer center.

With some of the highest cancer incidence and mortality rates in the world, the rate of cervical cancer in Micronesian women is 79.7 per 100,000, compared with a U.S. average of 9.9 per 100,000, according to a press release from the UH Cancer Center.

UH Cancer Center
The UH Cancer Center. UH Cancer Center

Palafox said that in Guam, Pacific Islanders have variable access to cervical cancer screenings and vaccines depending on educational opportunities, health insurance and other financial circumstances. He said low screening rates can also be due to misinformation and cultural beliefs.

“If we can correct that in the far end then we will have less cervical cancer because ultimately no woman in the 21st century should die from cervical cancer,” said Palafox.

He said that cervical cancer can take as long as 15 years to develop and is curable when detected early.

Palafox said researchers are looking into using social media, community outreach and culturally appropriate methods such as native-language brochures to increase awareness of the need for screening

He said that translated informational health material can become a problem as certain statements that sound appropriate in English, may come off as “harsh or insulting” in another language.

Betel Nut Chewing

The areca (betel) nut is consumed widely in southeast Asia and by approximately 10 percent of the world’s population, says a report by the Indian Journal of Medical and Paediatric Oncology.

Considered one of the most widely consumed addictive substances in the world behind nicotine, ethanol and caffeine, the betel nut is usually wrapped inside betel leaves or with tobacco and chewed.

Although some users believe that it helps the digestive system and also experience a mild high, studies have linked it to oral and esophageal cancer and other diseases.

Betel nut is chewed by many Western Pacific Islanders like Chamorros, Palauans, Yapese and Chuukese and is growing as Micronesians relocate to areas like Hawaii, where it is sold in stores.

Dr. Carl-Wilhelm Vogel, founder of the UH Cancer Center and UOG Partnership, said that worldwide 600 million people chew betel nut.

“I think one of the things we need to do is we need to have more education about betel nut,” said Vogel. “We need to make sure that people understand the health risks and from a scientific view we need to understand more about it.”

Palafox said that identifying what components of the betel net cause cancer could provide opportunities to neutralize the chemical or “engineer” the betel nut to remove its harmful properties.

He also said that programs that offer support and discourage betel nut use would help chronic chewers who want to quit. Palafox said that research would include finding out how to trace betel nut components in urine as a method of monitoring a patient’s usage.

UHCC/UOG Partnership

The UH Cancer Center’s partnership with the University of Guam began when the National Cancer Institute established the Advance Cancer Health Equity program. It allows institutions serving “underserved health disparity populations” and NCI-designated cancer centers to train scientists in cancer research so they can help disadvantaged populations.

The partnership was awarded a $12.6 million grant in 2010.

Last October, the University of Guam received $4.1 million for the partnership that will, with the latest grant awarded to the UH cancer center, fund another phase of research.

In Hawaii, the partnership is directed by senior investigators Palafox, Vogel and David Ward. In Guam, the partnership is directed by Hali Robinett, Rachael Leon-Guerrero and Robert Underwood.

About the Author