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

By Catherine Wilson
SYDNEY, Australia , Oct 24 2025 (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 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,” Tabitha Waka of the Country Women’s Association in Madang Province on the northeast coast of Papua New Guinea told IPS. “Most of our women residing in urban centers 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,” Dr. Berlin Kafoa, Director of the Pacific Community’s Public Health Division in Noumea, New Caledonia, told IPS, 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, and 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 tumors. 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. 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 centralized 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.

But 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 the “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 program is yet to be rolled out. Waka says there is a need for more investment in breast cancer services. “One or two facilities is not enough to cater for the large numbers of women living with breast cancer,” she stressed.

But 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,” Dr. Grant R. Muddle, ML, a global healthcare expert who has worked to assist health system transformation in Australia, the Pacific and other regions, told IPS. 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 tumor 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 emphasized. “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 50^th 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.
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Vehicle ownership in India is projected to hit 400 million by 2040 from the current 170 million, which could prompt a five-fold increase in poisonous gases emitted by cars and trucks. Credit: Neeta Lal/IPS

By Neeta Lal
NEW DELHI, Feb 25 2015 (IPS)

Like many others of her age, 15-year-old Aastha Sharma, a Class 10 student at a private school in India’s capital, New Delhi, loves being outdoors, going for walks with her friends and enjoying an occasional ice-cream. But the young girl can’t indulge in any of these activities.

Chronic obstructive pulmonary disease (COPD), a lung disorder likely caused by Delhi’s heavily polluted air, has severely cramped the girl’s lifestyle, confining her mostly to her home.

An estimated 1.5 million people die annually in India due to indoor and outdoor air pollution.
For the past three years, Sharma’s life has been a whirligig of doctors’ prescriptions, missed social outings and a restricted diet that does not include most of her favourite foods. Along with books and a lunchbox, she also packs a nebulizer in her satchel daily to ward off the wheezing attacks that she has now come to dread.

“I’m sick of the endless do’s and don’ts I have to follow. When will I be able to lead a free life?” the teen wonders.

Many other youngsters in Delhi are asking the very same question as they grapple with the effects of rampant air pollution in this city of 18 million, believed to be world’s most polluted.

Particulate matter: a deadly matter

Greenpeace India, an environmental NGO, recently released findings of its air quality monitoring survey highlighting how poor the air was inside five prominent schools in the capital.

“Air pollution levels inside Delhi’s schools are alarmingly high and children are consistently breathing bad air. The new government needs to acknowledge the severity of air pollution in the city,” said Aishwarya Madineni, a campaigner with Greenpeace.

Another study conducted in 2014, which monitored 11,628 school-going children from 36 schools in Delhi in different seasons, found that every third child in the city had reduced lung function because of particulate pollution.

In a report submitted last year to the Supreme Court, the country’s Environment Pollution (Prevention and Control) Authority urged the apex court to order all schools in Delhi to shut down on days when air pollution levels posed a threat to public health.

Studies by the United States’ Environmental Protection Agency (EPA) point out that when children are exposed to particulate matter – a complex mixture of acids (nitrates and sulfates), organic chemicals, metals, and soil or dust particles – of 2.5 micrometers, it can trigger a raft of deadly respiratory illnesses.

The International Agency for Research on Cancer (IARC) classified particulate matter pollution as carcinogenic to humans in 2013 and designated it as a “leading environmental cause of cancer deaths.”

“Apart from mucous membranes and nasal cavities, air pollution also severely irritates eyes and skin. Exposure to high levels of pollution can lead to serious health [issues] in the long run,” warns Dr. Abha Sood, a senior consultant oncologist at the New Delhi-based Max Hospital.

Mothers’ exposure to pollution for prolonged periods, adds the specialist, can lead to malformation of organs in newborns.

“[Particulate Matter] of less than 10 micrometers in diameter (PM 10) is particularly insidious as it gets lodged deep inside the lungs and penetrates the bloodstream, heightening a person’s vulnerability to cancer and heart disease,” she explains.

A national crisis

India’s high levels of air pollution, ranked by the WHO as being among the worst in the world, are adversely impacting the life spans of its citizens, reducing most Indian lives by over three years, says a study by economists from the Universities of Chicago, Harvard and Yale.

Over half of India’s population – roughly 660 million people – live in areas where fine particulate matter pollution is above India’s standards for what is considered safe, said the study.

If India reverses this trend to meet its air standards, this demographic would gain about 3.2 years in their expected life spans, according to the study. In other words, cleaner air would save 2.1 billion life-years, it said.

Furthermore, India has the distinction of recording the world’s highest death rate from chronic respiratory diseases, and more deaths from asthma than any other nation, according to the WHO. The health organisation also claims that India is home to 13 of the world’s 20 most polluted cities.

An estimated 1.5 million people die annually in India due to indoor and outdoor air pollution, which also contributes to both chronic and acute heart disease, the leading cause of death in the country.

In a report submitted to the Supreme Court in December 2014, the country’s Environment Pollution (Prevention and Control) Authority called for increasing the tax on diesel cars, and banning all private vehicles on high air pollution days.

The report also advised that cars older than 15 years be taken off the city’s roads and air purifiers installed at crowded markets; it also called for a crackdown on the burning of trash.

However, the implementation of these measures has been patchy at best, say health activists. Worse, vehicle ownership in India is projected to hit 400 million by 2040 from the current 170 million, says a joint study by the Energy and Resources Institute at the University of California, San Diego, and the California Air Resources Board.

This could result in a health crisis – a three-fold increase in PM 2.5 levels and a five-fold increase in poisonous, highly reactive gases emitted by cars and trucks, the study predicted.

The economic cost of pollution is already proving to be a heavy burden for Asia’s third largest economy. A 2013 World Bank Report highlighted how pollution and other environmental challenges costs India 80 billion dollars a year, nearly six percent of its gross domestic product (GDP).

About 23 percent of child mortality and 2.5 percent of all adult deaths in the country can be attributed to environmental degradation, the study further stated.

Coal-based power: adding fuel to the fire

Air pollution is now the fifth-leading cause of death in India. Between 2000 and 2010, the annual number of premature deaths linked to air pollution across India shot up six-fold to 620,000, according to the Centre for Science and Environment (CSE), an advocacy group in New Delhi.

Another CSE study out this week has sounded alarm bells over air pollution, particularly from coal-based power plants. The two-year comprehensive environmental audit, conducted on 47 thermal power plants owned by the Centre, state governments and private players, has found that Indian thermal power plants were among the most inefficient in the world, on an average operating at 60 to 70 percent of their installed capacity.

The coal-based power plants were also found to have carbon dioxide emissions that were 14 percent higher than similar plants in China. Also, 76 percent of the plants were unable to meet the targets for ulitisation of ‘fly ash‘, imposed by the Union Ministry of Environment and Forests (MoEF).

With the government showing little interest in formulating a cohesive action plan – involving all stakeholders – for tackling the many-headed hydra of air pollution, it looks like Sharma and her nebulizer will be inseparable for a while.

Edited by Kanya D’Almeida