Federated States of Micronesia National Breast and Cervical Cancer Standards: Developing & implementing resource appropriate policy

Significance: Chronic disease morbidity and mortality in the Pacific Islands exceed US rates, including cancers. The Pacific Center of Excellence in the Elimination of Disparities and the former Cancer Information Service collaborated with the Federated States of Micronesia Department of Health and Social Affairs, the four State Departments of Health Services and Comprehensive Cancer Control Programs (CCC) to develop resource-appropriate National Breast & Cervical Cancer (B&CC) Standards.

Objective: The objectives of the September 2008 technical meeting were to review evidence-based and resource-appropriate sources and draft the B&CC standards for prevention, early detection, diagnosis, treatment, and care to create national policy, improve practice and reduce cancer disparities.

Methods: Thirty-five government and private stakeholders participated in a consensus-driven consultative process. Local senior health professionals were resource persons. The CCC Coordinators presented their Assets' Mapping results, chaired the sessions, and facilitated group discussions.

Results: Draft standards were agreed for ‘core',‘expanded' and ‘desired' levels and endorsed as the first national health policy by the Directors of Health in March 2009.

Discussion/Conclusions: Preparations to implement the new standards began immediately. To increase cervical cancer screening and treatment, 12 clinicians were trained in Visual Inspection with Acetic Acid (VIA) who then trained 20 health assistants in Pohnpei and Yap. The Pohnpei Womens' Advisory Council trained 60 community leaders who outreached in 56 villages. The FSM Ad Hoc Training Committee has developed a national curriculum plan. The Community College is reviewing modules for their associate degree courses. B&CC screening has increased significantly in recent months.