Colorectal, Gastric and Esophageal

Cancers Pose Serious Human

Security Threat in the Solomon
Islands
By Dr. Eileen Natuzzi
Published: October 4, 2014
The Pacific Islands Region has one of the
highest Helicobacter pylori (commonly known
as H. pyroli) infection rates in the world. A
recent study conducted in Pohnpei, Federated
States of Micronesia suggests that nearly 90%
of Pacific Islanders could be infected.
1

The Solomon Islands is no exception. Early
testing indicates that infection rates there could
tip 50% of the population.
2

These high rates pose a serious threat to human
security - the most chronic bacterial infection in
the world is known to cause stomach ulcers,
bleeding, and even cancer.
3

Unfortunately, Helicobacter pylori is not the only
serious infectious disease threat facing Pacific
Islanders. In the Solomon Islands, one in five
has contracted the Hepatitis B virus. (commonly
known as HepB).
4

Again, the Solomon Islands is not alone. The
region is plagued by a hyper-endemic rate of
HepB infection. And, this too poses a major
public health risk the disease, which is largely
transmitted from mother to child at birth, can
lead to irreversible liver damage.
One of the major problems facing the Pacific
Islands Region is that doctors and public health
specialists across the region lack the capacity
to confront these infectious diseases. As a
consequence, colorectal, gastric and
esophageal cancers are killing Solomon
Islanders without giving them a fighting chance
for cure. What is urgently needed is better
diagnostic methods and preventive healthcare
for the causes of gastrointestinal diseases.
It is with this in mind that the Solomon Islands
Living Memorial Project (SILMP) created a
partnership between doctors and nurses from
the United States, Australian and Solomon
Islands in order to develop the means to
diagnose and treat these deadly gastrointestinal
diseases.
With the support of the Olympus America,
Pentax, Cook Medical, and Scanlan
International, SILMP has helped the doctors in
Solomon Islands establish a state of the art
endoscopy unit at the National Referral Hospital
(NRH) in Honiara, Guadalcanal.
For the past two years, American and Australian
gastrointestinal endoscopist teams have also
been traveling to the NRH to train Solomon
Islander doctors and nurses on how to perform
safe, effective endoscopy techniques. And, this
training has led to over 450 upper endoscopies
and 100 colonoscopies being performed by
Solomon Islander doctors.
Perhaps not surprisingly, the initial findings from
these operations reveal significant Helicobacter
pylori-induced gastritis, duodenitis, ulcers,
stomach cancers, and duodenal cancers. They
also demonstrate an unusual pattern of
esophageal cancer involving largely the mid-
esophagus.


Eileen Natuzzi is a Public Health Surgeon and
the Medical Education Coordinator for the
Solomon Islands Living Memorial Project.
Interactions
Insights from Public Health Practitioners
Interactions | Pacific Islands Society | October 4, 2014
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PO Box 632 | Ebensburg, PA 15931 | USA
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Domestic Non-Profit Organization
This may be due to heightened risk factors
among the population, including smoking,
alcohol consumption, and possibly betelnut
chewing.

Endoscopy procedure findings are also
providing strong evidence of the continued
threat posed by colorectal cancer to Solomon
Islanders. Among the projects sample
population, the distribution of tumors is
remarkably like what was seen in developed
countries 30 to 40 years ago - largely on the left
side only near the rectosigmoid junction.
5

In the months ahead, the partnership team
plans to pull its data from these procedures.
They then plan to publish early results of their
findings. Their hope is that their work will help
the local doctors in Solomon Islands to identify
the types and patterns of endemic
gastrointestinal diseases and provide insights
into the best care lines and/or protocols for
confronting these diseases.

Those affiliated with the project are also in the
process of organizing a symposium on defining
lines of care for colorectal cancer that work in
the Solomon Islands. The symposium will
include input from the Ministry of Health, health
educators, public health as will as health
providers in order to outline a comprehensive,
country-wide strategy on educating the public
on causes of and early detection of colorectal
cancer.

These care lines are expected to include cost
effective, context specific screening programs
that include endoscopic evaluation as well as
treatment of established disease including
surgery, chemotherapy and palliative care.

Such findings and follow-on projects are of
great interest to public health professionals.
But, they should matter to the average Pacific
Islander

In the US and Australia, less than 1% of all
endoscopies yield a diagnosis of cancer.
6

Compare this with the Solomon Islands, where
12% of all endoscopies yield a diagnosis of
cancer.
7

Something must be done to close this gap.

The views expressed and data shared are
those of the author.


[1] Isaac B. Helicobacter Pylori infection rates
at a family practice in Pohnpei, Federated
States of Micronesia. Health in Palau and
Micronesia 2005; 12(1).
[2] Solomon Islands Living Memorial Project
Data.
[3] Polk DB, Peek RM. Helicobacter pylori:
gastric cancer and beyond. Nat Rev Cancer
2010; 10(6) 403-414
[4] Furusyo N, Hayashi J, Kakuda K, Sawayama
Y et al. Markedly high seroprevalence of
Hepatitis B virus infection in comparison to
Hepatitis C virus and Human T Lymphotrophic
virus Type-1 infections in selected Solomon
Islands Populations. Am J Trop Med Hyg 1999;
61(1) 85-91.
[5] Solomon Islands Living Memorial Project
Data.
[6] Ibid.
[7] Ibid.