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By Giff Johnson

MAJURO, Marshall Islands (March 19, 1999 - Marshall Islands Journal)---Cancer rates in the Marshall Islands -- caused by a combination of exposure to nuclear test fallout and malnutrition and other factors associated with rapid westernization -- are "alarming," said a study published in a recent edition of Cancer, the journal of the American Cancer Society.

"The cancer incidence in the Marshall Islands is extreme," said the study written by Dr. Neal Palafox of the University of Hawaii, John A. Burns Medical School, and four other doctors, including Dr. Kennar Briand, the Director of Public Health in Majuro.

Additional study of the causes and actual incidence of cancers in the Marshall Islands would be a major aid to prevention and control of cancer in the future, the doctors said.

The study compared the rate of a variety of cancers in the Marshall Islands to the rate in the U.S. "Cancer incidence rates were higher in virtually every category in the Marshall Islands compared with the United States for the period 1985-1994," the study said. It pointed out that the Marshall Islands lung cancer rates were 3.8 times higher in males and 3.09 times higher in females, cervical cancer rates were 5.8 times higher, and liver cancer rates were 15.3 times higher in males and 40 times higher in females compared with U.S. rates.

Despite the significantly elevated levels of cancer in the Marshalls, the researchers believe that the level is actually underestimated because of "an underdeveloped health record-keeping system."

The study was based on records at the Nuclear Claims Tribunal of 470 people who had died of cancer. The Tribunal is a U.S.-funded agency that provides compensation to islanders for health problems associated with exposure to nuclear test fallout from the 67 American tests at Bikini and Enewetak. "The data presented here represents a very conservative estimation of the true cancer incidence in the Marshall Islands," the study said. "The finding of substantially higher cancer incidence rates in the Marshall Islands compared with the U.S. in virtually all categories studied, in view of the aforementioned under-ascertainment of cases, is alarming."

The study said that the difference in cancer rates between the Marshall Islands and the U.S. "can be explained by environmental and life-style factors."

Referring to the 67 nuclear tests, the study said that "increases in leukemia, breast cancer and thyroid cancer after radiation exposure have been well established, especially in childhood exposures."

Another risk factor for cancer is the high rate of malnutrition in the Marshall Islands, most notably vitamin A deficiency. A 1994 study of children in the one-to-five year age group showed that 62 percent had severe vitamin A deficiency by World Health Organization standards, the study said, adding that vitamin A deficiency has been "highly associated" with head and neck cancers, and has also been linked to lung, liver, cervical and bladder cancers.

"Westernization of the Marshall Islands brought social problems associated with urbanization and breakdown of indigenous cultural values," it said. "There are high rates of alcohol abuse, smoking and sexually transmitted diseases.

"In addition, the rates of hepatitis B are alarming, as they are throughout the Pacific. These factors may account for some of the high incidence rates of the cancers identified. For example, alcohol abuse and hepatitis B may account for some of the higher rates of liver cancer, sexually transmitted diseases are known to be associated with cervical cancer, and the high rate of smoking would naturally increase the incidence of lung cancer."

The study concluded that more complete analysis and study of cancer in the Marshall Islands is necessary to improve prevention and control.

MARSHALL ISLANDS JOURNAL Box 14, Majuro, Marshall Islands 96960 E-mail: Fax: 692-625-3136 Tel. 692-625-8143 Subscriptions (weekly): 1 year: US $87.00; International $227.00 (air mail)

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