It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.

Introduction: Guam, the largest U.S. territory in Micronesia, plays a central role in surgical care for the local indigenous community and surrounding Pacific Island nations, yet remains underrepresented in surgical systems research. Methods: We conducted a mixed-methods study. Quantitative data were collected on operating volume, personnel, infrastructure, and surgical services at Guam Memorial Hospital (GMH) and Guam Regional Medical City (GRMC). Semi-structured interviews with hospital leadership and surgical providers captured qualitative insights on strengths, challenges, and future plans. Results: GMH and GRMC collectively provide general emergency, obstetric, and basic pediatric surgery, although advanced subspecialty and oncologic care remain limited. Although surgeons are highly adaptable with broad-practice capability, challenges, including resource limitations, aging facilities, advanced presentation, and subspecialty recruitment, limit the cases that are operable on Guam, resulting in expensive medical transfer. Anticipated stressors such as oncologic and non-communicable disease burden may further strain the system, emphasizing the necessity for modernized facilities and targeted recruitment of surgeons with regional ties. Conclusion: Strengthening Guam’s surgical capacity is essential for the provision of oncologic care and the advancement of health equity across the Pacific region, emphasizing an urgent need for investment in infrastructure, locally relevant workforce training, and regional policy development.