Puerto Rico Comprehensive Cancer Control Plan 2025-2030

Objectives

The Puerto Rico Comprehensive Cancer Control Plan 2025–2030 is a five-year, third-edition blueprint to reduce cancer incidence, mortality and associated economic impact, while improving Puerto Ricans’ quality of life through collaborative, evidence-based prevention, early detection, access to services, treatment, rehabilitation, palliative care, survivorship support and cancer research.[1]It frames comprehensive cancer control as a collaborative process for reducing the cancer burden across the continuum, particularly for cancers that most affect Puerto Rico.[2]

• Address four principal priority areas: prevention; screening and early detection; treatment; and survivorship and quality of life.[1][3]
• Apply the Social-Ecological Model, recognising individual, interpersonal, organisational, community and public-policy influences on cancer-related behaviours and outcomes.[1]
• Reduce modifiable risk factors, including tobacco and electronic-cigarette use, alcohol use, physical inactivity, unhealthy weight and diet, ultraviolet exposure, infectious agents, and environmental or occupational exposures.[3][4]
• Increase human papillomavirus vaccine-series completion among young people aged 13 to 15 years, from a 2021 baseline of 67.2% among those aged 13 to 17 to a 2030 target range of 71.2% to 72.6%.[4]
• Improve early detection through evidence-supported cervical, breast and colorectal screening, while also addressing prostate and lung cancer screening.[5][6][7]
• Increase mammography among women aged 40 years and over from 75.6% in 2022 to 80.3% by 2030, cervical screening among women aged 21 to 65 years to 80.0%, and colorectal screening meeting United States Preventive Services Task Force recommendations among adults aged 45 to 75 years from 55.5% to 68.3%.[8][9][10]
• Promote timely, adequate and high-quality cancer treatment, patient-centred treatment planning, navigation, equitable access, an expanded oncology workforce, accredited cancer centres and clinical-trial participation.[11][12][13]
• Improve survivorship, including longer-term survival, survivorship care planning, supportive services, pain control, palliative care, caregiver support and reduced direct and indirect cancer-care costs.[14][15][16]
• Prevent infection-related cancers through vaccination, screening and timely treatment, with particular attention to human papillomavirus, hepatitis B and C, Helicobacter pylori and cervical-cancer elimination.[17][18][19]
• Reduce cancer inequities associated with education, income, insurance, health literacy, access to services, geography, environmental conditions and occupational exposures, while strengthening climate and disaster preparedness across cancer care.[20][21][22]

Implementation

The Puerto Rico Comprehensive Cancer Control Program, within the University of Puerto Rico Comprehensive Cancer Center, is responsible for developing, disseminating, implementing and evaluating the Plan in collaboration with the Puerto Rico Cancer Control Coalition and other stakeholders.[23]Under Puerto Rico Law No. 49, the Cancer Center, through the Programme, serves as the bona fide agent of the Puerto Rico Department of Health for government cancer-control efforts.[2]The Coalition, established in 2008, brings together more than 25 organisations, community leaders and public- and private-sector members, and receives technical assistance and training through the Comprehensive Cancer Control National Partnership.[1]

• Use collaborative planning to reduce duplication, allocate resources, support system and policy change, deliver multi-level interventions, and identify gaps and priorities.[2]
• Engage seven working groups covering prevention; screening and early detection; treatment; survivorship; infection-related cancers; social determinants of health; and environmental health.[23]
• Ground planning in Cancer Plan Self-Assessment Tool guidance, the National Cancer Plan, registry and behavioural-surveillance data, agency data, literature reviews, baseline comparisons, evidence-based interventions, feasibility and expected impact.[1][23]
• Partner with the Puerto Rico Department of Health, Department of Education, clinical facilities including Centers 330, community organisations, schools, insurers, hospitals, professional groups and government agencies to provide campaigns, education, outreach, screening support, navigation and evidence-based interventions.[24][25][26]
• Strengthen provider capacity through training on vaccination, tobacco cessation, screening, follow-up, early diagnosis, genetics, patient navigation, emergency preparedness, palliative care and new technologies.[24][9][27][28]
• Use patient navigation, electronic health records, health information technologies, web tools, telemedicine, decentralised care and patient-assistance information to identify at-risk populations, address barriers and support continuity of care.[7][29][27]
• Support quality improvement through Commission on Cancer accreditation, treatment plans, facility partnerships, patient needs and satisfaction assessments, and efforts to recruit and retain the cancer-care workforce.[29][30]
• Maintain surveillance through the Puerto Rico Central Cancer Registry and Puerto Rico Behavioral Risk Factor Surveillance System, including survivorship and risk-factor modules, and compare current measures with previous-plan baselines where available.[1][23][31]
• Track selected 2030 measures, including screening uptake, risk-factor prevalence, treatment-plan receipt, accredited facilities, clinical-trial participation, five-year survival, survivorship care, pain control, infection-related cancer burden, social inequities and climate-preparedness literacy.[10][29][13][14][16][18][32]
• Build resilience by incorporating cancer screening, treatment, survivorship and support services into disaster preparedness, response and recovery planning for hurricanes, heatwaves, flooding, droughts, wildfires and other emergencies.[33][32]

Funding support is reported from the United States Centers for Disease Control and Prevention National Comprehensive Cancer Control Program, including Cooperative Agreement No. 5NU58DP007164.[34][2]The available material does not specify a consolidated implementation budget, plan-wide costings, allocations, funding gaps, reporting timetable or overarching accountability framework; several indicators retain baselines or 2030 targets to be determined.[29][12][15][18]

Monitoring & Evaluation

The plan establishes surveillance and evaluation as a cross-cutting function for tracking progress, outcomes and impact across prevention, screening, treatment, survivorship, infection-related cancers, social determinants of health, and environmental health. It combines measurable objectives, baseline-to-target comparisons, population surveillance, registry data, service indicators and selected implementation measures, although reporting schedules and a unified accountability framework are largely unspecified.[2][1][23]

• Use the Puerto Rico Central Cancer Registry, Puerto Rico Behavioural Risk Factor Surveillance System, Puerto Rico Department of Health, Demographic Registry and other local or national sources to monitor cancer incidence, mortality, survival, screening, risk factors and survivorship outcomes.[35][23][36][37]
• Compare current data with second-edition baselines to classify progress as improvement, little or no change, or worsening, and apply measurable objectives and selected performance measures to each priority area.[1]
• Monitor cancer burden by site, sex, age, geography and stage, including incidence, mortality, relative survival and disparities. Incidence and mortality are reported as core measures, while 2020 incidence data were excluded from some trend analyses because COVID-19 affected case reporting.[36][38][39][40]
• Track prevention indicators including human papillomavirus vaccine-series completion, physical activity, healthy weight, fruit and vegetable consumption, tobacco and electronic-cigarette use, binge drinking, sunscreen use and tobacco-control policies.[4][24][41][42][43][44]
• Monitor screening participation for breast, cervical, colorectal, prostate and lung cancer. Examples include a 2030 mammography target of 80.3% for women aged 40 years and over, colorectal screening of 68.3% for adults aged 45–75 years, prostate-specific antigen testing of 59.2% for men aged 40 years and over, and lung screening of 7.5% among eligible current and former smokers.[8][10][6][7]
• Measure treatment and care quality through receipt of treatment plans, barriers to accessing or continuing care, availability of patient-assistance information, patient navigation enrolment, Commission on Cancer accreditation, workforce turnover and clinical-trial participation. Several baselines and targets remain to be determined.[29][27][12][30][13]
• Assess survivorship through five-year survival, receipt of survivorship care plans and treatment summaries, routine follow-up instructions, use of survivorship services, palliative-care availability and pain control. The plan proposes a survivorship surveillance system for preventive and screening tests during the five years after diagnosis or notification.[14][45][15][16]
• Strengthen monitoring of infection-related cancers through incidence, mortality, vaccination and screening data, including anal Pap testing among people living with HIV, and support data sharing between the Puerto Rico Health Insurance Administration and the Puerto Rico HIV/AIDS Surveillance Program.[17][46][18]
• Address equity, occupational and environmental risks through indicators disaggregated by education and income, employment-history surveillance, air and water monitoring, and proposed Behavioural Risk Factor Surveillance System questions on environmental awareness.[47][21][48][49][50]
• Monitor emergency preparedness through climate-stressor literacy, existence of preparedness plans for cancer-related groups and continuity of screening during disasters.[22][32]

The Puerto Rico Comprehensive Cancer Control Program is to oversee evaluation in collaboration with the Puerto Rico Cancer Control Coalition and other stakeholders. The material identifies external evaluators and multiple data contributors, but does not define reporting frequency, data-quality standards, a plan-wide evaluation design, escalation processes or named accountability arrangements for most objectives.[35][23][24][31]

Costing & Financing

The plan recognises cancer’s economic impact and includes an objective to reduce direct medical and indirect cancer-care costs by 2030, but it provides no overall implementation budget, programme cost estimates, funding-gap analysis, allocation schedule or economic assumptions.[1][16]

• Receive support for the Puerto Rico Comprehensive Cancer Control Program from the United States Centers for Disease Control and Prevention National Comprehensive Cancer Control Program, with funding reported from 2007 onwards.[2]
• Identify publication support through Cooperative Agreement No. 5NU58DP007164 from the Centers for Disease Control and Prevention, and financial assistance under Funding Opportunity Announcement 5-U58DP007164-02-00.[34][51]
• Collect direct medical and indirect cost data for all cancers and cancer types in partnership with hospitals, clinical facilities, the Puerto Rico Health Insurance Administration, private insurers and academic institutions; related baselines and 2030 targets are to be determined.[16]
• Advocate for legislation and public policy to monitor excess provider or insurer costs and regulate non-covered treatment costs.[16]
• Support financial access through patient-assistance programmes, resource directories, insurance reimbursement advocacy for survivorship care plans, and assistance with transport and housing for patients and caregivers.[27][14][45][30]
• Recognise resource needs for patient navigation, workforce recruitment and retention, accredited cancer centres, palliative care, clinical-trial infrastructure, decentralised care and emergency continuity, without quantifying required investment.[12][30][31][28][32]
• Note that more than 90% of Puerto Rico’s population has health insurance and that 46.9% are eligible for Government Health Insurance Plan coverage through Medicaid or the Medicare-expansion Children’s Health Insurance Program; the material identifies insurance-related access disparities but does not quantify their financial effects.[52]

Except for the cited federal support, financing arrangements for prevention, screening, treatment, survivorship, infection-related cancer control, social-determinants interventions and environmental-health measures are not specified. No explicit resource-mobilisation targets, funding sources beyond federal support, or quantified funding gaps are provided.[3][10][29][17][21][50]