Puerto Rico Comprehensive Cancer Control Plan 2025-2030

Objectives

The Puerto Rico Comprehensive Cancer Control Plan 2025–2030 is a five-year, third-edition framework for reducing cancer incidence, mortality and associated economic impact, while improving population health and quality of life through collaborative, evidence-based action.[1][2][3]It spans the cancer continuum, from risk reduction and early detection to treatment, survivorship, rehabilitation and palliative care.[4][5][6]

• Prevent cancer by addressing modifiable risks, including human papillomavirus infection, tobacco and electronic-cigarette use, alcohol, unhealthy diet, physical inactivity, obesity, sun exposure and infection-related risks.[7][8][9][10][11]
• Increase screening and early diagnosis for breast, cervical, colorectal, prostate and lung cancers, with attention to people who are uninsured, rural, rarely screened or otherwise underserved.[12][13][14][15]
• Improve timely, patient-centred and equitable treatment, including treatment planning, patient navigation, accredited care, clinical-trial participation and continuity during public health emergencies.[16][17][18][19]
• Strengthen survivorship and quality of life through survivorship care plans, rehabilitation, psychological and financial support, pain control, palliative care and caregiver support.[20][21][22][23]
• Advance health equity by addressing social determinants of health, geographic disparities, environmental and occupational exposures, and climate- and disaster-related disruption to cancer services.[24][25][26][27]

The Plan is structured around four main priority areas: prevention; screening and early detection; treatment; and survivorship and quality of life.[4][28][5]Emerging and cross-cutting priorities address infection-related cancers, social determinants of health, environmental and occupational health, and disaster preparedness.[4][11][24][29]Goals, measurable objectives and strategies are selected using cancer-burden data, baseline measures, evidence-based interventions, feasibility and expected short-, medium- and long-term impact.[28]

Priority targets include improving human papillomavirus vaccine completion, physical activity, healthy weight, fruit and vegetable consumption, tobacco use, alcohol use and sun protection.[8][30][31][9][10][32]The Plan also sets screening targets, including mammography, cervical screening, colorectal screening, prostate-specific antigen testing and low-dose computed tomography among eligible current and former smokers.[13][33][14][34][15][35]Several objectives retain baselines or targets to be determined, particularly for care barriers, navigation, patient assistance, survivorship-service use, palliative-care availability and some infection-related cancer measures.[36][17][37][38][39]

Implementation

Implementation uses a comprehensive, collaborative and locally responsive model that integrates programmes, avoids duplication, pools resources across the cancer continuum and supports policy, systems and environmental change.[4][2]It applies the Social-Ecological Model, recognising that individual, interpersonal, organisational, community and public-policy factors shape cancer risks, service access and outcomes.[28]

• Lead development, review, implementation and evaluation through the Puerto Rico Comprehensive Cancer Control Program within the University of Puerto Rico Comprehensive Cancer Center, acting under Law No. 49 as the Puerto Rico Department of Health’s bona fide agent for cancer-control efforts.[2]
• Coordinate planning and implementation through the Puerto Rico Cancer Control Coalition, established in 2008 and comprising more than 25 organisations, community leaders and public- and private-sector members.[2]
• Organise technical work through groups covering prevention; screening and early detection; treatment; survivorship and quality of life; infection-related cancers; social determinants of health; and environmental health.[40][41]
• Disseminate the Plan through press releases, email, webpages, social media and bulletin boards, while enabling organisations to adapt priorities to the populations they serve.[3]
• Convene periodic stakeholder meetings to review progress, identify barriers and support corrective action.[3]

Delivery relies on action by hospitals, clinical facilities, healthcare providers, community, faith-based and professional organisations, employers, schools, universities, insurers, government agencies and individuals.[3][42]Core service actions include guideline-based screening, timely cancer reporting, patient navigation, multidisciplinary tumour boards, telehealth, survivorship support, clinical-trial referral, community outreach and support for access among uninsured people.[3][42][43][17]Partnerships specifically involve the Puerto Rico Department of Health, the Puerto Rico Department of Education, Centres 330, the Puerto Rico Central Cancer Registry, the Puerto Rico Behavioural Risk Factor Surveillance System, hospitals and community organisations.[13][14][24]

Operational strategies include provider education, public campaigns, school-based and youth-focused activities, awareness-month events, evidence-based interventions, needs assessments and feedback from patients, parents, providers and agencies.[8][30][44][39]The Plan also promotes patient navigation to help people overcome financial, insurance, transport, communication, geographic, workforce and infrastructure barriers to diagnosis, treatment and recovery.[43][16][37]It supports service continuity during disasters through advance care plans, access to records, alternative communications, protected essential infrastructure and practical community support.[27][45]

Monitoring combines measurable objectives with surveillance from the Puerto Rico Central Cancer Registry, the Puerto Rico Behavioural Risk Factor Surveillance System, the Youth Risk Behaviour Survey, immunisation systems and other local and national sources.[28][8][30][21]The Plan proposes formative, process and outcome evaluation, compares current values with prior baselines, and uses Coalition and Programme oversight to assess implementation and progress.[28][3]Reporting schedules, universal accountability thresholds and a consolidated evaluation timetable are not specified.[28][3]

Funding support has been received from the United States Centers for Disease Control and Prevention National Comprehensive Cancer Control Program since 2007, including Cooperative Agreement No. 5NU58DP007164.[40][2]No quantified Plan budget, costed implementation schedule, resource allocation or financing gap is specified.[40][2]

Monitoring & Evaluation

The Plan combines surveillance, measurable objectives and periodic review across prevention, screening, treatment, survivorship, infection-related cancers, social determinants, environmental health and disaster preparedness. Part V is intended to track progress, outcomes and impact, supported by the Puerto Rico Comprehensive Cancer Control Programme, the Puerto Rico Cancer Control Coalition, external evaluators, the Puerto Rico Central Cancer Registry and other local and national data sources.[41][4][2][28]

• Use cancer incidence, mortality, stage, survival, treatment-delay and screening data from the Puerto Rico Central Cancer Registry and Demographic Registry, with age-adjusted rates standardised to the 2000 United States population and Average Annual Percent Change for trend analysis.[46][47][48][43][49]
• Compare selected measures with baselines from the previous Plan edition and classify change as improvement, little or no change, or worsening.[28]
• Monitor behavioural risk factors and preventive-service use through the Puerto Rico Behavioural Risk Factor Surveillance System, including insurance coverage, physical activity, obesity, tobacco and electronic-cigarette use, alcohol use, chronic conditions and depression.[50]
• Track priority prevention targets, including human papillomavirus vaccine-series completion, adult physical activity, healthy weight, adolescent obesity, fruit and vegetable intake, tobacco use, binge drinking and sunscreen use.[8][30][31][9][44][10][32]
• Measure screening objectives for mammography, cervical screening, colorectal screening, prostate-specific antigen testing and low-dose computed tomography among eligible current and former smokers; several measures for uninsured populations remain to be determined.[13][33][14][34][15][35]
• Assess treatment performance through receipt of treatment summary plans, care-access barriers, clinical-facility accreditation, workforce turnover and cancer clinical-trial participation.[36][17][37][18][19]
• Monitor survivorship through five-year survival, receipt of treatment summaries and follow-up-care instructions, use of survivorship services, access to palliative care, and the proportion of survivors whose pain is controlled.[20][51][21][38][22]
• Track infection-related cancer incidence and mortality, anal screening among people living with HIV, Helicobacter pylori awareness collaborations, hepatitis B virus incidence and confirmed hepatitis C virus infection.[39][52]
• Measure inequities using self-reported cancer prevalence by education and income, alongside municipality-level disparities in cancer burden, access to services, insurance coverage, health literacy and treatment availability.[24][53][25][54]
• Maintain environmental and occupational surveillance through employment histories, air-quality monitoring, drinking-water regulation, and monitoring of disaster-related screening disruption and care barriers.[26][55][27][45]
• Establish indicators for climate-stressor literacy, environmental-pollution literacy and emergency preparedness plans for patients, caregivers, professionals and oncology services.[29][56]

Implementation monitoring includes periodic Coalition and Programme stakeholder meetings to review progress and barriers, alongside formative, process and outcome evaluations. Hospitals and healthcare providers are expected to submit complete and timely cancer case reports to the Registry.[3][42]The Plan also proposes surveys and dedicated data-collection plans for patient assistance, navigation and survivorship services.[17][37][38][22]

Many objectives include explicit baselines and 2030 targets, but several indicators, particularly for care barriers, navigation, assistance programmes, workforce turnover, infection-related cancer screening, survivorship-service use and climate preparedness, have baselines or targets still to be determined.[36][17][37][18][21][38][39][29][56]Reporting frequency, a consolidated reporting framework, accountability thresholds and formal enforcement arrangements are not specified.[2][28][3][42]

Costing & Financing

Financing information is limited: the Puerto Rico Comprehensive Cancer Control Programme has received support from the United States Centers for Disease Control and Prevention National Comprehensive Cancer Control Programme since 2007, and the publication acknowledges support through Cooperative Agreement No. 5NU58DP007164.[40][2]The Plan does not provide a consolidated budget, costed implementation plan, expenditure allocation, quantified funding gap, resource-mobilisation target or economic assumptions.[2][28]

• Advocate for adequate and consistent funding for patient-navigation programmes, payment parity for healthcare providers and updates to Law No. 79 of 2020 to accommodate new technologies.[17][37]
• Seek funding to strengthen clinical-trial infrastructure and geographical access, including for the ten most prevalent cancers.[6]
• Promote insurer reimbursement for survivorship care-plan services, including through the Vital Health programme, and integration of these services into cancer-care certification requirements.[38]
• Reduce direct medical and indirect economic costs of cancer care, collect cost data from hospitals, clinical facilities, insurers and academic partners, and consider legislation to monitor excess provider or insurer charges and non-covered treatment costs.[22]
• Identify external economic, financial, legal and community resources through a survivorship resource directory to supplement treatment costs.[21]
• Consider Medicaid payment for high-value serious-illness services and managed-care contract requirements for palliative-care coverage, quality measures and incentives.[23]

Financial barriers identified for action include insurance pre-authorisations, treatment and transport costs, childcare, workforce constraints, infrastructure disruption and access barriers during disasters.[16][36][17][27][45]However, no monetary values, funding envelopes, cost-effectiveness analyses or financial risk estimates are specified for these measures.[17][37][22][23]