The South Pacific Commission Cancer Registry has been operational since 1977, and reasonably complete cancer incidence rates are available for New Caledonia, Fiji, Micronesia, the Cook Islands, and Niue. In addition, less complete reporting is available from American Samoa, Papua New Guinea, and French Polynesia. Cancers of the lung, oral cavity, esophagus, liver, and cervix are potentially preventable but prevalent in many Pacific island countries. Unusually low rates of many cancers were observed in Fiji, the most notable being lung and colon-rectum. Thyroid cancer rates are elevated in some but not all female populations. These and other variations in cancer by site are important areas for further research.