This article focuses on development of the psychosocial-cultural components of a breast cancer patient navigation program (PNP) in the medically underserved, albeit culturally-rich Territory of American Samoa. Efforts to reduce cancer morbidity and mortality in American Samoa must necessarily consider the territory’s limited cancer resources and indigenous culture, as well as the individuals at risk for poor health outcomes and premature death. Within this complex set of challenges resides the prospect of health equity and opportunities for advancing service innovations that meaningfully plait native ways of knowing with Western evidencebased practice. Increasing adherence to diagnostic and treatment procedures is of significant concern to the American Samoa Cancer Community Network who initiated this inquiry to assess patients lost to follow-up, describe treatment-seeking influences, and identify cultural preferences for inclusion in a PNP tailored on fa‘aSamoa or the Samoan worldview.