Cancer Among American Indians and Alaska Natives

American Indians and Alaska Natives (AI/AN) in the United States have unique cancer patterns due to their history and culture, where they live, and how they get health care. Many AI/ANs live on reservation lands or in remote rural areas, and their primary health care is provided by a tribally operated health program or the Indian Health Service. Rural and urban AI/ANs have more poverty, lower levels of education, and poorer housing conditions than the general U.S. population.

To improve the quality of cancer statistics for AI/AN people, death records and cancer incidence (new cases of cancer) records from state cancer registries were linked with Indian Health Service registration data to identify AI/AN people correctly; many times, they are incorrectly reported as being members of other racial groups. Studies show that nearly 30% of people who identify themselves as AI/AN when living are classified as another race at the time of death. Being able to connect cancer registry and death reports to people’s actual AI/AN status is called linkage. These linkages resulted in the most reliable data to date on cancer incidence and death among AI/AN people, and were used for a 2014 special collection of papers that was published in the American Journal of Public Health.

Results showed that over the last 20 years, cancer death rates fell more quickly among white people than among AI/AN people. From 2001 to 2009, death rates for all cancers combined went down for white men and women, but went up for AI/AN men and women. In addition, white people lived longer than AI/AN people after being diagnosed with nearly all types of cancer. These differences, called disparities, were different by region and type of cancer. Most likely, these differences are related to social, behavioral, and environmental factors that put people at greater risk of cancer, and lack of access to quality health services for cancer screening, diagnosis, and treatment for those with cancer.

Cancer Deaths

By Geographic Region and Cause of Cancer Death

From 2001 to 2009, death rates per 100,000 people for all cancer sites combined had significant differences by region for AI/ANs, but not nearly as much for white people.

For all areas combined, the five most common causes of cancer deaths among AI/AN men were lung, colon and rectum, prostate, liver, and kidney. The five most common causes of cancer death among AI/AN women were lung, breast, colon and rectum, pancreas, and ovary.

The relative ranking of cancer causes of death varied by region. The differences in death rates between AI/AN people and white people for several types of cancer were described in detail in separate papers (see citations below).

Some notable findings—

• Death rates for gallbladder, stomach, liver, and kidney cancers were higher among AI/AN people than white people in all six geographic regions, although some elevations did not reach statistical significance in all regions.
• Death rates for gallbladder cancer were much higher for AI/AN women in the Southwest region, where the rate was more than eight times the rate for white women.
• Death rates for liver and kidney cancers among AI/AN men and women were more than double the rates for white men and women in most regions.
• Death rates for brain cancer among AI/AN people were lower than those for white people across all regions except the Southern Plains, and death rates also were lower for urinary bladder cancers among AI/AN men than white men in most regions.
• In Alaska, death rates were higher among AI/AN men and women for cancers of the lung, colon and rectum, and among AI/AN men for cancer of the esophagus compared with white men and women.
• In both the Northern and Southern Plains regions, death rates for AI/AN men were higher than white men for cancers of the lung, colon and rectum, prostate, and larynx. AI/AN women in both regions also had significantly higher rates of lung, colon and rectum, and cervical cancers.
• In the Southwest region, AI/AN people had lower death rates than white people for lung, colon and rectum, brain, esophagus (male), bladder (male), and female breast cancers, but higher death rates than white people for cervical cancers and myeloma.
• In the East region, death rates among AI/AN women were significantly higher than those among white women for cancer of the colon and rectum, but significantly lower for cancers of the breast, lung, and ovary, whereas AI/AN men had lower rates than those for white men for cancers of the lung, pancreas, esophagus, and myeloid or monocytic leukemia.
• In the Pacific Coast region, rates for AI/AN people were higher than those for white people for colorectal cancer, and higher among AI/AN women for pancreatic cancer.

Trends

Overall cancer death rates went up among AI/AN men and women from 1990 to 2009, while overall cancer death rates went down among white men during this time, and among white women from 1993 to 1998 and 2001 to 2009. Compared with white people, deaths for all cancers combined among AI/AN people were lower from 1990 to 1998, but higher from 1999 to 2009.

Cancer Incidence

The relative ranking of cancer types varied by region. The differences in cancer incidence between AI/AN people and white people for several types of cancer were described in detail in separate papers (see citations below).

For all areas combined, the five most common types of cancers among AI/AN men were prostate, lung, colon and rectum, kidney, and urinary bladder. The five most common types of cancer among AI/AN women were breast, lung, colon and rectum, uterus, and kidney.

From 1999 to 2009, the incidence rates per 100,000 people for all cancers combined showed a geographic pattern similar to death rates.

Citations

White MC, Espey DK, Swan J, Wiggins CL, Eheman C, Kaur JS. Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States. American Journal of Public Health 2014;104 Suppl 3:S377-S387.

Li J, Weir HK, Jim MA, King SM, Wilson R, Master VA. Kidney cancer incidence and mortality among American Indians and Alaska Natives in the United States, 1990–2009. American Journal of Public Health 2014;104 Suppl 3:S396-S403.

Perdue DG, Haverkamp D, Perkins C, Daley CM, Provost E.Geographic variation in colorectal cancer incidence and mortality, age of onset, and stage at diagnosis among American Indian and Alaska Native people, 1990–2009. American Journal of Public Health 2014;104 Suppl 3:S404-S414.

Watson M, Benard V, Thomas C, Brayboy A, Paisano R, Becker T. Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999–2009. American Journal of Public Health 2014;104 Suppl 3:S415-S422.

Singh SD, Ryerson AB, Wu M, Kaur JS. Ovarian and uterine cancer incidence and mortality in American Indian and Alaska Native women, United States, 1999–2009. American Journal of Public Health 2014;104 Suppl 3:S423-S431.

White A, Richardson LC, Li C, Ekwueme DU, Kaur JS. Breast cancer mortality among American Indian and Alaska Native women, 1990–2009. American Journal of Public Health 2014;104 Suppl 3:S432–S438.

Hoffman RM, Li J, Henderson JA, Ajani UA, Wiggins C.Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999–2009. American Journal of Public Health 2014;104 Suppl 3:S439-S445.

Cobb N, Espey D, King J. Health behaviors and risk factors among American Indians and Alaska Natives, 2000–2010. American Journal of Public Health 2014;104 Suppl 3:S481-S489.