Cancer Disparities Among American Indian and Alaska Native People

Rethinking How Data Are Used to Represent American Indian and Alaska Native Populations

The rate of new cancer cases has decreased in the United States for many years, but researchers have reported growing disparities in cancer rates for certain communities, including American Indian and Alaska Native (AI/AN) populations.

Data continue to be the cornerstone for the work of CDC’s Division of Cancer Prevention and Control (DCPC). In addition to highlighting disparities in rates of new cancer cases, DCPC continues to focus on improving the quality of data for AI/AN populations. Many AI/AN persons are misclassified as another race in cancer registry records. This racial misclassification causes cancer incidence and death rates to appear lower among these groups. A unique collaboration between the Indian Health Service (IHS) and the cancer surveillance community reduced the misclassification of AI/AN persons by race. Linking IHS administrative records with cancer registry data made the reported rates more accurate.

The Importance of Data Linkages in Finding Cancer Disparities

“When we started the linkages between IHS and the central cancer registries in 2004, the US AI/AN rates appeared to be fairly low,” explains CDC field assignee epidemiologist, Melissa Jim. “After we incorporated the IHS linkage results, we discovered that there were regional differences for cancer sites. While some cancers were low in the Southwest, the same cancers were much higher than we expected in the Northern Plains and Alaska.

“The regional data was extremely helpful for the Tribes. They were able to use these data to get funding for cancer prevention programs that they hadn’t been able to do before. The data that were available previously did not show a need for such programs,” Jim continued.

On the linkage between IHS administrative records and cancer registry data, Dr. Jeffrey A. Henderson states, “This groundbreaking work helps us to accurately reflect cancer rates in American Indian and Alaska Native communities.”

CDC’s data have continued to show that AI/AN people have a higher risk of getting certain cancers than non-Hispanic White people. Factors that are known to increase the risk of certain cancers are:

• Diabetes.
• Obesity.
• Commercial tobacco use.
• Alcohol misuse.
• Viral hepatitis infection.

Cancer Disparities Among AI/AN Populations

Regional data can help us better understand what causes cancer in AI/AN populations. To examine differences in cancer rates more accurately, CDC researchers analyzed the data by six geographic regions: the Northern Plains, Alaska, Southern Plains, Pacific Coast, East, and Southwest.

Stephanie Melkonian, a CDC field assignee epidemiologist located in Albuquerque, New Mexico, works to understand why these differences occur and to help prevent cancer among AI/AN people. Her most recent study found large disparities for certain cancers in non-Hispanic AI/AN populations compared to non-Hispanic White populations in the United States between 2012 and 2016.

Compared to non-Hispanic White people, non-Hispanic AI/AN people have higher rates of getting:

• Lung cancer.
• Colorectal cancer.
• Liver cancer.
• Stomach cancer.
• Kidney cancer.
• Female breast cancer.

What Can Be Done to Address Cancer Disparities?

During a recent interview, Melkonian offered a suggestion to address cancer disparities among AI/AN people. She explained, “Addressing cancer disparities is complex. One possible avenue is through community public health programs and partnerships that are linked with clinical services in communities in which people live. Community health aides and patient navigators can potentially help community members access and understand the preventive care they need to make sure they get the right care at the right time.

“Some of these efforts might include promoting healthy environments and addressing underlying social determinants of cancer risk, including access to care, food insecurity, and lack of transportation. Community-based interventions to support healthy behaviors and promote recommended screening for cancer, or its risk factors, may also reduce cancer disparities for AI/AN populations,” Melkonian added.

Cancer disparities among AI/AN people can be decreased by:

• Improving access to commercial tobacco prevention programs.
• Promoting healthy eating and physical activity.
• Increasing access to cancer screenings to find cancer early.