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Preventing Chronic Disease | Cancer Disparities Among Alaska Native People, 1970–2011 - CDC

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Preventing Chronic Disease | Cancer Disparities Among Alaska Native People, 1970–2011 - CDC



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Cancer Disparities Among Alaska Native People, 1970–2011

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Janet J. Kelly, MS, MPH; Anne P. Lanier, MD, MPH; Teresa Schade, CTR; Jennifer Brantley; B. Michael Starkey

Suggested citation for this article: Kelly JJ, Lanier AP, Schade T, Brantley J, Starkey BM. Cancer Disparities Among Alaska Native People, 1970–2011. Prev Chronic Dis 2014;11:130369. DOI: http://dx.doi.org/10.5888/pcd11.130369External Web Site Icon.
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Abstract

Introduction
Cancer is the leading cause of death among Alaska Native people. The objective of this study was to examine cancer incidence data for 2007–2011, age-specific rates for a 15-year period, incidence trends for 1970–2011, and mortality trends for 1990–2011.
Methods
US data were from the Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat database and from the SEER Alaska Native Tumor Registry. Age-adjusted cancer incidence rates among Alaska Native people and US whites were compared using rate ratios. Trend analyses were performed using the Joinpoint Regression Program. Mortality data were from National Center for Health Statistics.
Results
During 2007–2011 the cancer incidence rate among Alaska Native women was 16% higher than the rate among US white women and was similar among Alaska Native men and US white men. Incidence rates among Alaska Native people exceeded rates among US whites for nasopharyngeal, stomach, colorectal, lung, and kidney cancer. A downward trend in colorectal cancer incidence among Alaska Native people occurred from 1999 to 2011. Significant declines in rates were not observed for other frequently diagnosed cancers or for all sites combined. Cancer mortality rates among Alaska Native people during 2 periods, 1990–2000 and 2001–2011, did not decline. Cancer mortality rates among Alaska Native people exceeded rates among US whites for all cancers combined; for cancers of the lung, stomach, pancreas, kidney, and cervix; and for colorectal cancer.
Conclusion
Increases in colorectal screening among Alaska Native people may be responsible for current declines in colorectal cancer incidence; however; improvements in treatment of colon and rectal cancers may also be contributing factors.
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Introduction

Cancer is the leading cause of death among Alaska Native (AN) people (1). Before the mid-1900s, cancer was considered a rare disease among AN people, but since then, cancer incidence has increased dramatically (2). Reports of salivary and esophageal cancers in the 1960s showed emerging patterns of cancer among Eskimo people in Alaska (3–7). During that time, cancer mortality overall did not differ from mortality among US whites; however, significantly higher mortality was noted for cancer of the nasopharynx, salivary glands, kidney, esophagus, and cervix (8). Subsequent cancer surveillance efforts showed that overall incidence was below expected rates for 1969–1973 (based on Connecticut cancer incidence rates) but that incidence exceeded expected rates for cancer of the nasopharynx, liver, salivary gland, gallbladder, kidney, and thyroid. Significantly lower incidence rates among AN people compared with US whites were reported for melanoma, lymphoma, and leukemia (9). Since then, we reported emerging patterns in cancer incidence among AN people, such as declines in cervical cancer incidence and increases in lung, breast, and colorectal cancer (CRC) (10–13). Cancer incidence data emphasize the unique patterns of cancer among the AN population compared with other US populations and guide culturally relevant programs in cancer education, prevention, and control.
The term “Alaska Native” refers to 3 broadly defined groups of indigenous people living in Alaska: Eskimo, Indian, and Aleut. AN people comprise approximately 18% of the Alaskan population; 33% live in one of 2 major cities. Health care for AN people was the responsibility of the Indian Health Service (IHS) until 1997, when the Alaska Tribal Health Compact, a self-governance agreement, allowed tribal governments and their regional health corporations to assume this responsibility (14). The objective of this study was to examine cancer incidence and mortality data for AN people from 1970 through 2011.

Acknowledgments

The authors recognize the work of the many cancer registrars and others working throughout the state who have ensured the completeness and accuracy of information on cancer among AN people. Funding for the SEER Alaska Native Tumor Registry is provided through Interagency Agreement No. Y1-PC-0064-01 with the National Institutes of Health, National Cancer Institute SEER Program.
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Author Information

Corresponding Author: Janet J. Kelly, Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center, Division of Community Health Services, 3900 Ambassador Dr, Anchorage, Alaska 99508. Telephone: 907-729-3949. E-mail: jjkelly@anthc.org.
Author Affiliations: Anne P. Lanier, Teresa Schade, Jennifer Brantley; B. Michael Starkey, Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center, Division of Community Health Services, Anchorage, Alaska.
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