Cancer statistics forAmericanIndian andAlaskaNative individuals, 2022: Including increasing disparities in early onset colorectal cancer

Abstract

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.

Colorectal cancer statistics, 2023

“…In contrast to declining rates in all other racial and ethnic groups, mortality is increasing by more than 2% annually in Alaska Native persons 98,100 . Furthermore, among individuals younger than 50 years, rates are increasing by 4% per year for incidence and by 3% per year for mortality 11 . Reasons for the elevated risk remain unclear but may include a higher prevalence of risk factors, such as vitamin D deficiency because of low sun exposure; smoking; obesity; a diet high in smoked fish and marine mammals and low in fiber, fruits, and vegetables 101–103 ; and perhaps Helicobacter pylori infection 104–106 .…”

“…National CRC screening prevalence (2021) was obtained from the NCHS' National Health Interview Survey (NHIS). 11 The NHIS is conducted by the US Census Bureau and was designed to provide national prevalence estimates on health behaviors, such as cancer screening. Data are collected through computer-assisted, in-person interviews of adults aged 18 years and older.…”

“…98,100 Furthermore, among individuals younger than 50 years, rates are increasing by 4% per year for incidence and by 3% per year for mortality. 11 Reasons for the elevated risk remain unclear but may include a higher prevalence of risk factors, such as vitamin D deficiency because of low sun exposure; smoking; obesity; a diet high in smoked fish and marine mammals and low in fiber, fruits, and vegetables [101][102][103] ; and perhaps Helicobacter pylori infection. [104][105][106] The high CRC burden among Alaska Natives is compounded by inadequate availability of endoscopic services in much of Alaska, 107,108 resulting in the lowest CRC screening prevalence in the nation.…”

Inequities Among Cancer Caregivers with Diverse Identities: A Review of the Literature and Future Directions

“…This gap is particularly troubling finding given the significant mortality rate for American Indian/Native Americans, which is 18% higher compared to other groups. [32]. Several interventions are undergoing development and testing for Black cancer caregivers.…”

Validation of Navigator-Assisted Hypofractionation (NAVAH) Program Survey to Aid American Indian Breast Cancer Patients

“…3 In addition to later diagnosis, American Indian populations experience a lack of access to cancer care, particularly in rural and underserved areas, have high rates of poverty, which contribute to financial barriers, and harbor justified mistrust in the health care system. 4,5 Furthermore, research has demonstrated that American Indian patients are less likely to receive guideline-concordant cancer care and experience a higher likelihood of significant treatment delays. 6,7 The pronounced mortality rates observed among American Indian populations suffering from breast cancer underscore the need to identify barriers to treatment and understand the underlying causes of these barriers.…”