Native North Americans and cancer
Native North Americans, also referred to as American Indians and Alaska Natives (AI/AN), represent a diverse group of over 570 federally recognized nations throughout the United States, with a population exceeding 8.5 million. Unfortunately, cancer stands as the leading cause of death within this community, with significantly higher incidence and mortality rates for certain cancers, such as lung, liver, and colorectal cancers, compared to non-Hispanic White Americans. Access to healthcare is a major challenge for many AI/AN individuals, particularly those living in remote areas, leading to delays in seeking treatment and a lack of regular medical screenings.
Various factors contribute to this public health crisis, including poverty, inadequate health insurance, and cultural perceptions of healthcare quality. The prevalence of unhealthy diets, compounded by historical injustices and systemic inequities, further heightens cancer risk. There is a pressing need for culturally competent healthcare approaches that integrate traditional practices with modern medical methods to improve health outcomes. Numerous organizations, including the Indian Health Service and community foundations, are actively working to address these disparities through research, education, and support initiatives. Enhancing trust and communication between healthcare providers and AI/AN populations is crucial for encouraging preventive care and improving cancer survival rates.
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Native North Americans and cancer
ALSO KNOWN AS: American Indians, Alaska Native, American Indian/Alaska Native (AI/AN), First Americans, Indigenous Americans
DEFINITION: Indigenous peoples of the United States are a widely dispersed group of individuals from hundreds of Nations throughout the United States. Cancer is the leading cause of death among individuals of American Indian and Native Alaskan (AI/AN) descent.
Description of the population: The United States government officially recognizes more than 570 AI/AN Nations that speak more than three hundred languages. Between 20 and 30 percent of American Indians live on federal reservations throughout the United States. In the second decade of the twenty-first century, the population of individuals identifying as AI/AN doubled. This population of more than 8.5 million people has experienced a disproportionate level of poverty, education, living conditions, and access to healthcare compared to non-Hispanic White Americans, regardless of living on or off the reservation in urban or rural areas.
Incidence, death, and survival statistics: Cancer is consistently among the most common causes of preventable deaths among AI/AN individuals. The incidence and mortality rates of lung, liver, kidney, stomach, and colorectal cancers in these individuals are much higher than in other groups. Additionally, the incidence of liver, kidney, and breast cancers increased sharply between 1999 and 2015. Mortality rates in infection-related cancers are typically two times higher in AI/AN populations. Overall, cancer rates are around 2 percent higher in AI/AN populations than in White Americans, but mortality rates are exponentially higher for AI/AN individuals. In cancer types with similar or lower incidence rates among the AI/AN population compared to White Americans, the mortality rate remains more than 15 percent higher for AI/AN individuals in most cases.
For example, overall incidence and mortality rates of colorectal cancer are 40 percent higher in AI/AN populations compared to White individuals. Colorectal cancer rates rose for all populations in the last decades of the twentieth century through the first decades of the twenty-first century, but while the incidence increased 33 percent among White individuals between twenty and forty-nine, the same age group of Alaskan Native individuals experienced an increase of 85 percent.
Risk statistics:
Many problems contribute to the lack of healthcare and medical screenings that prevent cancer or lead to early diagnosis. Many AI/AN individuals live in remote areas away from cancer centers and hospitals, leading them to delay seeking treatment and limiting access to regular comprehensive medical care. Additionally, the cost of medical care and a lack of quality health insurance are barriers to care. This lack of regular medical care, including general healthcare and routine screenings for diseases, is generally linked to adverse health outcomes. Cancer is less likely to have a positive result when not detected early.
Perception of the quality and effectiveness of healthcare services is generally low among AI/AN individuals. Many who seek care report dissatisfaction with the quality of care they receive. Many issues and concerns relate to poor provider communication, with around one-third of AI/AN individuals reporting poor communication with their healthcare provider. Identifying unique cultural and historical healthcare factors that impact the AI/AN community may allow clinicians to serve them better. Adopting a culturally competent, interdisciplinary approach to care by utilizing holistic, traditional methods with modern screening, prevention, and diagnostic methods fosters a more inclusive environment for healing. It improves health education for all parties involved.
A disproportionate number of AI/AN individuals live in poverty, a known risk factor for myriad health concerns. People living in poverty are less likely to have a well-balanced diet rich in fruits, vegetables, and whole grains, which helps reduce the risk of some cancers. Poor diets and concomitant obesity have historically been exacerbated by the unhealthy commodity foods provided by the US government. Mortality rates are increased by the prevalence of alcohol abuse and smoking tobacco, a significant risk factor for many types of cancer.
Perspective and prospects: Medical practitioners working with AI/AN populations may benefit from cultural awareness training. Improving doctor-patient communication, relationships, and trust are essential in creating positive cancer outcomes. Individuals with a positive relationship with their healthcare provider are more likely to seek screenings and early treatment, which can drastically improve cancer outcomes.
Many groups and foundations have sponsored research and educational outreach programs designed to help AI/AN individuals—the Native American Cancer Research Group, the Office of Tribal Affairs and Policy, the Substance Abuse and Mental Health Services Administration, and the American Indian Cancer Foundation. These organizations dedicate time and resources to educating about cancer, organizing research into genetic patterns of cancer inheritance, and providing cancer support services.
The US Department of Health and Human Services's Indian Health Service is a division of the federal government charged with providing health services to many AI/AN individuals founded in 1955. The Indian Health Service serves about 2.75 million individuals, mainly on recognized reservations. Since only a small portion of the AI/AN population lives on or near reservations, many lack access to available services.
Bibliography
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Siegel, Rebecca. "New Study Shows Cancer Mortality Higher Among American Indian and Alaska Native Individuals; Colorectal Cancer Rapidly Increasing Before Age 50." The American Cancer Society, 8 Nov. 2022, pressroom.cancer.org/AIANStudy. Accessed 20 June 2024.