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Cancer care still problematic

Indian health advocates call for congressional action

WASHINGTON - A new report labels American Indians with cancer as largely ''invisible'' to policymakers - a distressing problem that makes it difficult for many to receive quality treatment and prevention assistance.

The report, issued in April by the Intercultural Cancer Council, noted that cancer is the second leading cause of death among American Indians and Alaska Natives over the age of 45.

Compared to other racial groups, Indians have the poorest survival rate for all cancers, and there are many cancers that disproportionately affect Indian populations. Lung cancer was found to be the most common type of cancer death in eight of the nine IHS areas. Incidence and death rates from kidney cancer among Natives were also found to be higher than any other racial or ethnic groups.

Poverty, discrepancies between rural and urban health care, and a lack of access to prevention strategies, like screening tests, are all contributors to the alarming trends, according to Indian health officials.

Lovell Jones, co-founder of ICC, said during a press briefing announcing the report that the ''time is now'' for federal and state policymakers to address such disparities ''head on.'' He said the ''consequences would be unimaginable'' if immediate action is not taken. Part of the ICC's mission is to focus on eliminating the unequal burden of cancer among minorities.

Because American Indians as a group tend to be younger than other racial populations in the U.S., traditional research has previously suggested that cancer is less common in Native communities. However, Jones indicated that better health data collection in Indian country now shows that such research no longer rings true.

''Cancer rates were previously reported to be lower in American Indians,'' Lovell said, ''but they have actually been increasing over the past 20 years.''

Indian health experts note that data collection has long been a contentious area. Some tribes and individual Indians are particularly distrustful of researchers, since they feel much past research by non-Indians has actually done more harm than good for Native populations.

Jennie Cook, president of the ICC Caucus, said that better access to treatment for Indians and other minorities is crucial, but that a focus on prevention must also be ''put into the mold.''

''Public health needs to be the driving factor,'' she said. She noted that millions of dollars are spent each year by the federal government on new biological innovations and discoveries, but in the meantime, there are already known ways to reduce cancer. Namely, she said, those ways involve simple approaches like explaining the importance of quitting smoking and noting how regular breast and prostate cancer exams can be potential lifesavers.

Cook believes there should be an immediate stop to cuts in Centers for Disease Control and Prevention monies focused on cancer prevention and control.

As part of its report, the ICC recommended that state and federal legislators begin funding longstanding commitments they've made to addressing cancer care and prevention among minority and poor populations. The group also called on Congress to pass a strong Patient's Bill of Rights and work to achieve universal health insurance by 2010.

Indian health advocates have reacted strongly to the report and its recommendations.

Brenda Seals, director of the Native American Cancer Research Center, said her group sees the end results of how lacking policy affects Natives in terms of cancer.

''Every year, funding for the Indian Health Service comes up for reauthorization,'' she said, ''and the problem with IHS is that it is so chronically underfunded.'' She noted that the department has many difficulties providing quality cancer care to Indians on reservations, adding that lags in getting care are often huge.

A member of the Eastern Band of Cherokee Indians, Seals noted that there are many differences among cancer rates in different Indian communities. Overall, she said, it's a ''major problem that needs to be addressed.''

Seals feels it's important for American Indians to get their concerns about cancer care and prevention heard by members of Congress. ''We don't need to be ashamed in making our case,'' she said.

Celeste Whitewolf, a member of the Confederated Tribes of Umatilla who directs the Native People's Circle of Hope health support group in Oregon, said she's especially concerned that the Bush administration has attempted to cut funding for urban Indian health programs.

''The lack of congressional support and actions by the Bush administration is really discouraging,'' she said. ''It sometimes seems that the institutions are trying to kill us by their lack of action.''

Whitewolf said her own experience facing down breast cancer, which was first diagnosed in 1998 and is now in remission, has provided her with much insight into flaws in the current health system.

Whether legislators take action or not, Whitewolf feels it's important to note that Indians have long been survivors. She plans to keep up her own volunteer efforts focused on smoking cessation, promoting healthy living and building grass-roots Native coalitions.

''We are here. That says a lot.''