Lowering Cancer Rates Among American Indians Requires Better Education, Screening and Facilities

A story about what steps Native Americans must take to reduce cancer rates among their people.

Cancer is often preventable and survivable, but not if you ignore it. “We have to take cancer on like any other enemy. If you confront it you can beat it,” says Dr. David Perdue, Chickasaw, the medical director of the American Indian Cancer Foundation (AICAF).

AICAF Executive Director Kris Rhodes, a member of the Bad River Band of Lake Superior Chippewa and Fond du Lac Band of Lake Superior Chippewa, will attend the Reservation Economic Summit’s (RES) Celebrating Women in Business Luncheon and Fashion Show on March 1. The luncheon attracts about 2,500 people annually and features a different cause each year; this year’s focus is cancer awareness. Proceeds from a silent auction during the luncheon will benefit the AICAF, and Rhodes will have a booth where AICAF feather ribbon lapel pins will be sold for $5 each, with proceeds supporting cancer prevention and awareness in Indian country. A slide show will feature photographs of Native cancer survivors, those battling cancer and those lost to the disease, such as Elouise Cobell.

According to Rhodes, cancer has become the leading cause of death for American Indians, surpassing heart disease. Lung cancer is the leading cause of those deaths, followed closely by colorectal cancer. “Disease rates vary by region and tribes, so what is true for the Northern Plains and Alaska may not be true for tribes in the Southwest,” she explains.

American Indians and Alaska Natives have higher rates of lung cancer and colorectal cancer than non-Hispanic white populations (NHW) in Alaska and the Northern Plains. This is attributed to smoking, poor access to health care and cancer screenings, underfunding of the Indian Health Service, a lack of ability to pay for medical treatment and poor awareness of early detection and treatment options.

Rates of stomach, gallbladder, kidney and liver cancers are also higher for American Indians and Alaska Natives than they are for NHWs in Alaska, the Plains regions and in the Southwest. (Reversing that trend, cancer rates overall for American Indians and Alaska Natives were lower than the rates for NHW populations in the Southwest, the Pacific Coast and the East regions, according to a 2008 Centers for Disease Control and Prevention study.)

Perdue cites some other troubling statistics from that report: The number of new cases of colorectal cancer is 39 percent higher in Northern Plains tribes than it is in NHW populations, and Alaska Natives have double the colorectal cancer rate of NHWs. He says one reason those rates are so high could be that colorectal cancer screening rates for American Indians are half that of the NHW population. This is particularly disturbing, he explains, because that kind of cancer is one of the most preventable when patients undergo the proper screening processes and have access to quality care.

The AICAF is working as a subcontractor for the Shakopee Mdewakanton Sioux Community in Shakopee, Minnesota, which got a $625,000 two-year grant funded by the Centers for Disease Control and Prevention through the Indian Health Service to increase colorectal cancer screenings in Northern Plains tribes. Perdue says his team will be visiting 54 tribal health systems in the region to assess each system’s knowledge and procedures for colorectal cancer screenings.

Dr. Judith Kaur, a member of the Choctaw Nation of Oklahoma, is medical director for the Native American Programs of the Mayo Clinic Comprehensive Cancer Center, which provides outreach to American Indian communities. “We have a tremendously vocal cancer survivor group across Indian country. They are telling family, friends and their communities that if you get screened, diagnosed and treated, there is a good chance you can beat this,” she says. “In the past, people didn’t talk about cancer because of their fear of it, and it was the general assumption that if you were diagnosed with cancer it was already too late.”

Access to care and screenings are important elements of cancer prevention, detection and treatment, but they aren’t the only weapons in this fight. Mitigating the risk factors is also crucial. The number-one cancer risk factor in Indian country is smoking. The second, according to Perdue, is obesity. “The biggest thing is: Don’t smoke,” he says. “Going back to healthier, more traditional diets, cutting out foods high in fats and getting regular exercise will decrease cancer risk.”

Rhodes says cigarette smoke is linked to nine out of 10 cases of lung cancer and one out of three cases of all other cancers. “We can all contribute to the health of our community by reserving tobacco for sacred purposes only,” she says. “It is important to ask for help when quitting smoking—ask for help from the Creator, from your family, from your clinic and from your friends.”

Perdue says American Indians often have misconceptions that can be barriers to cancer screening and treatment. Some of his patients believed if they were to talk about cancer they would be more likely to get it. Or that cancer is infectious, or that it comes from breaking taboos. “People need to understand that cancer is a biologic process and a lot of cancers are treatable and preventable,” he says.

Joy Rivera, Haudenosaunee, is the colon cancer–screening navigator at the AICAF—she is, according to Perdue, their “face on the street,” the person who talks to tribal members about screenings and walks them through the process. Rhodes says Rivera has been incredibly successful in getting both men and women in following through with their medical providers to request and complete cancer screenings.

Rhodes says there are many barriers to detection and care, such as underfunded health systems, lack of data, lack of programs and professional staff shortages. American Indians in both rural and urban areas have less health-care coverage and less access to health care than the NHW population—added to that are fewer prevention programs, cancer screenings and specialist care targeted to American Indians.

Despite the formidable task she has undertaken, Kaur is hopeful. “We have more resources today than even five or 10 years ago—but it’s not enough. We need to continually educate new leaders in health promotion and cancer prevention,” she says. “Now that I am an elder with three grandchildren, I am very concerned that the next generation benefits from both traditional knowledge and western science. There needs to be a lot of dialogue about what new advances there are in cancer treatment.”

What this all boils down to is: don’t smoke, don’t abuse alcohol, don’t eat foods high in fat, do eat lean meats, fruits and vegetables—a more traditional diet. Exercise, even if that just means walking short distances during breaks at work. Do ask your medical providers questions and find cancer screenings appropriate for your risk factors and family history. Don’t ignore, forget, procrastinate or be stubborn about your health.

To learn more about AICAF, visit AmericanIndianCancer.org. To learn more about the resources available to American Indians and American Indian communities through the Mayo Clinic Comprehensive Cancer Center, visit NativeAmericanPrograms.org.