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Why screening is important

Tailoring the message is key to preventing cancer in American Indians

SIOUX FALLS, S.D. - National Minority Cancer Awareness Week was April 20 - 26, and while much progress has been made in the prevention, detection and treatment of cancer, these health advances have not benefited all populations equally.

In this column, Roberta Cahill talks about the unequal cancer burden facing American Indians and other ethnic and medically underserved populations. Cahill is Yankton Sioux and lives in Pierre. Her work for the American Cancer Society focuses on cancer education to diverse populations.

Charlotte Hofer: What are some of the challenges facing Native Americans that affect cancer treatment and survival?

Roberta Cahill: Screenings save lives, yet some minority groups in the U.S. are less likely to get these lifesaving early detection tests. Several populations - including Native Americans - encounter barriers to information, access, treatment and support options.

We also want people to know how lifestyle factors like your diet can impact cancer risk - that obesity, physical inactivity, a diet high in processed foods or red meat, or a diet low in vegetables and fruits, for example, all increase your odds of cancer. But if you trim up and lose the extra weight, start moving and eat a healthy diet - these simple changes can be powerful in preventing cancer.

The prevention message still isn't getting through to enough men and women in the tribal communities. There are still a lot of people we need to reach, and we're working to find better ways of tailoring our messages - to emphasize the importance of a good diet and exercise: quitting smoking and getting preventive screenings - as a way to take control of your health and increase your chances of living a cancer-free life.

Hofer: What is the American Cancer Society doing to help Native Americans?

Cahill: We're working to build strong relationships with underserved communities. We're listening to the people in the communities to better understand their culture and needs. We're working to eliminate the problems in health care faced by these underserved groups. The American Cancer Society used National Minority Cancer Awareness Week as an opportunity to increase awareness about the unequal cancer burden facing ethnic and medically underserved populations, and we're working to eliminate disparities all year long.

Hofer: Do Native Americans and other minority populations tend to have lower survival rates from cancer?

Cahill: Yes, minority populations are more likely to be diagnosed with and die from preventable cancers and be diagnosed with late-stage disease for cancers that could have been detected through screening at an early stage. Add to that, that these populations receive either no treatment or treatment that may not meet current standards of care and die of generally curable cancers and often do not have the benefit of palliative care.

Hofer: What are some of the barriers to care that Native Americans encounter?

Cahill: There are a lot of factors that contribute to disparities, ranging from language issues to racial biases to basic transportation problems in getting to treatment to the complexity of the health care system and suspicion of it, to the number of uninsured and the cost of cancer care.

The American Cancer Society is working to educate the general public about access to care issues and in particular, how lack of insurance affects patients. Research shows that uninsured patients are more likely to be treated for cancer at late stages of disease, and they're more likely to receive substandard care.

The society has long funded research to discover early detection measures and effective ways to provide equal access to optimal care for underserved populations. And ACS provides trained staff throughout the U.S. to help cancer patients by arranging transportation to and from treatment, providing referrals to local services like support groups or nutrition counseling, or finding information on financial assistance programs.

Hofer: Can you explain how language or cultural differences can affect cancer treatment for Native Americans?

Cahill: Native Americans don't have a word for cancer in their languages, so translations can foster confusion and fear about the disease. In addition, many tribes believe that talking about an illness will bring it into your life, and that if you're healthy, you should not look for sickness ... so a person may not go in for preventive screening.

The American Cancer Society is working to address these cultural differences in several ways - for example, by working with tribal leaders and state and tribal cancer coalitions such as the Northern Plains Comprehensive Cancer Control - to work together on cancer prevention and control programs, and to make preventive strategies relevant to the population.

Hofer: How does tailoring the message help?

Cahill: We need to do a better job explaining why screening is important and why lifestyle choices like diet and exercise matter, so that people will know they can cut their cancer risk, so they will hear the message and act on it.

We need more Native Americans to take advantage of cancer prevention strategies and to participate in prevention studies like the ''Sister Study''* for breast cancer research. We need to get more people at the grass-roots level talking about screening - for breast and cervical cancer, for colon cancer. We need to find more ways to educate the community about screening and prevention - but in ways that meet their needs and lifestyles.

Progress is being made - the American Cancer Society is working to develop culturally appropriate health communications for Native Americans, and working to tailor the message so it's relevant to people right where they live, in their communities.

Hofer: What do you want people to remember?

Cahill: The great news is, a significant number of cancer cases can be prevented - through diet, exercise, smoking cessation and by getting screenings BEFORE you see symptoms - and we will keep on saying this message and finding more ways to make the message relevant to tribal communities. You have the power to decrease your odds of getting cancer.

The American Cancer Society is dedicated to preventing cancer and saving lives through research, education, advocacy and service. For cancer information anytime, call (800) 227-2345 or visit

*The Sister Study ( is enrolling 50,000 sisters diagnosed with breast cancer to study causes of the disease. Currently, the study has recruited more than 46,000 women, although only 7,000 are from minority groups. If you want to participate, contact the American Cancer Society for more information.For information about this article, contact Charlotte Hofer at