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Endia Fontanez
Cronkite News

PHOENIX – Colorectal cancer has received a great deal of attention since actor Chadwick Boseman lost his four-year battle to the disease in August. It’s the second-leading cause of cancer death among Native Americans, prompting calls for increased screenings to improve detection and treatment of colorectal disease.

Donald Haverkamp, an epidemiologist with the U.S. Centers for Disease Control and Prevention, said many factors play a role in the number of cases among Native Americans, including lack of access to health care or insurance, increased natural bacteria on some reservations and diet and lifestyle.

“Cultural beliefs can come into play as well,” he said. “There are tribes, for example, that don’t even want to mention the word cancer, for fear of bringing on that disease, bringing it onto yourself by mentioning it.”

Native Americans, along with Hispanics, have the lowest colorectal screening rates in the U.S., statistics show, with 48.7 percent of those age 50 to 75 undergoing tests in 2015. That compares with 65.4 percent of non-Hispanic whites.

These factors, combined with the number of American Indians who do not have health insurance or reliable transportation to cancer clinics, play a role in the high mortality rate of American Indians and Alaskan Natives diagnosed with colorectal cancer.

With proper screening, Haverkamp said, polyps can be detected early and the survival rate is as high as 90 percent. With late-stage diagnoses, the survival rate drops to 14 percent.

Misha Loeffler, cancer equity coordinator at the American Indian Cancer Foundation, said it is especially important to provide screenings to those living on reservations, sometimes even before the CDC’s recommended age of 50.

When federal cancer statistics are narrowed just to counties that contain tribal lands, overall rates of colorectal cancer are even worse, with nearly 16 percent of cases in people younger than 50.

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“There’s a lot of lack of opportunity for health care access or insurance for many of our communities,” Loeffler said. “And a lot of these things are related to systemic policies that are really unfair and unjust to the health and well-being of our communities.”

The University of Arizona Cancer Center is working to address this problem. The program was recently awarded $3 million by the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research and prevention.

Jennifer Hatcher, associate director of community outreach and engagement for the UArizona center, said only about 20 percent to 30 percent of eligible Native Americans are being screened for colorectal cancer in Arizona, compared with 75 percent of the general population. Her goal with this funding is to increase those numbers by at least 25 percent.

“Ultimately,” she said, “the goal is to increase survivorship, to decrease mortality.”

Hatcher and her team plan to mail test kits to tribal residents that can detect blood in the stool – a potential sign of precancerous polyps in the colon.

Kellen Polingyumptewa, a health coach at Native Americans for Community Action, a Flagstaff group that aims to improve wellness for Native Americans, described the test kits as a sort of “check-engine light for our body” that can alert someone that they may need a follow-up with a doctor.

This type of mail kit has been especially useful during the COVID-19 pandemic because many people are hesitant to visit a clinic in person, especially if they are high-risk or have an underlying condition.

“Even through the pandemic, we’re able to mail those out to the patient, so it’s totally contact free as far as having them to come in,” Polingyumptewa said. “(The tests are) sent back with a self-mailed, self-addressed and paid-for mailing envelope.”

There’s been more conversation about ways to prevent colorectal cancer since the death of Boseman on Aug. 28. Polingyumptewa said there also has been an uptick in requests for test kits.

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