Cancer Prevention Among Urban Southwestern American Indian Women

Abstract

PURPOSE: The health issues which have historically faced American Indians are related to infectious disease, but today many chronic diseases play a large role in the health status of this special population. For example, existing data indicate that American Indians have the poorest cancer survival of any group in the U.S. (34% vs. 50% for U.S. Whites). Regular participation in cancer screening and lifestyle factors such as smoking, diet, and alcohol have been found to significantly contribute to cancer risk. However, available information about these behaviors is sparse and suffers from limitations. The purpose of this study was to assess the prevalence of cancer risk behaviors and provider recommendation for cancer screening among urban American Indian women.

METHODS: A random household cross-sectional survey was administered to 519 adult American Indian women in Phoenix, Arizona. Smoking and weight status, alcohol consumption, physical activity, and provider referral were assessed by self-report.

RESULTS: The results indicate that weight (69.6% were overweight) and excessive alcohol consumption (12.1% reported chronic drinking) were significant health issues in this population. The prevalence of provider referral for smoking cessation (14.9% among ever smokers) and breast as well as cervical cancer screening (30.1% and 55.5%, respectively) were below the 75% level set forth in the Year 2000 Goals.

CONCLUSIONS: The results of this study suggest that increased cancer prevention and control efforts are needed in this special population to address the link between diet, weight, and long-term disease prevention.

Introduction

There are approximately 2 million people (0.8% of the U.S. population) who self-reported American Indian or Alaska Native status in the 1990 Census. The health issues which have historically faced this special population are related to infectious disease, such as tuberculosis. Today chronic diseases such as diabetes and hypertension play a large role in the health status of American Indians. However, cancer among American Indians has not received much attention until recently (1). Available information indicates that American Indians have the poorest cancer survival of any group in the U.S., despite the overall low incidence and mortality rates. The 5-year survival rate among American Indians is 34% vs. 50% for U.S. Whites. The leading cause of cancer death among American Indian women is lung cancer (9.3 cancer deaths/100,000). This is closely followed by breast, colon, and cervix cancer (9.0, 8.0, and 5.5 deaths per 100,000, respectively) (2).

Examination of the occurrence of cancer by site of diagnosis and region/tribe also indicates several areas of concern. For example, American Indians have an increased incidence of cervical cancer, ranging from 2–6 times higher than in U.S. Whites. And while the incidence of lung cancer among the Sioux and Eastern Cherokee is similar to that of U.S. Whites (36.3/100,000), the incidence rate is three times higher among Alaska Natives. In contrast, Navajo Indians have a tribal rate of 4.6/100,000 (3).

Many lifestyle factors such as smoking, diet, and alcohol have been found to significantly contribute to cancer risk. Regular participation in cancer screening can also affect the risk of cancer death, because many cancers are curable if detected early (4). However, the existing information about cancer and associated behaviors in this special population is sparse and suffers from limitations. For example, data from the Surveillance, Epidemiology, and End Results (SEER) program reflect only the cancer experience of American Indians living in New Mexico and Arizona due to small numbers in other SEER sites (1). The Behavioral Risk Factor Surveillance System (BRFSS), which is designed to monitor progress toward the Department of Health and Human Services Healthy People 2000 Objectives, is limited because of restriction to telephone responses (5). Finally, information from the Indian Health Service (IHS) typically includes American Indians living on-reservation, and does not reflect the estimated 54% of this group who live and receive medical care in urban areas (6).

The Healthy Native Women Project was a random household survey of American Indian women living in an urban southwestern setting. The purpose of this project was to collect information on American Indian women's health issues in Phoenix, Arizona. The purpose of this paper is to report the prevalence of several risk factors and behaviors related to cancer prevention and control among urban American Indian women.