An Update on Cancer in American Indians and Alaska
Supplement to Cancer
Introduction to the Supplement on Cancer in the
American Indian and Alaska Native Populations
in the United States
Nathaniel Cobb, MD1
Phyllis A. Wingo, PhD2
Brenda K. Edwards, PhD3
1Division of Epidemiology and Disease Prevention,
Indian Health Service, Albuquerque, New Mexico.
2Division of Cancer Prevention and Control,
National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Con-
trol and Prevention, Atlanta, Georgia.
3Division of Cancer Control and Population
Sciences, National Cancer Institute, Bethesda,
The collection of papers in this Supplement combines cancer incidence data
from the National Program of Cancer Registries and the Surveillance, Epidemiol-
ogy, and End Results program, enhanced by record linkages and geographic
factors, to provide a comprehensive description of the cancer burden in the
American Indian/Alaska Native population in the United States. Cancer incidence
rates among this population varied widely, sometimes more than 5-fold, by
geographic region. Cancer 2008;113(5 supp):1113–6. Published 2008 by the Ameri-
can Cancer Society.*
KEYWORDS: cancer incidence, American Indian, Alaska Native, race, misclassifi-
among American Indians and Alaska Natives (AI/AN) in the United
States.1Although there is great diversity among the hundreds of
tribes and linguistic groups that comprise the AI/AN population,
they share many features, including a history of defeat, displace-
ment, and cultural trauma in the not-so-distant past, as well as a
rich cultural heritage that can be a source of strength in the present.
Many AI/AN live on reservation lands or in remote rural areas, with
primary healthcare needs provided only by the Indian Health Ser-
vice (IHS) or tribally operated health programs.2,3Both rural and
urban AI/AN populations experience greater poverty, lower levels of
education, and poorer housing conditions than the general US
population.4The risk factor profile for many AI/AN communities is
quite different from others, including use of tobacco and alcohol,
physical activity level, and obesity.5,6Dietary practices and exposure
to harmful environmental agents are less well documented, yet may
also be important risk factors. Many of these influences on the bur-
den of cancer for this group tend to be lost when data from AI/AN
cancer cases from all regions of the United States are combined into
composite rates. Careful study of the incidence of cancer among AI/
AN can be helpful in understanding the influence of different expo-
sures, in addition to quantifying the burden of disease for this
population. The special collection of papers in this Supplement uses
nique circumstances of culture, location, history, and healthcare
combine to produce unusual patterns of cancer occurrence
This supplement was sponsored by Cooperative
Agreement Number U50 DP424071-04 from the
Centers for Disease Control and Prevention, Divi-
sion of Cancer Prevention and Control.
Phyllis A. Wingo is employed by the Arctic Slope
Regional Corporation, Inc., which is a contractor
to the Indian Health Service.
Address for reprints: Nat Cobb, MD, Indian Health
Service Division of Epidemiology and Disease Pre-
vention, 5300 Homestead NE, Albuquerque, NM
87110; Fax: 505-248-4393; E-mail: nathaniel.
*This article is a US Government work and, as
such, is in the public domain in the United
States of America.
Received May 5, 2008; accepted June 3, 2008.
Published 2008 by the American Cancer Society*
Published online 20 August 2008 in Wiley InterScience (www.interscience.wiley.com).