Cancer Screening and Risk Factor Rates Among American Indians

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American Journal of Public Health (Impact Factor: 4.55). 03/2006; 96(2):340-50. DOI: 10.2105/AJPH.2004.053231
Source: PubMed


We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations.
We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods.
Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used.
Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

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Available from: Judith Swan
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    • "This approach reduces the potential for racial misclassification (Burhansstipanov, 1998). Although multiple measures of race/ethnicity are available in the 2003 CHIS, we used the 2000 U.S. Census single race definition because of its widespread use and straightforward interpretation (Swan et al., 2006). Because the 2000 U.S. Census classifies Hispanic heritage as an ethnicity rather than a race, we did not exclude individuals who classified their race as AI/AN alone and their ethnicity as Hispanic. "
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    ABSTRACT: Breast cancer incidence and mortality have been increasing among American Indian and Alaska Native (AI/AN) women, and their survival rate is the lowest of all racial/ethnic groups. Nevertheless, knowledge of AI/AN women's breast cancer screening practices and their correlates is limited. Using the 2003 California Health Interview Survey, we 1) compared the breast cancer screening practices of AI/AN women to other groups and 2) explored the association of several factors known or thought to influence AI/AN women's breast cancer screening practices. Compared with other races, AI/AN women had the lowest rate of mammogram screening (ever and within the past 2 years). For clinical breast examination receipt, Asian women had the lowest rate, followed by AI/AN women. Factors associated with AI/AN women's breast cancer screening practices included older age, having a high school diploma or some college education, receipt of a Pap test within the past 3 years, and having visited a doctor within the past year. Significant differences in breast cancer screening practices were noted between races, with AI/AN women often having significantly lower rates. Integrating these epidemiologic findings into effective policy and practice requires additional applied research initiatives.
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    • "Pap screening rates to whites, while foreign-born women, including whites, have markedly lower screening rates than their US-born counterparts [22]. For AI/AN women, racial misclassification is reported as one of the most difficult obstacles in accurate and informative data collection [20]. Meta-analysis of the literature has revealed that disparities in cervical cancer screening rates become more pronounced as age increases [23]. "
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    ABSTRACT: Significant disparities in cervical cancer incidence and mortality rates among minority groups have been documented in the United States, despite an overall decline in these rates for the population as a whole. Differences in cervical cancer screening practices have been suggested as an explanation for these disparities, as have differences in treatment among various racial and ethnic groups. A number of factors are attributed to these observed differences. As minority populations continue to grow in size over the next 50 years, persistent disparities will place an ever increasing burden on these populations and on the national healthcare system. Strategies to reduce cervical cancer disparities need to be employed in order to reverse these trends.
    Full-text · Article · Jun 2008 · Gynecologic Oncology
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    • "Cervical cancer among American Indian/Alaska Native (AIAN) women is a health problem that is of growing concern. Although calculated rates may vary depending on how AIAN race is determined (Swan et al., 2006) several regional analyses over the past twenty years have demonstrated a cervical cancer incidence disparity for AIAN women (Horm and Burhansstipanov, 1992; Baquet, 1996; Bleed et al., 1992; Leman et al., 2005), and higher rates of abnormal Pap smear findings (Bernard et al., 2001), although there are exceptions (Paltoo and Chu, 2004). A recent comparison of AIAN cervical cancer rates with those of non-Hispanic white women residing in Indian Health Service Contract Health Service Delivery Areas (where calculation of race is likely to be most accurate), found that AIAN women had significantly higher cervical cancer rates overall (Becker et al., 2008), with variation by region. "
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    ABSTRACT: Objective: To quantify the loss to follow-up rate after abnormal Pap test results at the Phoenix Indian Medical Center, an Indian Health Service regional facility, and identify barriers to follow-up from the patients' point of view. Materials and Methods: Patient records were used to identify women who had abnormal Pap tests in 2002 and to document the status of their follow-up care. Women who had no clinical record of follow-up were contacted by telephone to arrange a follow-up appointment and to request participation in a structured qualitative interview to identify barriers to follow-up at the individual, family, community, and health care system levels. Structured qualitative interviews were conducted with 15 women. Results: Of the 930 women with abnormal Pap test results in 2002, 11.1% received follow-up care at PIMC in accordance with the recommended timeframe stipulated in clinical protocols; 74.6% received follow-up care at PIMC, but not in accordance with protocols; 2.6% were followed-up at another facility, 1% had moved out of the area, 3.5% were never treated, and we were unable to contact 6.6%. Most of the barriers to follow-up were related to communicating the need for follow-up and providing access to care within a timeframe appropriate for clinical care. Conclusion: While these findings place an important additional responsibility and burden on the health care system serving American Indian women, our research outreach efforts suggest that given the availability of appropriate resources, these barriers can be overcome.
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