Preventable cancer mortality in American Indian and Alaska Native women.

This report describes a series of six studies on cancer in American Indian and Alaska Native (AI/AN) women, with a particular emphasis on cancer of the breast and cervix. Data from the Indian Health Service (IHS) inpatient data system was used to generate estimates of incidence of cancer among AI/AN populations. Additionally, breast cancer rates among Indian women in Arizona and New Mexico were compiled from extensive chart review of the New Mexico Tumor Registry and the IHS Inpatient Data System. Study of the performance of the health care system for cancer screening in women suggest that the major deficiency lies not in a failure to bring women in for screening, but rather to complete the screening after contact has been made and the need for screening recognized. The studies indicate that cancer is generally diagnosed in American Indian women at a more advanced stage and survival experience of Indian cancer patients is worse than non-Indian, even when corrected for later stage at diagnosis. Several of the studies suggest that failure to diagnose cancer in its very early stages appears to be in large part dependent on patient behavior. An alarming number of women do not keep follow-up appointments, even after multiple referrals and rescheduling of appointments. These findings suggest the need for intervention strategies that encourage women to become knowledgeable about cancer and to accept responsibility for their screening. The studies suggest that the relative difficulty in improving screening rates are traced to an inadequate understanding of cancer and its prevention on the part of women in the community