Mammographic findings and family history risk for breast cancer in American Indian women

Talking Circles: Northern Plains Tribes American Indian Women's Views of Cancer as a Health Issue

OBJECTIVE

The purpose of this research was to understand the cultural meanings of cancer among American Indian women from Northern Plains tribes living in western South Dakota and their experiential view of breast and cervical cancer screening.

DESIGN AND SAMPLE

Using an exploratory design, a purposive sample of 28 women, 35-75 years of age, were recruited into three Talking Circles.

MEASUREMENT

Talking Circle and focus group methodology, combined with Affonso's Focus Groups Analytic Schema, were used to generate contextual data sets including thematic findings.

RESULTS

Ten themes emerged indicating interrelationships between cultural traditions and health structures of care. The themes provided a unique perspective for conceptualizing women's experiences with breast and cervical cancer screening.

CONCLUSIONS

Incorporating women's cultural experiences into screening services is necessary to address clinical and policy challenges for reducing breast and cervical cancer mortality among American Indian women. Findings from this research will be used to guide a future study investigating breast-screening patterns related to mammography adherence and development of interventions specific to American Indian women.

Can the Gail model be useful in American Indian and Alaska Native populations?

BACKGROUND

Very little is known about breast carcinoma risk factors for American Indian/Alaska Native (AI/AN) women undergoing screening. The Gail model has been a useful tool for predicting the risk of breast carcinoma in several populations. It has not been applied systematically to AI/AN women.

METHODS

The current study was a retrospective review of 1458 screening mammograms performed for AI/AN women. The authors applied the Gail model to estimate both absolute risk and relative risk for breast carcinoma for AI/AN women screened in South Dakota, Arizona, and Alaska.

RESULTS

The mean age of the women was 52.4 years. The onset of menses was not significantly different than expected. The average age at first birth was 20 years, very few women were nulliparous, and few women were age > 30 years at first live birth. The proportion of women reporting a first- or second-degree relative with breast carcinoma was similar to the proportion in the general population. The results of the model indicated an overall average relative risk that ranged from 1.42 to 2.69 compared with white American women, depending on the model assumptions used. Using a modified Gail model and calculating an imputed absolute risk, the expected incidence of breast carcinoma in this population increased to rates of 170-180 per 100,000 in the next 10 years, a significant increase over the Surveillance, Epidemiology and End Results-derived incidence rates from 1988 to 1992 of 31.6 per 100,000 for AI women in New Mexico and 78.9 per 100,000 for AN women.

CONCLUSIONS

The model indicated a likelihood of increasing rates of breast carcinoma in the study population. The data obtained were useful in generating preliminary estimates of breast carcinoma risk in the study population, for which no prospective population survey has been completed. The inherent weaknesses in the current retrospective study indicated the need for a large-scale prospective data collection to confirm these exploratory findings.