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Llaneza AJ, Holt A, Seward J, Piatt J, Campbell JE. Assessment of Racial Misclassification Among American Indian and Alaska Native Identity in Cancer Surveillance Data in the United States and Considerations for Oral Health: A Systematic Review. Health Equity 2024; 8:376-390. [PMID: 39011076 PMCID: PMC11249132 DOI: 10.1089/heq.2023.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Misclassification of American Indian and Alaska Native (AI/AN) peoples exists across various databases in research and clinical practice. Oral health is associated with cancer incidence and survival; however, misclassification adds another layer of complexity to understanding the impact of poor oral health. The objective of this literature review was to systematically evaluate and analyze publications focused on racial misclassification of AI/AN racial identities among cancer surveillance data. Methods The PRISMA Statement and the CONSIDER Statement were used for this systematic literature review. Studies involving the racial misclassification of AI/AN identity among cancer surveillance data were screened for eligibility. Data were analyzed in terms of the discussion of racial misclassification, methods to reduce this error, and the reporting of research involving Indigenous peoples. Results A total of 66 articles were included with publication years ranging from 1972 to 2022. A total of 55 (83%) of the 66 articles discussed racial misclassification. The most common method of addressing racial misclassification among these articles was linkage with the Indian Health Service or tribal clinic records (45 articles or 82%). The average number of CONSIDER checklist domains was three, with a range of zero to eight domains included. The domain most often identified was Prioritization (60), followed by Governance (47), Methodologies (31), Dissemination (27), Relationships (22), Participation (9), Capacity (9), and Analysis and Findings (8). Conclusion To ensure equitable representation of AI/AN communities, and thwart further oppression of minorities, specifically AI/AN peoples, is through accurate data collection and reporting processes.
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Affiliation(s)
- Amanda J Llaneza
- Southern Plains Tribal Health Board, Oklahoma City, Oklahoma, USA
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, Oklahoma, USA
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, Oklahoma, USA
| | - Jamie Piatt
- Southern Plains Tribal Health Board, Oklahoma City, Oklahoma, USA
| | - Janis E Campbell
- Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Gartner DR, Maples C, Nash M, Howard-Bobiwash H. Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices. Epidemiol Rev 2023; 45:63-81. [PMID: 37022309 DOI: 10.1093/epirev/mxad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.
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Affiliation(s)
- Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Ceco Maples
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Madeline Nash
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Heather Howard-Bobiwash
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
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3
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani R, Salciccioli JD, Marshall DC, Singh H, Sheng I, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 2023; 26:552-562. [PMID: 36522462 DOI: 10.1038/s41391-022-00628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019. METHODS We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons. RESULTS Between 1999-2019, ASMR decreased at the national level in Black (-44.6%), Asian (-44.8%), White (-31.8%), and American Indian or Alaskan native men (-19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (-47.0%) for WM and Delaware (-57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM. CONCLUSIONS During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ruchi Jani
- Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Justin D Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, University of Wisconsin, Milwaukee, WI, USA
| | - Iris Sheng
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rana R McKay
- University of California San Diego, San Diego, CA, 2021, USA
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Joyce DD, Tilburt JC, Pacyna JE, Cina K, Petereit DG, Koller KR, Flanagan CA, Stillwater B, Miller M, Kaur JS, Peil E, Zahrieh D, Dueck AC, Montori VM, Frosch DL, Volk RJ, Kim SP. The Impact of Within-Consultation and Preconsultation Decision Aids for Localized Prostate Cancer on Patient Knowledge: Results of a Patient-Level Randomized Trial. Urology 2023; 175:90-95. [PMID: 36898587 PMCID: PMC10239323 DOI: 10.1016/j.urology.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate the role of timing (either before or during initial consultation) on the effectiveness of decision aids (DAs) to support shared-decision-making in a minority-enriched sample of patients with localized prostate cancer using a patient-level randomized controlled trial design. METHODS We conducted a 3-arm, patient-level-randomized trial in urology and radiation oncology practices in Ohio, South Dakota, and Alaska, testing the effect of preconsultation and within-consultation DAs on patient knowledge elements deemed essential to make treatment decisions about localized prostate cancer, all measured immediately following the initial urology consultation using a 12-item Prostate Cancer Treatment Questionnaire (score range 0 [no questions correct] to 1 [all questions correct]), compared to usual care (no DAs). RESULTS Between 2017 and 2018, 103 patients-including 16 Black/African American and 17 American Indian or Alaska Native men-were enrolled and randomly assigned to receive usual care (n = 33) or usual care and a DA before (n = 37) or during (n = 33) the consultation. After adjusting for baseline characteristics, there were no statistically significant proportional score differences in patient knowledge between the preconsultation DA arm (0.06 knowledge change, 95% CI -0.02 to 0.12, P = .1) or the within-consultation DA arm (0.04 knowledge change, 95% CI -0.03 to 0.11, P = .3) and usual care. CONCLUSION In this trial oversampling minority men with localized prostate cancer, DAs presented at different times relative to the specialist consultation showed no improvement in patient knowledge above usual care.
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Affiliation(s)
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Kristin Cina
- Walking Forward Avera Health, Division of Research, Rapid City, SD
| | - Daniel G Petereit
- Cancer Care Institute at Monument Health, Rapid City, SD; Walking Forward Avera Health, Division of Research, Rapid City, SD
| | - Kathryn R Koller
- Alaska Native Tribal Health Consortium Research Services, Anchorage, AK
| | - Christie A Flanagan
- Alaska Native Tribal Health Consortium Research Services, Anchorage, AK; Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK
| | | | - Mariam Miller
- Department of Urology, Alaska Native Medical Center, Anchorage, AK
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Elizabeth Peil
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - David Zahrieh
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Amylou C Dueck
- Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, University of Colorado, Aurora, CO
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Chu CE, Leapman MS, Zhao S, Cowan JE, Washington SL, Cooperberg MR. Prostate cancer disparities among American Indians and Alaskan Natives in the United States. J Natl Cancer Inst 2023; 115:413-420. [PMID: 36629492 PMCID: PMC10086629 DOI: 10.1093/jnci/djad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/25/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Americans Indians and Alaska Natives face disparities in cancer care with lower rates of screening, limited treatment access, and worse survival. Prostate cancer treatment access and patterns of care remain unknown. METHODS We used Surveillance, Epidemiology, and End Results data to compare incidence, primary treatment, and cancer-specific mortality across American Indian and Alaska Native, Asian and Pacific Islander, Black, and White patients. Baseline characteristics included prostate-specific antigen (PSA), Gleason score (GS), tumor stage, 9-level Cancer of the Prostate Risk Assessment risk score, county characteristics, and health-care provider density. Primary outcomes were first definitive treatment and prostate cancer-specific mortality (PCSM). RESULTS American Indian and Alaska Native patients were more frequently diagnosed with higher PSA, GS greater than or equal or 8, stage greater than or equal to cT3, high-risk disease overall (Cancer of the Prostate Risk Assessment risk score ≥ 6), and metastases at diagnosis than any other group. Adjusting for age, PSA, GS, and clinical stage, American Indian or Alaska Native patients with localized prostate cancer were more likely to undergo external beam radiation than radical prostatectomy and had the highest rates of no documented treatment. Five-year PCSM was higher among American Indian and Alaska Natives than any other racial group. However, after multivariable adjustment accounting for clinical and pathologic factors, county-level demographics, and provider density, American Indian and Alaska Native patient PCSM hazards were no different than those of White patients. CONCLUSIONS American Indian or Alaska Native patients have more advanced prostate cancer, lower rates of definitive treatment, higher mortality, and reside in areas of less specialty care. Disparities in access appear to account for excess risks of PCSM. Focused health policy interventions are needed to address these disparities.
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Affiliation(s)
- Carissa E Chu
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Shoujun Zhao
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Janet E Cowan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Samuel L Washington
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Borges MFDSO, Koifman S, Koifman RJ, da Silva IF. Cancer incidence in indigenous populations of Western Amazon, Brazil. ETHNICITY & HEALTH 2022; 27:1465-1481. [PMID: 33673784 DOI: 10.1080/13557858.2021.1893663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown. DESIGN This is a descriptive study of cancer incidence among the indigenous population (2000-2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco's public and private laboratories' reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference. RESULTS From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 + . Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67-1.83), liver (SIR=1.77; 95%CI:1.66-1.88), and leukemia (SIR=1.64; 95%CI:1.49-1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34-4.64) and liver (SIR=2.11; 95%CI:1.88-2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05-0.07) and female breast (SIR=0.12; 95%CI:0.11-0.14) was observed. CONCLUSIONS Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations.
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Affiliation(s)
| | - Sergio Koifman
- National School of Public Health, Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosalina Jorge Koifman
- National School of Public Health, Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ilce Ferreira da Silva
- National School of Public Health, Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Dobyns AC, Coutelle NA, Suthumphong CY, Rodriguez PE, Castro G, Varella MH. Race/ethnicity and advanced stage of renal cell carcinoma in adults: results from surveillance, epidemiology, and end results program 2007-2015. Eur J Cancer Prev 2022; 31:172-177. [PMID: 34115692 DOI: 10.1097/cej.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Non-Hispanic Blacks were shown to have an earlier stage of renal cell carcinoma (RCC) at diagnosis compared to non-Hispanic Whites. It is less clear whether disparities in RCC staging occurs for other minority races/ethnicities. We aimed to assess the association between racial/ethnic minorities and stage at diagnosis of RCC, and test for potential effect modification by histological subtype. Sourced from the Surveillance, Epidemiology and End Results (SEER) database, patients ≥20 years diagnosed with RCC from 2007 to 2015 were included (n = 37 493). Logistic regression analyses were performed to assess the independent association between race/ethnicity [non-Hispanic White, non-Hispanic Black, non-Hispanic Asian Pacific Islander, non-Hispanic American Indian/Alaskan Native (AI/AN) and Hispanic] and advanced RCC stage at diagnosis (i.e. regional spread or distant metastasis). Interaction terms were tested and stratified regression was performed accordingly. Twenty-eight percent of patients had advanced RCC stage at diagnosis. After adjusting for age, gender, year of diagnosis, histological subtype and insurance status, compared to non-Hispanic Whites, non-Hispanic Blacks had lower odds of advanced stage at diagnosis [odds ratio (OR) = 0.79; 95% confidence interval (CI) = 0.72-0.87 for clear cell; OR = 0.48; CI = 0.30-0.78 for chromophobe and OR = 0.26; CI = 0.10-0.35 for other subtypes]. Higher odds of advanced stage at diagnosis were found for non-Hispanic AI/AN in clear cell (OR = 1.27; CI = 1.04-1.55) and for Hispanics in papillary subtypes (OR = 1.58; CI = 1.07-2.33). Racial disparities in the RCC stage at diagnosis varied according to histological subtype. Further investigation on the racial disparities reported is warranted to optimize detection and ultimately improve the prognosis of patients with RCC.
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Affiliation(s)
- Alyssa C Dobyns
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Nino A Coutelle
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Corey Y Suthumphong
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Pura E Rodriguez
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Grettel Castro
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
| | - Marcia H Varella
- Division of Medical and Population Health Sciences Research
- Department of Translational Medicine, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida, USA
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8
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Iyengar S, Hall IJ, Sabatino SA. Racial/Ethnic Disparities in Prostate Cancer Incidence, Distant Stage Diagnosis, and Mortality by U.S. Census Region and Age Group, 2012-2015. Cancer Epidemiol Biomarkers Prev 2020; 29:1357-1364. [PMID: 32303533 DOI: 10.1158/1055-9965.epi-19-1344] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/12/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We sought to characterize recent prostate cancer incidence, distant stage diagnosis, and mortality rates by region, race/ethnicity, and age group. METHODS In SEER*Stat, we examined age-specific and age-adjusted prostate cancer incidence, distant stage diagnosis, and mortality rates by race/ethnicity, census region, and age group. Incidence and mortality analyses included men diagnosed with (n = 723,269) and dying of (n = 112,116) prostate cancer between 2012 and 2015. RESULTS Non-Hispanic black (NHB) and non-Hispanic Asian/Pacific Islander (NHAPI) men had the highest and lowest rates, respectively, for each indicator across regions and age groups. Hispanic men had lower incidence and mortality rates than non-Hispanic white (NHW) men in all regions except the Northeast where they had higher incidence [RR, 1.16; 95% confidence interval (CI), 1.14-1.19] and similar mortality. Hispanics had higher distant stage rates in the Northeast (RR, 1.18; 95% CI, 1.08-1.28) and South (RR, 1.22; 95% CI, 1.15-1.30), but similar rates in other regions. Non-Hispanic American Indian/Alaskan Native (NHAIAN) men had higher distant stage rates than NHWs in the West (RR, 1.38; 95% CI, 1.15-1.65). NHBs and Hispanics had higher distant stage rates than NHWs among those aged 55 to 69 years (RR, 2.91; 95% CI, 2.81-3.02 and 1.24; 95% CI, 1.18-1.31, respectively), despite lower overall incidence for Hispanics in this age group. CONCLUSIONS For Hispanic and NHAIAN men, prostate cancer indicators varied by region, while NHB and NHAPI men consistently had the highest and lowest rates, respectively, across regions. IMPACT Regional and age group differences in prostate cancer indicators between populations may improve understanding of prostate cancer risk and help inform screening decisions.
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Affiliation(s)
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Gopalani SV, Janitz AE, Martinez SA, Gutman P, Khan S, Campbell JE. Trends in Cancer Incidence Among American Indians and Alaska Natives and Non-Hispanic Whites in the United States, 1999-2015. Epidemiology 2020; 31:205-213. [PMID: 31764279 PMCID: PMC7386857 DOI: 10.1097/ede.0000000000001140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Female breast, prostate, lung, and colorectal cancers are the leading incident cancers among American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) persons in the United States. To understand racial differences, we assessed incidence rates, analyzed trends, and examined geographic variation in incidence by Indian Health Service regions. METHODS To assess differences in incidence, we used age-adjusted incidence rates to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Using joinpoint regression, we analyzed incidence trends over time for the four leading cancers from 1999 to 2015. RESULTS For all four cancers, overall and age-specific incidence rates were lower among AI/ANs than NHWs. By Indian Health Service regions, incidence rates for lung cancer were higher among AI/ANs than NHWs in Alaska (RR: 1.46; 95% CI: 1.37, 1.56) and Northern (RR: 1.29; 95% CI: 1.25, 1.33) and Southern (RR: 1.06; 95% CI: 1.03, 1.09) Plains. Similarly, colorectal cancer incidence rates were higher in AI/ANs than NHWs in Alaska (RR: 2.29; 95% CI: 2.14, 2.45) and Northern (RR: 1.04; 95% CI: 1.00, 1.09) and Southern (RR: 1.11; 95% CI: 1.07, 1.15) Plains. Also, AI/AN women in Alaska had a higher incidence rate for breast cancer than NHW women (RR: 1.05; 95% CI: 1.05, 1.20). From 1999 to 2015, incidence rates for all four cancers decreased in NHWs, but only rates for prostate (average annual percent change: -4.70) and colorectal (average annual percent change: -1.80) cancers decreased considerably in AI/ANs. CONCLUSION Findings from this study highlight the racial and regional differences in cancer incidence.
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Affiliation(s)
- Sameer V. Gopalani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sydney A. Martinez
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Pamela Gutman
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Sohail Khan
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Deuker M, Knipper S, Pecoraro A, Palumbo C, Rosiello G, Luzzago S, Tian Z, Saad F, Chun F, Karakiewicz PI. Prostate cancer characteristics and cancer-specific mortality of Native American patients. Prostate Cancer Prostatic Dis 2019; 23:277-285. [PMID: 31695139 DOI: 10.1038/s41391-019-0184-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/05/2019] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Historical epidemiological data indicate that Native American patients may have worse prostate cancer (PCa) characteristics than Caucasian patients (CAP). To test for cancer-specific mortality (CSM) differences among Native American vs. CAP, the most contemporary version of the SEER database (Surveillance, Epidemiology, and End Results database [2004-2016]) was used. METHODS Descriptives and time trend analyses focused on a combined cohort of 357,289 Caucasian and Native American PCa patients of all stages. After 1:4 propensity-score (PS) matching for stage, grade, and other patient characteristics, cumulative incidence plots, and competing-risks-regression-models (CRR) were used, with further stratification according to non-metastatic (TanyN0M0) vs. metastatic (TanyN1 and/or M1) stages. RESULTS Native American patients accounted for 1804 (0.5%) of the study cohort. Native American patients had higher PSA (8 ng/ml vs. 6.3 ng/ml), higher rate of D'Amico high-risk PCa (30.8 vs. 24.8%), higher rate of T3/T4-PCa (5.5 vs. 3.7%), higher rate of N1 stage (4.5 vs. 2.8%), and higher rate of M1 stage (7.5 vs. 3.9%, all p < 0.001) than CAP. In TanyN0M0 patients after PS-matching, 10-year CSM was 5.7 vs. 6.2% in Native American vs. CAP. In TanyN1 and/or M1 patients, 10-year CSM was 64.3 vs. 63.3% in Native American vs. CAP, (both p = 0.8). In CRR, Native American race did not represent an independent predictor of CSM. CONCLUSIONS Native American patients have more unfavorable stage and grade at presentation. However, after adjustment for these characteristics, CSM in Native American patients is not higher than in CAP. In consequence, PCa prognosis does not differ between Native American and Caucasian race. Therefore, efforts should be made to diagnose PCa in Native Americans at an earlier and more favorable stage like in CAP.
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Affiliation(s)
- Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.,European Institute of Oncology, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Felix Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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11
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Melkonian SC, Jim MA, Haverkamp D, Wiggins CL, McCollum J, White MC, Kaur JS, Espey DK. Disparities in Cancer Incidence and Trends among American Indians and Alaska Natives in the United States, 2010-2015. Cancer Epidemiol Biomarkers Prev 2019; 28:1604-1611. [PMID: 31575554 PMCID: PMC6777852 DOI: 10.1158/1055-9965.epi-19-0288] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/12/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cancer incidence rates for American Indian and Alaska Native (AI/AN) populations vary by geographic region in the United States. The purpose of this study is to examine cancer incidence rates and trends in the AI/AN population compared with the non-Hispanic white population in the United States for the years 2010 to 2015. METHODS Cases diagnosed during 2010 to 2015 were identified from population-based cancer registries and linked with the Indian Health Service (IHS) patient registration databases to describe cancer incidence rates in non-Hispanic AI/AN persons compared with non-Hispanic whites (whites) living in IHS purchased/referred care delivery area counties. Age-adjusted rates were calculated for the 15 most common cancer sites, expressed per 100,000 per year. Incidence rates are presented overall as well as by region. Trends were estimated using joinpoint regression analyses. RESULTS Lung and colorectal cancer incidence rates were nearly 20% to 2.5 times higher in AI/AN males and nearly 20% to nearly 3 times higher in AI/AN females compared with whites in the Northern Plains, Southern Plains, Pacific Coast, and Alaska. Cancers of the liver, kidney, and stomach were significantly higher in the AI/AN compared with the white population in all regions. We observed more significant decreases in cancer incidence rates in the white population compared with the AI/AN population. CONCLUSIONS Findings demonstrate the importance of examining cancer disparities between AI/AN and white populations. Disparities have widened for lung, female breast, and liver cancers. IMPACT These findings highlight opportunities for targeted public health interventions to reduce AI/AN cancer incidence.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico.
| | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Jeffrey McCollum
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, Maryland
| | - Mary C White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith S Kaur
- Native American Programs, Mayo Clinic, Jacksonville, Florida
| | - David K Espey
- Office of the Director, Centers for Disease Control and Prevention, Albuquerque, New Mexico
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12
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Prussing E. Critical epidemiology in action: Research for and by indigenous peoples. SSM Popul Health 2018; 6:98-106. [PMID: 30246140 PMCID: PMC6146565 DOI: 10.1016/j.ssmph.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/08/2018] [Accepted: 09/07/2018] [Indexed: 11/02/2022] Open
Abstract
Global social justice movements, including transnational activism for indigenous rights, are working to promote health equity by transforming public health research and policy. Yet little social scientific research has examined how professional epidemiologists are figuring within such efforts. Discussions are unfolding, however, in critical sectors of epidemiology about how to improve the profession's input into advocacy. Findings from a multi-sited ethnographic study of epidemiological research for and by indigenous peoples in three settings (Aotearoa/New Zealand, the continental U.S., and Hawai'i) demonstrate how researchers/practitioners connect epidemiology and advocacy by: (1) linking the better-known legitimacy of quantitative methods to a lesser-known causal framework that positions colonialism as a sociopolitical determinant of health, (2) producing technical critiques that aim to improve the accuracy and accessibility of indigenous population health statistics, and (3) adopting a pragmatic flexibility in response to the shifting political conditions that shape when, whether and how epidemiological findings support advocacy for indigenous health equity. Attending closely to the credibility tactics at hand in this work, and to the skills and sensibilities of its practitioners, charts new directions for future research about epidemiology's contributions to advocacy for health equity.
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Affiliation(s)
- Erica Prussing
- Department of Anthropology and Department of Community & Behavioral Health, 114 MH, University of Iowa, Iowa City, IA 52242-1322, USA
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13
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Pacyna JE, Kim S, Yost K, Sedlacek H, Petereit D, Kaur J, Rapkin B, Grubb R, Paskett E, Chang GJ, Sloan J, Basch E, Major B, Novotny P, Taylor J, Buckner J, Parsons JK, Morris M, Tilburt JC. The comparative effectiveness of decision aids in diverse populations with early stage prostate cancer: a study protocol for a cluster-randomized controlled trial in the NCI Community Oncology Research Program (NCORP), Alliance A191402CD. BMC Cancer 2018; 18:788. [PMID: 30081846 PMCID: PMC6080528 DOI: 10.1186/s12885-018-4672-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Treatments for localized prostate cancer present challenging tradeoffs in the face of uncertain treatment benefits. These options are best weighed in a process of shared decision-making with the patient’s healthcare team. Minority men experience disparities in prostate cancer outcomes, possibly due in part to a lack of optimal communication during treatment selection. Decision aids facilitate shared decision-making, improve knowledge of treatment options, may increase satisfaction with treatment choice, and likely facilitate long-term quality of life. Methods/design This study will compare the effect of two evidence-based decision aids on patient knowledge and on quality of life measured one year after treatment, oversampling minority men. One decision aid will be administered prior to specialist consultation, preparing patients for a treatment discussion. The other decision aid will be administered within the consultation to facilitate transparent, preference-sensitive, and evidence-informed deliberations. The study will utilize a four-arm, block-randomized design to test whether each decision aid alone (Arms 1 and 2) or in combination (Arm 3) can improve patient knowledge and quality of life compared to usual care (Arm 4). The study, funded by the National Cancer Institute’s Community Oncology Research Program (NCORP), will be deployed within select institutions that have demonstrated capacity to recruit minority populations into urologic oncology trials. Discussion Upon completion of the trial, we will have 1) tested the effectiveness of two evidence-based decision aids in enhancing patients’ knowledge of options for prostate cancer therapy and 2) estimated whether decision aids may improve patient quality of life one year after initial treatment choice. Trial registration Clinicaltrials.gov: NCT03103321. The trial registration date (on ClinicalTrials.gov) was April 6, 2017.
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Affiliation(s)
| | - Simon Kim
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Hillary Sedlacek
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Robert Grubb
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Jeff Sloan
- Alliance Statistics And Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brittny Major
- Alliance Statistics And Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Adams SV, Burnett-Hartman AN, Karnopp A, Bansal A, Cohen SA, Warren-Mears V, Ramsey SD. Cancer Stage in American Indians and Alaska Natives Enrolled in Medicaid. Am J Prev Med 2016; 51:368-72. [PMID: 27020318 PMCID: PMC5154762 DOI: 10.1016/j.amepre.2016.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/26/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Nationally, a greater proportion of American Indians and Alaska Natives (AI/ANs) are diagnosed with advanced-stage cancers compared with non-Hispanic whites. The reasons for observed differences in stage at diagnosis between AI/ANs and non-Hispanic whites remain unclear. METHODS Medicaid, Indian Health Service Care Systems, and state cancer registry data for California, Oregon, and Washington (2001-2008, analyzed in 2014-2015) were linked to identify AI/ANs and non-Hispanic whites diagnosed with invasive breast, cervical, colorectal, lung, or prostate cancer. Logistic regression was used to estimate ORs and 95% CIs for distant disease versus local or regional disease, in AI/ANs compared with non-Hispanic white case patients. RESULTS A similar proportion of AI/AN (31.2%) and non-Hispanic white (35.5%) patients were diagnosed with distant-stage cancer in this population (AOR=1.03, 95% CI=0.88, 1.20). No significant differences in stage at diagnosis were found for any individual cancer site. Among AI/ANs, Indian Health Service Care Systems eligibility was not associated with stage at diagnosis. CONCLUSIONS In contrast to the general population of the U.S., among Medicaid enrollees, AI/AN race is not associated with later stage at diagnosis. Cancer survival disparities associated with AI/AN race that have been observed in the broader population may be driven by factors associated with income and health insurance that are also associated with race, as income and insurance status are more homogenous within the Medicaid population than within the broader population.
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Affiliation(s)
- Scott V Adams
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Andrea N Burnett-Hartman
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado
| | - Andrew Karnopp
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aasthaa Bansal
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pharmacy, University of Washington, Seattle, Washington
| | - Stacey A Cohen
- Division of Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Scott D Ramsey
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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15
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Goins RT, Schure MB, Noonan C, Buchwald D. Prostate Cancer Screening Among American Indians and Alaska Natives: The Health and Retirement Survey, 1996-2008. Prev Chronic Dis 2015; 12:E123. [PMID: 26247423 PMCID: PMC4552140 DOI: 10.5888/pcd12.150088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Among US men, prostate cancer is the leading malignancy diagnosed and the second leading cause of cancer death. Disparities in cancer screening rates exist between American Indians/Alaska Natives and other racial/ethnic groups. Our study objectives were to examine prostate screening at 5 time points over a 12-year period among American Indian/Alaska Native men aged 50 to 75 years, and to compare their screening rates to African American men and white men in the same age group. Methods We analyzed Health and Retirement Study data for 1996, 1998, 2000, 2004, and 2008. Prostate screening was measured by self-report of receipt of a prostate examination within the previous 2 years. Age-adjusted prevalence was estimated for each year. We used regression with generalized estimating equations to compare prostate screening prevalence by year and race. Results Our analytic sample included 119 American Indian/Alaska Native men (n = 333 observations), 1,359 African American men (n = 3,704 observations), and 8,226 white men (n = 24,292 observations). From 1996 to 2008, prostate screening rates changed for each group: from 57.0% to 55.7% among American Indians/Alaska Natives, from 62.0% to 71.2% among African Americans, and from 68.6% to 71.3% among whites. Although the disparity between whites and African Americans shrank over time, it was virtually unchanged between whites and American Indians/Alaska Natives. Conclusion As of 2008, American Indians/Alaska Natives were less likely than African Americans and whites to report a prostate examination within the previous 2 years. Prevalence trends indicated a modest increase in prostate cancer screening among African Americans and whites, while rates remained substantially lower for American Indians/Alaska Natives.
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Affiliation(s)
- R Turner Goins
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, 4121 Little Savannah Rd, Cullowhee, NC 28723.
| | - Marc B Schure
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
| | - Carolyn Noonan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Dedra Buchwald
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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16
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Lima Junior MMD, Reis LO, Ferreira U, Cardoso UO, Barbieri RB, Mendonça GBD, Ward LS. Unraveling Brazilian Indian population prostate good health: clinical, anthropometric and genetic features. Int Braz J Urol 2015; 41:344-52. [PMID: 26005978 PMCID: PMC4752100 DOI: 10.1590/s1677-5538.ibju.2015.02.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare dietary, lifestyle, clinical, anthropometric, genetic and prostatic features of Brazilian Indians and non-Indians (Amazon). METHODS 315 men, 228 Indians and 89 non-Indians, ≥ 40 years old were submitted to digital rectal examination, serum prostate specific antigen (PSA), testosterone, TP53 and GSTP1 genotyping, anthropometric, lifestyle, dietary, personal and familial medical history. Prostatic symptoms were evaluated with the International Prostate Symptom Score (IPSS). RESULTS Macuxis and Yanomamis represented 43.6% and 14.5% of Indians respectively who spontaneously referred no prostate symptoms. Mean IPSS was 7, range 3-19, with only 15% of moderate symptoms (score 8-19); Mean age was 54.7 years, waist circumference 86.6 cm, BMI 23.9 kg/m(2). Yanomamis presented both lower BMI (21.4 versus 24.8 and 23.3, p=0,001) and prostate volume than Macuxis and "other ethnic groups" (15 versus 20, p=0.001). Testosterone (414 versus 502 and 512, p=0.207) and PSA (0.48 versus 0.6 and 0.41, p=0.349) were similar with progressive PSA increase with aging. Val/Val correlated with lower PSA (p=0.0361). Indians compared to control population presented: - TP53 super representation of Arg/Arg haplotype, 74.5% versus 42.5%, p<0.0001. -GSTP1 Ile/Ile 35.3% versus 60.9%; Ile/Val 45.9% versus 28.7%; Val/Val 18.8% versus 10.3%; p=0.0003. CONCLUSIONS Observed specific dietary, lifestyle, anthropometric and genetic profile for TP53 and GSTP1 may contribute to Brazilian Indian population prostate good health.
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Affiliation(s)
- Mario M de Lima Junior
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Leonardo O Reis
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Ubirajara Ferreira
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Ulieme Oliveira Cardoso
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Raquel Bueno Barbieri
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Gustavo B de Mendonça
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Laura S Ward
- Departments of Genetics and Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
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Burhansstipanov L, Krebs LU, Dignan MB, Jones K, Harjo LD, Watanabe-Galloway S, Petereit DG, Pingatore NL, Isham D. Findings from the native navigators and the Cancer Continuum (NNACC) study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:420-427. [PMID: 25053462 PMCID: PMC4144404 DOI: 10.1007/s13187-014-0694-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Native Navigators and the Cancer Continuum (NNACC) was a community based participatory research study among Native American Cancer Research Corporation, CO; Inter-Tribal Council of Michigan, MI; Rapid City Regional Hospital's Walking Forward, SD; Great Plains Tribal Chairman's' Health Board, SD; and Muscogee (Creek) Nation, OK. The project goal was to collaborate, refine, expand, and adapt navigator/community education programs to address American Indian communities' and patients' needs across the continuum of cancer care (prevention through end-of-life). The intervention consisted of four to six site-specific education workshop series at all five sites. Each series encompassed 24 h of community education. The Social Ecology Theory guided intervention development; community members from each site helped refine education materials. Following extensive education, Native Patient Navigators (NPNs) implemented the workshops, referred participants to cancer screenings, helped participants access local programs and resources, and assisted those with cancer to access quality cancer care in a timely manner. The intervention was highly successful; 1,964 community participants took part. Participants were primarily American Indians (83 %), female (70 %) and between 18 and 95 years of age. The education programs increased community knowledge by 28 %, facilitated referral to local services, and, through site-specific navigation services, improved access to care for 77 participants diagnosed with cancer during the intervention. Approximately, 90 % of participants evaluated workshop content as useful and 92.3 % said they would recommend the workshop to others. The intervention successfully increased community members' knowledge and raised the visibility of the NPNs in all five sites.
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Affiliation(s)
- Linda Burhansstipanov
- Native American Cancer Research Corporation (NACR), 3022 South Nova Road, Pine, CO 880470-7830, and 3110 S. Wadsworth Blvd, Suite 103, Denver, CO, 80227, USA,
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18
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Nishri ED, Sheppard AJ, Withrow DR, Marrett LD. Cancer survival among First Nations people of Ontario, Canada (1968-2007). Int J Cancer 2014; 136:639-45. [PMID: 24923728 DOI: 10.1002/ijc.29024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/12/2022]
Abstract
We aimed to compare cancer survival in Ontario First Nations people to that in other Ontarians for five major cancer types: colorectal, lung, cervix, breast and prostate. A list of registered or "Status" Indians in Ontario was used to create a cohort of over 140,000 Ontario First Nations people. Cancers diagnosed in cohort members between 1968 and 2001 were identified from the Ontario Cancer Registry, with follow-up for death until December 31st, 2007. Flexible parametric modeling of the hazard function was used to compare the survival experience of the cohort to that of other Ontarians. We considered changes in survival from the first half of the time period (1968-1991) to the second half (1992-2001). For other Ontarians, survival had improved over time for every cancer site. For the First Nations cohort, survival improved only for breast and prostate cancers; it either declined or remained unchanged for the other cancers. For cancers diagnosed in 1992 or later, all-cause and cause-specific survival was significantly poorer for First Nations people diagnosed with breast, prostate, cervical, colorectal (male and female) and male lung cancers as compared to their non-First Nations peers. For female lung cancer, First Nations women appeared to have poorer survival; however, the result was not statistically significant. Ontario's First Nations population experiences poorer cancer survival when compared to other Ontarians and strategies to reduce these inequalities must be developed and implemented.
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Affiliation(s)
- E Diane Nishri
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON
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19
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Hoffman RM, Li J, Henderson JA, Ajani UA, Wiggins C. Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999-2009. Am J Public Health 2014; 104 Suppl 3:S439-45. [PMID: 24754659 PMCID: PMC4035887 DOI: 10.2105/ajph.2013.301690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We linked databases to improve identification of American Indians/Alaska Natives (AI/ANs) in determining prostate cancer death and incidence rates. METHODS We linked prostate cancer mortality and incidence data with Indian Health Service (IHS) patient records; analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. We calculated age-adjusted incidence and death rates for AI/AN and White men for 1999 to 2009; men of Hispanic origin were excluded. RESULTS Prostate cancer death rates were higher for AI/AN men than for White men. Death rates declined for White men (-3.0% per year) but not for AI/AN men. AI/AN men had lower prostate cancer incidence rates than White men. Incidence rates declined among Whites (-2.2% per year) and AI/ANs (-1.9% per year). CONCLUSIONS AI/AN men had higher prostate cancer death rates and lower prostate cancer incidence rates than White men. Disparities in accessing health care could contribute to mortality differences, and incidence differences could be related to lower prostate-specific antigen testing rates among AI/AN men.
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Affiliation(s)
- Richard M Hoffman
- Richard M. Hoffman and Charles Wiggins are with the University of New Mexico School of Medicine and the University of New Mexico Cancer Center, Albuquerque. Richard M. Hoffman is also with the New Mexico VA Health Care System, Albuquerque. Jun Li and Umed A. Ajani are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jeffrey A. Henderson is with the Black Hills Center for American Indian Health, Rapid City, SD
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20
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Tilburt JC, Koller K, Tiesinga JJ, Wilson RT, Trinh AC, Hill K, Hall IJ, Smith JL, Ekwueme DU, Petersen WO. Patterns of clinical response to PSA elevation in American Indian/Alaska Native men: a multi-center pilot study. J Health Care Poor Underserved 2013; 24:1676-85. [PMID: 24185163 PMCID: PMC4733625 DOI: 10.1353/hpu.2013.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess clinical treatment patterns and response times among American Indian/Alaska Native men with a newly elevated PSA. METHODS We retrospectively identified men ages 50-80 receiving care in one of three tribally-operated clinics in Northern Minnesota, one medical center in Alaska, and who had an incident PSA elevation (> 4 ng/ml) in a specified time period. A clinical response was considered timely if it was documented as occurring within 90 days of the incident PSA elevation. RESULTS Among 82 AI/AN men identified from medical records with an incident PSA elevation, 49 (60%) received a timely clinical response, while 18 (22%) had no documented clinical response. CONCLUSIONS One in five AI/AN men in our study had no documented clinical action following an incident PSA elevation. Although a pilot study, these findings suggest the need to improve the documentation, notification, and care following an elevated PSA at clinics serving AI/AN men.
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21
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So C, Kirby KA, Mehta K, Hoffman RM, Powell AA, Freedland SJ, Sirovich B, Yano EM, Walter LC. Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy. J Gen Intern Med 2012; 27:653-60. [PMID: 22180196 PMCID: PMC3358397 DOI: 10.1007/s11606-011-1945-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 10/27/2011] [Accepted: 11/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although guidelines recommend against prostate-specific antigen (PSA) screening in elderly men with limited life expectancy, screening is common. OBJECTIVE We sought to identify medical center characteristics associated with screening in this population. DESIGN/PARTICIPANTS We conducted a prospective study of 622,262 screen-eligible men aged 70+ seen at 104 VA medical centers in 2003. MAIN MEASURES Primary outcome was the percentage of men at each center who received PSA screening in 2003, based on VA data and Medicare claims. Men were stratified into life expectancy groups ranging from favorable (age 70-79 with Charlson score = 0) to limited (age 85+ with Charlson score ≥1 or age 70+ with Charlson score ≥4). Medical center characteristics were obtained from the 1999-2000 VA Survey of Primary Care Practices and publicly available VA data sources. KEY RESULTS Among 123,223 (20%) men with limited life expectancy, 45% received PSA screening in 2003. Across 104 VAs, the PSA screening rate among men with limited life expectancy ranged from 25-79% (median 43%). Higher screening was associated with the following center characteristics: no academic affiliation (50% vs. 43%, adjusted RR = 1.14, 95% CI 1.04-1.25), a ratio of midlevel providers to physicians ≥3:4 (55% vs. 45%, adjusted RR = 1.20, 95% CI 1.09-1.32) and location in the South (49% vs. 39% in the West, adjusted RR = 1.25, 95% CI 1.12-1.40). Use of incentives and high scores on performance measures were not independently associated with screening. Within centers, the percentages of men screened with limited and favorable life expectancies were highly correlated (r = 0.90). CONCLUSIONS Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy.
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Affiliation(s)
- Cynthia So
- School of Medicine, University of California, San Francisco, CA USA
| | - Katharine A. Kirby
- Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA USA
| | - Kala Mehta
- Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA USA
| | - Richard M. Hoffman
- New Mexico VA Health Care System, Albuquerque and Department of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Adam A. Powell
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Stephen J. Freedland
- Durham VA Medical Center and Duke Prostate Center, Duke University, Durham, NC USA
| | | | - Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health System and Department of Health Services, UCLA School of Public Health, Los Angeles, CA USA
| | - Louise C. Walter
- Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA USA
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Watanabe-Galloway S, Flom N, Xu L, Duran T, Frerichs L, Kennedy F, Smith CB, Jaiyeola AO. Cancer-related disparities and opportunities for intervention in Northern Plains American Indian communities. Public Health Rep 2011; 126:318-29. [PMID: 21553659 PMCID: PMC3072852 DOI: 10.1177/003335491112600304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We examined behavioral trends associated with cancer risk and cancer screening use from 1997 through 2006 among American Indians/Alaska Natives (AI/ANs) in the Northern Plains region (North Dakota, South Dakota, Nebraska, and Iowa) of the United States. We also examined disparities between that population and non-Hispanic white (NHW) people in the Northern Plains and AI/ANs in other regions. METHODS We analyzed Behavioral Risk Factor Surveillance System data from the Centers for Disease Control and Prevention for 1997-2000 and 2003-2006. We used age-adjusted Wald Chi-square tests to test the difference between these two periods for AI/ANs and the difference between AI/ANs and NHW people during 2003-2006. RESULTS There was no statistically significant improvement among AI/ANs in the Northern Plains region for behaviors associated with cancer risk or cancer screening use, and there was a significant increase in the obesity rate. The prevalence of binge drinking, obesity, and smoking among AI/ANs in the Northern Plains was significantly higher than among NHW people in the same region and among AI/AN populations in other regions. Although the percentage of cancer screening use was similar for all three groups, the use of sigmoidoscopy/colonoscopy was significantly lower among the Northern Plains AI/ANs than among NHW people. CONCLUSION These results indicate a need for increased efforts to close the gaps in cancer health disparities between AI/ANs and the general population. Future efforts should focus not only on individual-level changes, but also on system-level changes to build infrastructure to promote healthy living and to increase access to cancer screening.
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Affiliation(s)
- Shinobu Watanabe-Galloway
- Northern Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's Health Board, Rapid City, SD 68198-4395, USA.
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Scoggins JF, Fedorenko CR, Donahue SMA, Buchwald D, Blough DK, Ramsey SD. Is distance to provider a barrier to care for medicaid patients with breast, colorectal, or lung cancer? J Rural Health 2011; 28:54-62. [PMID: 22236315 DOI: 10.1111/j.1748-0361.2011.00371.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. METHODS Driving distances and times from patient residence to primary care provider were calculated for 3,917 breast, colorectal (CRC) and lung cancer Medicaid patients in Washington State from 1997 to 2003 using MapQuest.com. We fitted regression models of stage at diagnosis and time-to-treatment (number of days between diagnosis and surgery) to test the hypothesis that travel burden is associated with timely diagnosis and treatment of cancer. FINDINGS Later stage at diagnosis for breast cancer Medicaid patients is associated with travel burden (OR = 1.488 per 100 driving miles, P= .037 and OR = 1.270 per driving hour, P= .016). Time-to-treatment after diagnosis of CRC is also associated with travel burden (14.57 days per 100 driving miles, P= .002 and 5.86 days per driving hour, P= .018). CONCLUSIONS Although travel burden is associated with timely diagnosis and treatment for some types of cancer, we did not find evidence that driving time was, in general, better at predicting timeliness of cancer diagnosis and treatment than driving distance. More intensive efforts at early detection of breast cancer and early treatment of CRC for Medicaid patients who live in remote areas may be needed.
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Affiliation(s)
- John F Scoggins
- Research and Economic Assessment in Cancer and Healthcare (REACH) Group, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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24
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Reply by Authors. J Urol 2010. [DOI: 10.1016/j.juro.2009.11.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mahoney MC, Va P, Stevens A, Kahn AR, Michalek AM. Changes in cancer incidence patterns among a northeastern American Indian population: 1955-1969 versus 1990-2004. J Rural Health 2009; 25:378-83. [PMID: 19780918 DOI: 10.1111/j.1748-0361.2009.00247.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This manuscript examines shifts in patterns of cancer incidence among the Seneca Nation of Indians (SNI) for the interval 1955-1969 compared to 1990-2004. METHODS A retrospective cohort design was used to examine cancer incidence among the SNI during 2 time intervals: 1955-1969 and 1990-2004. Person-years at risk were multiplied by cancer incidence rates for New York State, exclusive of New York City, over 5-year intervals. A computer-aided match with the New York State Cancer Registry was used to identify incident cancers. Overall and site-specific standardized incidence ratios (SIRs = observed/expected x 100), and 95% confidence intervals (CIs), were calculated for both time periods. RESULTS During the earlier interval, deficits in overall cancer incidence were noted among males (SIR = 56, CI 36-82) and females (SIR = 71, CI 50-98), and for female breast cancers (SIR = 21, CI 4-62). During the more recent intervals, deficits in overall cancer incidence persisted among both genders (males SIR = 63, CI 52-77; females SIR = 67, CI 55-80). Deficits were also noted among males for cancers of the lung (SIR = 60, CI 33-98), prostate (SIR = 51, CI = 33-76) and bladder (SIR = 17, CI = 2-61) and among females for breast (SIR = 33, CI = 20-53) and uterus (SIR = 36, CI = 10-92). No cancer sites demonstrated increased incidence. Persons ages 60-69 years, 70-79 years, and ages 80+ years tended to exhibit deficits in overall incidence. CONCLUSIONS Despite marked changes over time, deficits in overall cancer incidence have persisted between the time intervals studied. Tribal-specific cancer data are important for the development and implementation of comprehensive cancer control plans which align with local needs.
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Cobb N, Wingo PA, Edwards BK. Introduction to the supplement on cancer in the American Indian and Alaska Native populations in the United States. Cancer 2008; 113:1113-6. [PMID: 18720369 DOI: 10.1002/cncr.23729] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The collection of papers in this Supplement combines cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, 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.
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Affiliation(s)
- Nathaniel Cobb
- Division of Epidemiology and Disease Prevention, Indian Health Service, Albuquerque, New Mexico, USA.
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