Cancer Prevention in Native American Communities

It’s National Cancer Prevention Month. Cancer might be the most frightening word in that sentence, but it’s really prevention that’s our focus in February. Instead of viewing cancer as an inevitable and horrific event waiting for us at some point in the future, all of us can take steps to minimize our risk. More than 40% of all cancers – and almost half of all deaths from cancer in the United States – are attributed to preventable causes, like smoking, sun exposure, or excess weight. And cancer doesn’t represent an automatic death sentence these days; mortality rates dropped by 29% from 1991 to 2017. Recent clinical advances have also transformed recovery and quality of life for cancer survivors.

However, not all populations have benefited equally from these improvements. American Indian and Alaska Native people have much higher rates of getting several cancers compared to non-Hispanic White people in the United States – and lower survival rates, making prevention especially vital.

Financial and Medical Disparities

One study examining leading cancer rates among Native American populations found marked disparities in most regions:

  • Compared to White men, Native American men have higher rates of liver, kidney, colorectal, and lung cancer and myeloma. They are 30 percent more likely to have stomach cancer – and over twice as likely to die from it.
  • Compared to White women, Native American women have higher rates of liver, stomach, colorectal, and cervical cancer. They are 20 percent more likely to have kidney/renal pelvis cancer.
  • Native American men are more likely to get cancer than Native American women. The difference ranged from 23% more likely for lung cancer to 129% more likely for liver cancer.

Those are extreme differences. So are these: Native American people are less likely to receive timely diagnosis and treatment –14% less likely to be diagnosed early with lung cancer, 19% less likely to receive surgical treatment, and 15% more likely to not receive any treatment compared to White Americans. 

Now factor in the disparities that creep into every aspect of Indigenous healthcare. Cancer is not a finite illness with a clear start and a clear stop. Many families lose income and employment when someone is sick, whether it’s a parent caring for a child with pediatric lymphoma or an adult struggling through surgery and chemotherapy for pancreatic cancer. Survivorship usually involves ongoing medical expenditures. Those financial burdens can impact a family’s ability to afford healthcare services for other family members – and Native American families living on remote reservations or depending on facilities with limited resources can shoulder a disproportionately heavy burden.

5 Pillars of Cancer Prevention

Many of the following strategies rest on one primary change: funding. Indian Health Service facilities and Tribal health systems need to fund programs, equipment purchases, and staff; patients may need to pay for transportation to distance clinics, temporary housing, and childcare in addition to treatment and the long-term cost of survivorship.

Here are the 5 components of better Native American cancer prevention and treatment.

Access to local screenings, prevention and education, and specialty care

Community facilities may lack mammograms, screening and diagnostic tools, and preventative programs. The lack of resources means that patients who live on reservations may need to travel hundreds of miles for screenings, oncology appointments, surgeries, or chemotherapy. Worried about becoming a financial burden on their family, or dreading long drives while feeling tired and nauseous, some patients give up on treatment.

Facilities are unlikely to get enough funding to implement full-service cancer wings anytime soon – but they can connect their providers and patients to many services through telemedicine. That includes prevention and education modules, support groups, oncologists, and other tools that help patients receive care in their own community. Also helpful: mobile health services that bring important screenings to remote areas.

Smoking cessation programs

Native communities have the highest rate of cigarette smoking of all racial/ethnic groups in the United States. (This is distinct from using tobacco for ceremonial, religious, or medicinal purposes.) Because of the link between cigarettes and lung cancer, the American Lung Association developed a Freedom from Smoking (FFS) program that includes the medicine wheel model and acknowledges the differences between commercial tobacco products and Traditional Tobacco. This kind of culturally sensitive cessation program can help reduce lung cancer in Native American community.

Accurate racial classification and population health data

Data is crucial to forming useful population health insights, but Native American patients have a more than 50% chance of being listed as the wrong race on hospital discharge records or on their death certificates. Many government forms and software systems force them to choose one racial category, despite 61% of Native Americans being multiracial. Improving data accuracy is critical for clinical research and treatment development.

Regional data is also important. Studies have found important disparities in cancer rates and mortality between the six regions where most Native American people live. Documenting patients’ Tribal affiliations and geographic background can provide valuable insight into risk factors and useful preventative programs.

Culturally centric care and services

Understanding community values, nuances, and traditions is vital to ensure Native American patients feel respected and invested in their healthcare system. Nurses who roll their eyes at a 30-year-old patient who brings his mother with him to an appointment are failing to understand that her presence is a sign of respect; a physician who repeatedly makes eye contact with an Elder from a certain tribe may not understand why the patient skips a follow-up appointment.

Traditional Indigenous therapies can also help foster stronger patient engagement, such as healing ceremonies, visits from medicine men, or community services. Without that cultural connection, many Native American people may forego preventative screenings or fail to complete treatment.

Food sovereignty

Food poverty persists in Indigenous communities, where 1 in 4 Native Americans is food insecure. Residents who lack local grocery stores or farmers markets are forced to rely on poor quality fast food or convenience store items. With junk food connected to higher cancer rates, Indigenous communities can benefit from Food Sovereignty – a movement to provide nourishing and culturally relevant food. This can include community gardens, new agricultural systems, and local farmers markets – as well as educating younger generations of Native Americans on positive nutritional habits.

Preventing Cancer Before It Starts

From education on risk factors to improving early detection and access to treatment, Tribal nations need more resources at every point of the cancer continuum. Systemic barriers have systemic solutions – and by treating cancer prevention as a community initiative, healthcare systems can help all Indigenous communities close the gap in cancer outcomes.

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