Regional differences in colorectal cancer incidence, stage, and subsite among American Indians and Alaska Natives, 1999–2004§

Authors

  • David G. Perdue MD, MSPH,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Program in Health Disparities, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
    2. Minnesota Gastroenterology, P.A., Minneapolis, Minnesota
    • Minnesota Gastroenterology, P.A., P.O. Box 14909, Minneapolis, MN 55414
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    • Fax: (612) 870-5837

  • Carin Perkins PhD,

    1. Minnesota Cancer Surveillance System, Minneapolis, Minnesota
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  • Jeannette Jackson-Thompson MSPH, PhD,

    1. Missouri Cancer Registry and Department of Health Management and Informatics, University of Missouri-Columbia, Columbia, Missouri
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  • Steven S. Coughlin PhD,

    1. 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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  • Faruque Ahmed PhD,

    1. 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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  • Donald S. Haverkamp MPH,

    1. 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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  • Melissa A. Jim MPH

    1. 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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  • This supplement was sponsored by Cooperative Agreement Number U50 DP424071-04 from the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control.

  • The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • §

    This article is a U.S. Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND.

Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality for American Indians and Alaska Natives (AI/ANs), but misclassification of race causes underestimates of disease burden.

METHODS.

The authors compared regional differences in CRC incidence, stage at diagnosis, and anatomic distribution between AI/ANs and non-Hispanic whites (NHWs). To reduce misclassification, data from the National Program of Cancer Registries; the Surveillance, Epidemiology, and End Results Program; and the Indian Health Service (IHS) were linked. The analysis was limited to the 56% of AI/AN who live in IHS Contract Health Service Delivery Areas.

RESULTS.

From 1999 to 2004, the overall incidence rate (per 100,000 persons per year) of CRC was 9% lower in the AI/AN population (46.3) than in the NHW population (50.8). However, AI/AN CRC incidence rates varied nearly 5-fold regionally, from 21 in the Southwest to 102.6 in Alaska. Compared with NHW rates, AI/AN rates were significantly higher in Alaska (rate ratio [RR], 2.03), the Northern Plains (RR, 1.39), and the Southern Plains (RR, 1.16) but were lower in the Pacific Coast (RR, 0.80), the East (RR, 0.65), and the Southwest (RR, 0.45). AI/ANs were diagnosed more often with advanced CRC than with localized CRC (RR, 1.92) compared with NHWs (RR, 1.48). Females more often had proximal CRC among both the AI/AN population (females, 40.1%; males, 33.5%) and the NHW population (females, 50.1%; males, 40.3%), although AI/ANs had a higher proportion of distal cancers overall.

CONCLUSIONS.

CRC incidence rates in AI/AN populations varied dramatically between regions. Efforts are needed to make CRC screening a priority, overcome barriers to endoscopic screening, and to engage AI/AN communities in culturally appropriate ways to participate in prevention and early detection programs. Cancer 2008;113(5 suppl):1179–90. Published 2008 by the American Cancer Society.

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