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Version of Record online: 20 AUG 2008
Published 2008 American Cancer Society
Supplement: An Update on Cancer in American Indians and Alaska Natives, 1999–2004
Volume 113, Issue Supplement 5, pages 1244–1255, 1 September 2008
How to Cite
Jim, M. A., Perdue, D. G., Richardson, L. C., Espey, D. K., Redd, J. T., Martin, H. J., Kwong, S. L., Kelly, J. J., Henderson, J. A. and Ahmed, F. (2008), Primary liver cancer incidence among American Indians and Alaska Natives, US, 1999–2004. Cancer, 113: 1244–1255. doi: 10.1002/cncr.23728
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 US Government work and, as such, is in the public domain in the United States of America.
- Issue online: 20 AUG 2008
- Version of Record online: 20 AUG 2008
- Manuscript Accepted: 3 JUN 2008
- Manuscript Received: 5 MAY 2008
- liver cancer;
- hepatocellular carcinoma;
- American Indian;
- Alaska Native;
- United States;
- health disparity
American Indians and Alaska Natives (AI/AN) experience higher morbidity and mortality from primary liver cancer than other United States (US) populations, but racial misclassification in medical records results in underestimates of disease burden.
To reduce misclassification, National Program of Cancer Registries and Surveillance, Epidemiology, and End Results data were linked with Indian Health Service (IHS) enrollment records to compare primary liver cancer incidence and stage at diagnosis between AI/AN and non-Hispanic whites (NHW) living within the regionalized IHS Contract Health Service Delivery Area counties. Incidence rates are expressed per 100,000 persons and age-adjusted by 19 age groups to the 2000 US standard population.
Overall, AI/AN have a higher proportion of hepatocellular carcinoma compared with NHW, 77.8% versus 66.7%. Liver cancer incidence rates among AI/AN males and females were higher than those among NHW males and females for all regions except for the East. Among males, rates ranged from 7.3 (95% confidence interval [CI], 3.8‒12.6) in the East to 17.2 (95% CI, 10.4‒26.3) in Alaska. Among females, rates ranged from 3.8 (95% CI, 1.4‒8.2) in the East to 6.9 (95% CI, 3.6‒11.6) in Alaska. The AI/AN rates for all regions were consistently higher than the NHW rates at every age. An increasing trend among AI/AN was suggested but did not achieve statistical significance.
Reducing racial misclassification revealed higher disparities in primary liver cancer incidence between NHW and AI/AN populations than previously reported. Further description of the reasons for regional differences in this disparity is needed, as are programs to reduce risk factors and to diagnose primary liver cancer at earlier, more treatable stages. Cancer 2008;113(5 supp):1244–55. Published 2008 by the American Cancer Society.