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November 15, 2007 / Volume 110 / Number 10

stable. White, API, and non-Hispanic women experi- enced a decrease in cancer of the colon and rectum, whereas the rates for black, AI/AN, and Hispanic women remained stable. Uterine cancer decreased among white women, increased among black and Hispanic women, and was stable for API and AI/AN women. Cervical cancer declined for all race/ethnic populations except AI/AN women, in whom it was stable, as did stomach cancer for all except Hispanic women, in whom rates were stable. Ovarian cancer decreased in white, API, and non-Hispanic women and remained stable in black, AI/AN, and Hispanic women. The use of joinpoint methods for the period from 1995 through 2004 revealed a 1.0% decline per year in ovarian cancer incidence from 1995 through 2001 and an increased rate of decline of 3.3% per year from 2001 through 2004 for all races combined (data not shown); this increased rate of decline was confined to white women. Similar patterns were observed for uterine cancer (data not shown). Thyr- oid cancer rates had the largest annual increase (7.0% per year).

Update on Cancer Death Rates, 20002004 and Fixed Interval Trends, 19952004 Among men, overall cancer death rates from 2000 through 2004 were highest for black men and lowest for API men (Table 5). Cancers of the lung, prostate, and colon and rectum were the leading causes of cancer death from 2000 through 2004 among men for all race/ethnic populations except API men, in whom cancer of the liver ranked second. Beyond the top 3 sites, race-specific rankings varied.

For men of most race/ethnic populations, trends of all cancers combined and trends of the 3 leading causes of cancer death declined from 1995 through 2004. For AI/AN men, trends in death rates were level for all cancers combined, prostate cancer, and colorectal cancer and declined for lung cancer.

Among women, overall cancer death rates from 2000 through 2004 were highest for black women and lowest for API and Hispanic women (Table 5). Among all race/ethnic populations, cancer of the lung ranked first in cause of death, breast cancer ranked second, and colorectal cancer ranked third with the exception of Hispanic women, for whom breast cancer ranked first and lung cancer ranked second. Similar to men, among women, race-specific rankings of less common cancers varied. From 1995 through 2004, women experienced a smaller decrease than men in death rates for all cancers combined (1.0% per year vs 1.7% per year, respectively). Simi- larly, the slight increase in lung cancer mortality in

women (0.2% per year) contrasted with the substan- tial decrease in men (2.0% per year). A comparison of death rates from 2000 through 2004 for all cancer sites combined showed that API women had the lar- gest annual decline (1.4% per year), and AI/AN women had a stable death rate.

SPECIAL SECTION: CANCER AMONG AMERICAN INDIANS AND ALASKA NATIVES, 19992004 General Characteristics The 2004 intercensal population estimates of 3.3 mil- lion AI/AN persons represented 1.1% of the total U.S. population.18 These persons are members of—or related to—1 or more of > 550 federally recognized or > 200 nonfederally recognized tribes with diverse languages, cultures, and histories. The median age of the U.S. AI/AN population was 29 years in 2000, which was younger than the nationwide median age of 35 years.40 Approximately 75% of the AI/AN popu- lation reside west of the Mississippi River and is con- centrated in Alaska, Oklahoma, and other selected regions—the Southwest, Northern Plains, and Pacific Northwest (Fig. 2). Approximately one-third of AI/AN reside on tribal reservations, trust lands, or other tribal-affiliated areas, and others live primarily in urban areas.40,45

Socioeconomic Characteristics, Cancer Risk Factors, and Use of Cancer Screening Poverty among the AI/AN population was 3 times that of the NHW population, with the Southwest AI/ AN population having the highest regional preva- lence of poverty (Table 6). AI/AN adults were less likely to graduate from high school and were more likely to have less than a ninth grade education than NHW adults, with Alaska and Southwest AI/AN populations having the lowest formal education attained. The percentage of AI/AN persons age < 65 years with no health coverage was twice that of NHW adults. The proportion of persons ages 18 to 64 years with no usual source of care was higher among the AI/AN population overall and in all regions. For NHW and AI/AN populations in all regions, men were more likely than women to have no usual source of medical care. It is noteworthy that AI/AN persons in Alaska aged 65 years reported the high- est prevalence of no healthcare coverage; a 10-fold higher prevalence than NHW persons aged > 65 years. Additional information regarding cancer inci- dence and county poverty level among AI/AN and NHW populations for selected cancer sites is avail- able in Table Supplement-Poverty (available at URL: www.seer.cancer.gov/report_to_nation/).

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