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TABLE 6 (continued)

AI/AN by Indian health service (IHS) region

Southwest

East

Pacific coast

Southern plains

Alaska

Northern plains

U.S. AI/AN

U.S. NHW

95% CI

%

95% CI

%

95% CI

%

95% CI

%

95% CI

%

95% CI

%

95% CI

%

95% CI

%

Characteristics

(76.9–86.2)

82.1

(76.5–84.6)

80.9

(76.4–88.7)

83.4

(75.5–84.6)

80.4

(89.4–95.1)

92.7

(79.9–88.0)

84.4

(80.1–84.5)

82.4

(86.2–86.6)

86.4

e

Pap test in women (aged 18 years and older) within the past 3 years

(28.2–49.4)

38.2

(42.1–58.0)

50.1

(25.2–66.0)

44.7

(52.2–73.9)

63.7

(24.8–45.7)

34.5

(34.3–55.1)

44.5

(43.0–55.1)

49.1

(57.4–58.4)

57.9

g

PSA test in men (aged 50 years and older) within 1 year

a

AI/AN indicates American Indian/Alaska Native; NHW, non-Hispanic white; 95% CI, 95% confidence interval; Pap, Papanicolaou; PSA, prostate-specific antigen. Source: Tables P148C, P148I, P159C, P159I from the Census 2000 Summary File 3 (SF 3) prepared by the U.S. Census Bureau, 2002. Source: Behavioral Risk Factor Surveillance System (BRFSS), 1999–2002, 2004, and 2005. Source: BRFSS, 2001, 2002, 2004, and 2005; obesity is based on body mass index >30 kg/m and <99.8 kg/m .

b

2

2

c

Source: BRFSS, 2001, 2002, 2004, and 2005. Source: BRFSS, 1999, 2000, 2002, and 2004.

d

e

f

g

Source: BRFSS, 1999, 2001, 2002, and 2004. Endoscopy includes sigmoidoscopy and colonoscopy. Source: BRFSS, 2001 and 2002. Data suppressed because of small numbers of <50 persons.

Report to the Nation, 19752004/Espey et al.

2135

for NHW women in Alaska, 3 times greater than for NHW women in the Southwest, and 2 times greater than for NHW women in the Northern and Southern Plains. The rate of liver cancer among AI/AN women ranged from 1.9 times the rate among NHW women in the Southern Plains to 3.4 times greater in the Northern Plains. The rate of cancer of the cervix was elevated in AI/AN women in the Northern and Southern Plains. The incidence rate of gallbladder cancer was elevated in AI/AN women in the South- ern Plains and the Southwest, whereas it was 2.7 and 7.1 times the rate of NHW women, respectively. The incidence rates of NHL, melanoma, and bladder can- cer generally were lower in AI/AN women than in NHW women.

Cancer Stage Overall, AI/AN persons were less likely than NHW persons to be diagnosed with early stages of colorec- tal cancer, although this pattern varied by region; the difference between AI/AN and NHW persons was larger in the Southwest, Northern Plains, and South- ern Plains than in other regions (Table 9). Approxi- mately three-fourths of prostate cancer cases were diagnosed with localized stage among NHW men overall and among AI/AN men in Alaska and the Southern Plains regions. AI/AN women in all regions were less likely than NHW women to be diagnosed with localized breast cancer. Similarly, AI/AN women in all regions combined were less likely than NHW women to be diagnosed with localized cervical cancer.

DISCUSSION Overall Cancer Incidence and Mortality Trends in the U.S. The overall decline in cancer death rates, which was noted first in the 1990s, has accelerated in recent years. Declines in colorectal cancer mortality in men and women, especially recent declines from 2002 through 2004, together with the continuation of long-term declines in mortality from lung and pros- tate cancer in men and from breast cancer in women, strongly contribute to the overall declining cancer death rates.

Noteworthy in this year’s report are the decline in the incidence of colorectal cancer in men and women, the decline in breast cancer incidence in women from 2001 through 2004, and a leveling of lung cancer incidence in women after long-term increases. Lung cancer incidence rates in men con- tinue to decline, and the prostate cancer trend was level.

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