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November 15, 2007 / Volume 110 / Number 10

Outreach and Community Programs for American Indians and Alaska Natives Cancer control only recently has become an impor- tant concern for many AI/AN communities as cancer surveillance has revealed substantial increases in cancers that once were quite rare in this popula-


Committed professionals, community lea-

ders, survivors, and partnering agencies have initiated programs to promote comprehensive cancer control in AI/AN communities. Although much remains to be done, the CDC, NCI, ACS, and other agencies have collaborated with the IHS and tribal and state partners around the country to improve cancer control for AI/AN populations by funding screening and treatment services, supporting coali- tions, building cancer control infrastructure, educat- ing professionals and the public, and supporting

surveillance and research.






screening in the 1960s and 1970s resulted in declin- ing cervical cancer incidence and mortality rates in the 1980s and 1990s,90,144 little screening mammog- raphy was being provided to women served by the IHS before the establishment of the CDC’s National Breast and Cervical Cancer Early Detection Program. Fourteen tribal programs, in addition to all 50 states, currently receive support from this program to build infrastructure and provide screening services (Arctic Slope Native Association Limited, Barrow, Ark; Cher- okee Nation, Tahlequah, Okla; Cheyenne River Sioux Tribe, Eagle Butte, SD; Hopi Tribe, Kykotsmovi, Ariz; Kaw Nation of Oklahoma, Newkirk, Okla; Mississippi Band of Choctaw Indians, Choctaw, Miss; Native American Rehabilitation Association of the North- west, Portland, Ore; Navajo Nation, Window Rock, Ariz; Poarch Band of Creek Indians, Atmore, Ala; South East Alaska Regional Health Consortium, Sitka, Alaska; South Puget Intertribal Planning Agency, Shelton, Wash; Southcentral Foundation, Anchorage, Alaska; and Yukon-Kuskokwim Health Corporation, Bethel, Ark). Annual training for primary care provi- ders to perform colposcopy, part of standard diag- nostic follow-up for abnormal Pap smear results, is provided by IHS and CDC to increase the number and distribution of providers trained in colposcopy and to reduce the time from abnormal screening results to definitive diagnosis.151,152 Continued dili- gence in education, training, and prevention services to further reduce the death rate from cervical cancer is essential.

The NCI Network for Cancer Control Research Among AI/AN Populations (the Network) is a forum for Native and non-Native researchers with a mission to reduce preventable cancer morbidity and mortal-

ity to the lowest levels possible and to improve sur- vival from cancer to the highest level possible in AI/ AN populations.153 Realizing the importance of AI/ AN community participation in research, the Net- work also provides curriculum development and instructors for an annual cancer control training course for Native researchers.154 NCI is an important partner in promoting and funding community net- works programs, such as the ‘‘Spirit of Eagles’’ based at the Mayo Clinic in Rochester, Minnesota. This program works with major cancer centers, nonprofit organizations, policy boards, professional societies, and educators through community-based cancer control grants.155 NCI has funded 3 other regional or local community networks in the Pacific Northwest, the Southwest, and Oklahoma. The NCI Cancer In- formation Service collaborates with community net- works to reach medically underserved audiences and partners with researchers to develop messages, chan- nels, and strategies for communicating risk and early detection approaches for AI/AN populations. In addi- tion, NCI has initiated the Patient Navigator Research Program to reduce the time from an abnormal screening, to a definitive diagnosis, and, finally, to treatment.

IHS, CDC, NCI, ACS, NAACCR, and others work to improve cancer data among AI/AN populations. NCI gives technical assistance and training to tribes and regional Indian Health Boards to establish and maintain tribally operated cancer registration sys- tems. Current projects are the Cherokee Nation Can- cer Registry (Oklahoma), the Northwest Portland Area Registry Project (Idaho, Oregon, and Washing- ton),92,156 and the South Dakota Patterns of Care Pro- ject. In addition, the Alaska Native Tumor Registry is a part of the SEER Program. In most cases, the indi- vidual tribal projects collaborate with state-operated cancer registries through special agreements to exchange information, maintain confidentiality, and contribute to more complete and accurate informa- tion concerning cancer in AI/AN communities. Finally, the CDC provides epidemiologic support and funding to the IHS to conduct the linkages for popu- lation-based cancer registries and promotes other cancer control activities that target AI/AN popula- tions.

In the mid-1990s, CDC, ACS, and others pro- moted the concept of comprehensive cancer control to improve coordination of cancer control activities in state and local health departments and tribal orga- nizations.157 The CDC Comprehensive Cancer Con- trol Program began in 1998 and, since then, it has funded 6 tribal organizations (Alaska Native Tribal Health Consortium, South Puget Intertribal Planning

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