Cancer Causes & Control

, Volume 19, Issue 7, pp 725–737 | Cite as

Prevalence and predictors of cancer screening among American Indian and Alaska native people: the EARTH study

  • Mary Catherine Schumacher
  • Martha L. Slattery
  • Anne P. Lanier
  • Khe-Ni Ma
  • Sandra Edwards
  • Elizabeth D. Ferucci
  • Lillian Tom-Orme
Original Paper

Abstract

Purpose

The purpose of this study was to examine the prevalence rates for cervical, breast, and colorectal cancer screening among American Indian and Alaska Native people living in Alaska and in the Southwest US, and to investigate predictive factors associated with receiving each of the cancer screening tests.

Methods

We used the Education and Research Towards Health (EARTH) Study to measure self-reported cancer screening prevalence rates among 11,358 study participants enrolled in 2004–2007. We used prevalence odds ratios to examine demographic, lifestyle and medical factors associated with receiving age- and sex-appropriate cancer screening tests.

Results

The prevalence rates of all the screening tests were higher in Alaska than in the Southwest. Pap test in the past 3 years was reported by 75.1% of women in Alaska and 64.6% of women in the Southwest. Mammography in the past 2 years was reported by 64.6% of women aged 40 years and older in Alaska and 44.0% of those in the Southwest. Colonoscopy or sigmoidoscopy in the past 5 years was reported by 41.1% of study participants aged 50 years and older in Alaska and by 11.7% of those in the Southwest US. Multivariate analysis found that location (Alaska versus the Southwest), higher educational status, income and the presence of one or more chronic medical condition predicted each of the three screening tests. Additional predictors of Pap test were age (women aged 25–39 years more likely to be screened than older or younger women), marital status (ever married more likely to be screened), and language spoken at home (speakers of American Indian Alaska Native language only less likely to be screened). Additional predictors of mammography were age (women aged 50 years and older were more likely to be screened than those aged 40–49 years), positive family history of breast cancer, use of smokeless tobacco (never users more likely to be screened), and urban/rural residency (urban residents more likely to be screened). Additional predictors of colonoscopy/sigmoidoscopy were age (men and women aged 60 years and older slightly more likely to be screened than those aged 50–59 years), family history of any cancer, family history of colorectal cancer, former smoking, language spoken at home (speakers of American Indian Alaska Native language less likely to be screened), and urban/rural residence (urban residents more likely to be screened).

Conclusion

Programs to improve screening among American Indian and Alaska Native people should include efforts to reach individuals of lower socioeconomic status and who do not have regular contact with the medical care system. Special attention should be made to identify and provide needed services to those who live in rural areas, and to those living in the Southwest US.

Keywords

Papanicolaou test Mammography Colon cancer screening American Indian Alaska Native 

Notes

Acknowledgments

The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the National Cancer Institute. We would like to acknowledge the contributions and support of the Navajo Nation, the Indian Health Service, the Alaska Native Tribal Health Consortium Board of Directors, Southcentral Foundation, Southeast Alaska Regional Health Consortium, the Yukon-Kuskokwim Health Corporation, the Ft. Defiance and Shiprock Health Boards, Dr. Freeland, Dr. Ruth Etzel, Dr. Joseph Klejka, Kari Lundgren PA-C, Dr. Cindy Schraer, Tribal Advisory Board Members Beverley Pigman, George Ridley, Ileen Sylvester, Tim Gilbert and Fritz George, the staff on the Navajo Nation including Clarina Clark, Amy Rogers, and Carmen George, and the staff in Alaska including Diana Redwood, Jason Sandidge, Gretchen Ehrsam Day, Katie Rose Hulett, Sharon Lindley, Cheri Hample, Maybelle Filler, Antoinelle Thompson, and Jayleen Wheeler. We would also like to acknowledge Dr. Maureen Murtaugh for her input into the study and Roger Edwards, James Bryner, Kelly Cunningham, and Elvin Asay for computer programming.

References

  1. 1.
    Indian Health Service (2000) Trends in Indian health 1998–1999. Indian Health Service, RockvilleGoogle Scholar
  2. 2.
    Ehrsam G, Lanier A, Holck P, Sandidge J (2001) Cancer mortality among Alaska Natives 1994–1998. Alaska Med 43:50–60PubMedGoogle Scholar
  3. 3.
    Espey D, Paisano R, Cobb N (2005) Regional patterns and trends in cancer mortality among American Indians and Alaska Natives, 1990–2001. Cancer 103:1045–1053PubMedCrossRefGoogle Scholar
  4. 4.
    Swan J, Edwards BK (2003) Cancer rates among American Indians and Alaska Natives. Is there a national perspective. Cancer 98:1262–1272PubMedCrossRefGoogle Scholar
  5. 5.
    Coughlin SS, Uhler RJ, Blackman DK (1999) Breast and cervical cancer screening practices among American Indian and Alaska Native women in the United States, 1992–1997. Prev Med 29:287–295PubMedCrossRefGoogle Scholar
  6. 6.
    Risendal B, Roe D, DeZapein J, Papenfuss M, Giuliano A (1999) Influence of health care, cost and culture on breast cancer screening: issues facing urban American Indian women. Prev Med 29:501–509PubMedCrossRefGoogle Scholar
  7. 7.
    Giuliano A, Papenfuss M, de Zapien JG, Tilousi S, Nuvayestewa L (1998) Breast cancer screening among Southwest American Indian women living on-reservation. Prev Med 27:135–143PubMedCrossRefGoogle Scholar
  8. 8.
    Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A, Thun M (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93PubMedGoogle Scholar
  9. 9.
    Denny CH, Holtzman D, Cobb N (2003) Surveillance for health behaviors of American Indians and Alaska Natives: findings from the behavioral risk factor surveillance system, 1997–2000. MMWR Surveill Summ 52(SS07):1–13PubMedGoogle Scholar
  10. 10.
    Strauss KF, Mokdad A, Ballew C et al (1997) The health of Navajo women: Findings from the Navajo Health and Nutrition Survey, 1991–1992. J Nutr 127:2128S–2133SPubMedGoogle Scholar
  11. 11.
    Gilliland FD, Rosenberg RD, Hunt WC, Stauber P, Key CR (2000) Patterns of mammography use among Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1994–1997. Am J Epidemiol 152:432–437PubMedCrossRefGoogle Scholar
  12. 12.
    Swan J, Breen N, Burhansstipanov L, Satter DE, Davis WW, McNeel T, Snipp CM (2006) Cancer screening and risk factor rates among American Indians. Am J Public Health 96:340–350PubMedCrossRefGoogle Scholar
  13. 13.
    Satter DE, Seals BF, Chia J, Gatchell M, Burhansstipanov L, Tsai L (2005) American Indian and Alaska Natives in California: women’s cancer screening and results. J Cancer Educ 20(Suppl):58–64PubMedCrossRefGoogle Scholar
  14. 14.
    Lanier AP, Kelly JJ, Holck P(1999) Pap prevalence and cervical cancer prevention among Alaska Native women. Health Care Women Int 20:471–486PubMedCrossRefGoogle Scholar
  15. 15.
    Provost EM (1996) Cervical cancer screening on the Yukon-Kuskokwim Delta, Southwest Alaska. Cancer 78:1598–1602PubMedGoogle Scholar
  16. 16.
    Giroux J, Welty TK, Oliver FK, Kaur JS, Leonardson G, Cobb N (2000) Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes. J Am Board Fam Pract 13:239–245PubMedGoogle Scholar
  17. 17.
    Slattery M, Schumacher MC, Lanier AP et al (2007) A prospective cohort of American Indians and Alaska Natives: study design, methods, and implementation. Am J Epidemiol 166:606–615PubMedCrossRefGoogle Scholar
  18. 18.
    Eligibility requirements for health services from the indian health services http://www.ihs.gov/generalweb/helpcenter/customerservices/elig.asp. Accessed 8/15/2007
  19. 19.
    Federal Register: March 15, 2002 (Vol 67, Number 51)Google Scholar
  20. 20.
    Pearce N (2004) Effect measures in prevalence studies. Environ Health Perspect 112:1047–1050PubMedCrossRefGoogle Scholar
  21. 21.
    Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR (2006) Functional limitations in elderly female cancer survivors. J Nat Cancer Inst 98:521–529PubMedCrossRefGoogle Scholar
  22. 22.
    Thompson ML, Meyers JE, Krieble D (1998) Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? Occup Environ Med 55:272–277PubMedCrossRefGoogle Scholar
  23. 23.
    Census 2000 American Indian Alaska Native Summary File. Available at http://factfinder.census.gov/servlet/DatasetMainPageServlet. Accessed 28 April 2006
  24. 24.
    Indian Health Service, Clinical reporting system version 5.1, reporting year 1 July 2004 to 20 June 2005Google Scholar
  25. 25.
    Division of Public Health, Department of Health and Social Services, State of Alaska, (2006) Health risks in Alaska among adults. Alaska behavioral risk factor surveillance system 2002/2003Google Scholar
  26. 26.
    Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH (2005) Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health 95:1410–1416PubMedCrossRefGoogle Scholar
  27. 27.
    Blanchard K, Colbert JA, Puri D et al (2004) Mammographic screening: patterns of use and estimated impact on breast carcinoma survival. Cancer 101:495–507PubMedCrossRefGoogle Scholar
  28. 28.
    Solomon TGA, Gottlieb NH (1999) Measures of American Indian traditionality and its relationship to cervical cancer screening. Health Care Women Int 20:493–504PubMedCrossRefGoogle Scholar
  29. 29.
    Coronado GD, Thompson B, Koepsell TD, Schwartz SM, McLerran D (2004) Use of Pap test among Hispanics and non-Hispanic whites in a rural setting. Prev Med 38:713–722PubMedCrossRefGoogle Scholar
  30. 30.
    Sambamoorthi U, McAlpine DD (2003) Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med 37:475–484PubMedCrossRefGoogle Scholar
  31. 31.
    Gorin SS, Heck JE (2005) Cancer screening among Latino subgroups in the United States. Prev Med 40:515–526PubMedCrossRefGoogle Scholar
  32. 32.
    Datta GD, Colditz GA, Kawachi I, Subramanian SV, Palmer JR, Rosenberg L (2006) Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis. Cancer 106:664–669PubMedCrossRefGoogle Scholar
  33. 33.
    McGregor SE, Bryant HE (2005) Predictors of colorectal cancer screening: a comparison of men and women. Can J Gastroenterol 19:343–349PubMedGoogle Scholar
  34. 34.
    Coughlin SS, King J, Richards TB, Ekwueme DU (2006) Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002. Cancer Epidemiol Biomarkers Prev 15:2154–2159PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Mary Catherine Schumacher
    • 1
  • Martha L. Slattery
    • 2
  • Anne P. Lanier
    • 1
  • Khe-Ni Ma
    • 2
  • Sandra Edwards
    • 2
  • Elizabeth D. Ferucci
    • 1
  • Lillian Tom-Orme
    • 2
  1. 1.Office of Alaska Native Health ResearchAlaska Native Tribal Health ConsortiumAnchorageUSA
  2. 2.University of UtahSalt Lake CityUSA

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