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

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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.


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.


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).


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.

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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.

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Correspondence to Mary Catherine Schumacher.

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Funded by grants CA88958 and CA96095 from the National Cancer Institute.

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Schumacher, M.C., Slattery, M.L., Lanier, A.P. et al. Prevalence and predictors of cancer screening among American Indian and Alaska native people: the EARTH study. Cancer Causes Control 19, 725–737 (2008).

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