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Patel MI, Hinyard L, Merrill JK, Smith KT, Lei J, Carrizosa D, Kamaraju S, Hlubocky FJ, Kalwar T, Fashoyin-Aje L, Gomez SL, Jeames S, Florez N, Kircher SM, Tap WD. Challenges and Solutions to Support Oncology Professionals Serving Underserved Populations With Cancer in the United States: Results From the ASCO Serving the Underserved Task Force. JCO Oncol Pract 2024; 20:688-698. [PMID: 38354324 DOI: 10.1200/op.23.00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Little data exist regarding approaches to support oncology professionals who deliver cancer care for underserved populations. In response, ASCO developed the Serving the Underserved Task Force to learn from and support oncology professionals serving underserved populations. METHODS The Task Force developed a 28-question survey to assess oncology professionals' experiences and strategies to support their work caring for underserved populations. The survey was deployed via an online link to 600 oncology professionals and assessed respondent and patient demographic characteristics, clinic-based processes to coordinate health-related social services, and strategies for professional society support and engagement. We used chi-square tests to evaluate whether there were associations between percent full-time equivalent (FTE) effort serving underserved populations (<50% FTE v ≥50% FTE) with responses. RESULTS Of 462 respondents who completed the survey (77% response rate), 79 (17.1%) were Asian; 30 (6.5%) Black; 43 (9.3%) Hispanic or Latino/Latina; and 277 (60%) White. The majority (n = 366, 79.2%) had a medical doctor degree (MD). A total of 174 (37.7%) had <25% FTE, 151 (32.7%) had 25%-50% FTE, and 121 (26.2%) had ≥50% FTE effort serving underserved populations. Most best guessed patients' sociodemographic characteristics (n = 388; 84%), while 42 (9.2%) used data collected by the clinic. Social workers coordinated most health-related social services. However, in clinical settings with high proportions of underserved patients, there was greater reliance on nonclinical personnel, such as navigators (odds ratio [OR], 2.15 [95% CI, 1.07 to 4.33]) or no individual (OR, 2.55 [95% CI, 1.14 to 5.72]) for addressing mental health needs and greater reliance on physicians or advance practice practitioners (OR, 2.54 [95% CI, 1.11 to 5.81]) or no individual (OR, 1.91 [95% CI, 1.09 to 3.35]) for addressing childcare or eldercare needs compared with social workers. Prioritization of solutions, which did not differ by FTE effort serving underserved populations, included a return-on-investment model to support personnel, integrated health-related social needs screening, and collaboration with the professional society on advocacy and policy. CONCLUSION The findings highlight crucial strategies that professional societies can implement to support oncology clinicians serving underserved populations with cancer.
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Affiliation(s)
- Manali I Patel
- Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | | | | | | | - Jennifer Lei
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Tricia Kalwar
- Veterans Administration, Miami Healthcare System, Miami, FL
| | | | | | | | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - William D Tap
- Memorial Sloan Kettering Cancer Center, New York, NY
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Cartwright K, Kanda D, Kosich M, Sheche J, Leekity S, Edwardson N, Pankratz VS, Mishra SI. Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: identifying cornerstones for building effective mammogram screening intervention programs. Cancer Causes Control 2024; 35:583-595. [PMID: 37940784 PMCID: PMC10960741 DOI: 10.1007/s10552-023-01814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Breast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and behaviors of Zuni women in the Southwest United States (U.S.). METHODS In 2020 and 2021, a survey was administered to better understand cancer screening patterns in Zuni Pueblo; 110 women from 50 to 75 years of age were recruited to respond to the breast cancer screening portion. Inclusion criteria included self-identifying as AI, a member of the Zuni tribe, or married to a Zuni tribal member, and meeting the age and gender requirements. Descriptive statistics and bivariate analyses were conducted examining the associations between measures of breast cancer knowledge, beliefs, and behaviors and breast cancer screening status (never, ever/non-compliant, and ever/compliant). RESULTS Of survey participants, 47.3% have had a breast cancer screening and are up-to-date, 39.1% have had a screening in the past but are not up-to-date, and 13.6% have never been screened. Age was the only statistically significant socioeconomic predictor of breast cancer screening; the median (interquartile range) ages of each group are 62 (54, 68) ever/compliant, 56 (54, 68) ever/non-compliant, and 53 (51, 55) never (p-value < 0.001). Significant differences by health status and access to medical care include having a regular health care provider and going to see a provider for routine check-ups. The survey also shows differences in knowledge about breast cancer risk factors, beliefs, and behaviors. Women across all three screening statuses reported that they would get screened if encouraged by a health care provider. CONCLUSION While survey respondents report a relatively high rate of ever having had a breast cancer screening, less than half are compliant with screening guidelines, which shows there is an opportunity to improve breast cancer screening rates. With culturally tailored interventions, providers have the potential to improve breast cancer screening for Zuni women.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA.
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Mikaela Kosich
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Judith Sheche
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Samantha Leekity
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
- Departments of Pediatric and Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
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Melkonian SC, Jim MA, Reza A, Peipins LA, Haverkamp D, Said N, Sharpe JD. Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019. Am J Epidemiol 2024; 193:58-74. [PMID: 37823258 PMCID: PMC10990004 DOI: 10.1093/aje/kwad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/12/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Avid Reza
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Lucy A. Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Nathania Said
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - J. Danielle Sharpe
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
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Seanez CM, Nuño T, Gachupin FC, Harris RB. Mammography Compliance for Arizona and New Mexico Hispanic and American Indian Women 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:19. [PMID: 38248484 PMCID: PMC10815889 DOI: 10.3390/ijerph21010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024]
Abstract
Hispanic and American Indian (AI) women experience lower breast cancer incidence than non-Hispanic White (NHW) women, but later-stage diagnoses and lower survival rates, suggesting issues with screening and healthcare access. Between 1999-2015, NHW breast cancer incidence decreased by 10% but increased by 8% for AI women. This study used 2016 and 2018 Behavioral Risk Factor Surveillance System data for Arizona and New Mexico to explore mammography screening. Analyses included Hispanic, AI, and NHW women aged ≥40 years (n = 12,830) to calculate age-specific compliance by race/ethnicity, logistic regression, and adjusted and sample-weighted evaluated associations between compliance and socio-economic covariates. In total, 75.1% of Hispanic women aged 50-74 reported mammography in the past two years (United States Preventive Services Task Force compliant) compared to 73.9% of NHW and 71.0% of AI women. Women who reported doctor visits in the past 12 months were likelier to comply than those without (AOR = 4.2 for Hispanic, 2.9 for AI, and 3.2 for NHW women). Reporting access to a personal doctor was related to compliance, except for AI women. While screening compliance was over 74%, visiting a healthcare provider in the past 12 months was essential. AI women reported issues that suggest unique challenges when deciding on mammography.
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Affiliation(s)
- Carol M. Seanez
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
| | - Tomas Nuño
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
| | - Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, 1601 N Tucson Blvd., Ste 32, Tucson, AZ 85716, USA;
| | - Robin B. Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; (T.N.); (R.B.H.)
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Gartner DR, Maples C, Nash M, Howard-Bobiwash H. Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices. Epidemiol Rev 2023; 45:63-81. [PMID: 37022309 DOI: 10.1093/epirev/mxad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.
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Affiliation(s)
- Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Ceco Maples
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Madeline Nash
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Heather Howard-Bobiwash
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
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Hill CM, Nash SH, Hopkins SE, Boyer BB, OBrien DM, Bersamin A. Diet quality is positively associated with intake of traditional foods and does not differ by season in remote Yup'ik communities. Int J Circumpolar Health 2023; 82:2221370. [PMID: 37312577 PMCID: PMC10269404 DOI: 10.1080/22423982.2023.2221370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.
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Affiliation(s)
- Courtney M Hill
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. OBrien
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
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Mishra SI, Adsul P, Leekity S, Rodman J, Sussman AL, Kelly K, Sheche J, Faber T, Shah V. A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico. Cancer Causes Control 2023; 34:855-871. [PMID: 37277513 PMCID: PMC10460346 DOI: 10.1007/s10552-023-01721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Affiliation(s)
- Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Prajakta Adsul
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131 USA
| | - Keith Kelly
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Thomas Faber
- Albuquerque Area Indian Health Service, 4101 Indian School Rd, NE, Albuquerque, NM 87110 USA
| | - Vallabh Shah
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
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Franco-Rocha OY, Lewis KA, Longoria KD, De La Torre Schutz A, Wright ML, Kesler SR. Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review. J Cancer Res Clin Oncol 2023; 149:12561-12587. [PMID: 37432455 DOI: 10.1007/s00432-023-05088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS Our findings indicate that racial and ethnic minoritized individuals may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA.
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kayla D Longoria
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Brain Health Neuroscience Lab, School of Nursing, The University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, USA
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Melkonian SC, Chen L, Jim MA, Haverkamp D, King JB. Disparities in incidence and trends of colorectal, lung, female breast, and cervical cancers among non-Hispanic American Indian and Alaska Native people, 1999-2018. Cancer Causes Control 2023; 34:657-670. [PMID: 37126144 PMCID: PMC10951714 DOI: 10.1007/s10552-023-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE This study is the first to comprehensively describe incidence rates and trends of screening-amenable cancers (colorectal, lung, female breast, and cervical) among non-Hispanic AI/AN (NH-AI/AN) people. METHODS Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we, calculated incidence rates for colorectal, lung, female breast, and cervical cancers for NH-AI/AN and non-Hispanic White (NHW) people for the years 2014-2018 combined. We calculated age-adjusted incidence rates (per 100,000), total percent change in incidence rates between 1999 and 2018, and trends over this time-period using Joinpoint analysis. Screening prevalence by region was calculated using Behavioral Risk Factor Surveillance System data. RESULTS Rates of screening-amenable cancers among NH-AI/AN people varied by geographic region and age at diagnosis. Over half of all lung and colorectal cancers in NH-AI/AN people were diagnosed at later stages. Rates of lung and colorectal cancers decreased significantly between 1999-2018 among NH-AI/AN men, but no significant changes were observed in rates of screening-amenable cancers among NH-AI/AN women. CONCLUSION This study highlights disparities in screening-amenable cancers between NH-AI/AN and NHW people. Culturally informed, community-based interventions that increase access to preventive health services could reduce cancer disparities among AI/AN people.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA.
| | | | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 500 Gold Ave SW, 9th Floor, Suite 9222, Albuquerque, New Mexico 87102, USA
| | - Jessica B King
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kendrick P, Kelly YO, Baumann MM, Compton K, Blacker BF, Daoud F, Li Z, Mouhanna F, Nassereldine H, Schmidt C, Sylte DO, Force LM, Hay SI, Rodriquez EJ, Mensah GA, Nápoles AM, Pérez-Stable EJ, Murray CJ, Mokdad AH, Dwyer-Lindgren L. The burden of stomach cancer mortality by county, race, and ethnicity in the USA, 2000-2019: a systematic analysis of health disparities. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100547. [PMID: 37600165 PMCID: PMC10435837 DOI: 10.1016/j.lana.2023.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/22/2023]
Abstract
Background There are persistent disparities in stomach cancer mortality among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically is not well understood. This analysis estimated age-standardised mortality for five racial-ethnic groups, in 3110 USA counties over 20 years, to describe spatial-temporal variations in stomach cancer mortality and disparities between racial-ethnic groups. Methods Redistribution methods for insufficient cause of death codes and validated small area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual stomach cancer mortality rates. Estimates were stratified by county and racial-ethnic group (non-Latino and non-Hispanic [NL] American Indian or Alaska Native [AIAN], NL Asian or Pacific Islander [Asian], NL Black [Black], Latino or Hispanic [Latino], and NL White [White]) from 2000 to 2019. Estimates were corrected for misreporting of racial-ethnic group on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial-ethnic group combinations with a mean annual population of less than 1000; thus, we report estimates for 3079 (of 3110) counties for the total population, and 474, 667, 1488, 1478, and 3051 counties for the AIAN, Asian, Black, Latino, and White populations, respectively. Findings Between 2000 and 2019, national age-standardised stomach cancer mortality was lowest among the White population in every year. Nationally, stomach cancer mortality declined for all racial-ethnic groups across this time period, with the most rapid declines occurring among the Asian (percent decline 48.3% [45.1-51.1]) and Black populations (42.6% [40.2-44.6]). Mortality among the other racial-ethnic groups declined more moderately, decreasing by 36.7% (35.3-38.1), 35.1% (32.2-37.7), and 31.6% (23.9-38.0) among the White, Latino, and AIAN populations, respectively. Similar patterns were observed at the county level, although with wide geographic variation. In 2019, a majority of counties had higher mortality rates among minoritised racial-ethnic populations compared to the White population: 81.1% (377 of 465 counties with unmasked estimates for both racial-ethnic groups) among the AIAN population, 88.2% (1295 of 1469) among the Latino population, 99.4% (663 of 667) among the Asian population, and 99.9% (1484 of 1486) among the Black population. However, the size of these disparities ranged widely across counties, with the largest range from 0.3 to 17.1 among the AIAN population. Interpretation Stomach cancer mortality has decreased substantially across populations and geographies in the USA. However, disparities in stomach cancer mortality among racial-ethnic groups are widespread and have persisted over the last two decades. Local-level data are crucial to understanding the scope of this unequal burden among minoritised groups in the USA. Funding National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, National Institutes of Health (contract #75N94019C00016).
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Roh S, Lee YS, Kenyon DB, Elliott AJ, Petereit DG, Gaba A, Lee HY. Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study. JMIR Form Res 2023; 7:e47851. [PMID: 37471115 PMCID: PMC10401399 DOI: 10.2196/47851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. OBJECTIVE This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. METHODS Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. RESULTS A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. CONCLUSIONS This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, SD, United States
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, United States
| | - DenYelle B Kenyon
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | - Amy J Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, United States
| | - Daniel G Petereit
- Monument Health Cancer Care Institute, Rapid City, SD, United States
| | - Anu Gaba
- Sanford Roger Maris Cancer Center, University of North Dakota, Fargo, ND, United States
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, United States
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12
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Melkonian SC, Said N, Weir HK, Jim MA, Siegel DA. Incidence of selected cancers in Non-Hispanic American Indian and Alaska Native adolescent and young adult populations, 1999-2019. Ann Epidemiol 2023; 83:78-86.e2. [PMID: 37119997 PMCID: PMC10965038 DOI: 10.1016/j.annepidem.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Studies have highlighted geographic variation in cancer incidence rates among American Indian and Alaska Native (AI/AN) populations. This is the first study to comprehensively evaluate incidence rates and trends among non-Hispanic AI/AN (NH-AI/AN) adolescents and young adults (AYAs) ages 15-39 years. METHODS Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we identified all malignant cancer cases for NH-AI/AN AYA populations for the years 1999-2019. We calculated age-adjusted incidence rates (per 100,000) for NH-AI/AN populations overall, by region, and by age group. We calculated the total percent change in the incidence of leading AYA cancers between 1999 and 2019, and trends by region and cancer type using Joinpoint analysis. RESULTS Testicular (13.6) and breast (19.0) cancers had the highest incidence of all AYA cancers in NH-AI/AN males and females, respectively. Overall AYA cancer rates increased by 1.4% in NH-AI/AN males and 1.8% in NH-AI/AN females annually between 1999 and 2019. Increases were observed by age group and geographic region. CONCLUSIONS This study describes regional differences in incidence rates of AYA cancers among NH-AI/AN populations. This data can help inform resource and cancer control priorities and strategies to reduce cancer risk and enhance access to quality diagnostic and treatment services for this population.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM.
| | | | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM
| | - David A Siegel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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13
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Amiri S, Jiang L, Manson SM, Buchwald DS. Trends in Alzheimer Disease Mortality Among American Indian and Alaska Native People Between 2011 and 2019. Alzheimer Dis Assoc Disord 2023; 37:93-99. [PMID: 37141452 PMCID: PMC10239373 DOI: 10.1097/wad.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The number of American Indian and Alaska Native (AI/AN) people living with dementia is expected to increase 5-fold by 2060. Social determinants of health may explain disparities in the incidence of Alzheimer disease (AD) but remain largely overlooked. METHODS We examined the time trend of AD mortality rates and associations of the percentage of AI/ANs, density of primary care physicians and neurologists, area deprivation index, rurality, and Indian Health Service region with AD mortality in 646 purchased/referred care delivery area counties. RESULTS AD mortality rates significantly increased over time. Counties with higher concentrations of AI/AN people had lower AD mortality. More deprived counties had 34% higher AD mortality compared with less deprived counties. AD mortality was 20% lower in nonmetro counties than in metro counties. CONCLUSIONS Findings have implications for prioritizing areas where more resources for AD care, education, or outreach are needed.
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Affiliation(s)
- Solmaz Amiri
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA
| | - Spero M Manson
- Department of Community and Behavioral Health, Centers for American Indian and Alaska Native Health, University of Colorado, Aurora, CO
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
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14
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Chebli P, Adsul P, Kranick J, Rohweder CL, Risendal BC, Bilenduke E, Williams R, Wheeler S, Kwon SC, Trinh-Shevrin C. Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network. Cancer Causes Control 2023; 34:371-387. [PMID: 36781715 PMCID: PMC9925365 DOI: 10.1007/s10552-023-01668-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023]
Abstract
Reflecting their commitment to advancing health equity, the Cancer Prevention and Control Research Network (CPCRN) established a Health Equity Workgroup to identify and distill guiding principles rooted in health equity, community-engaged participatory research (CBPR), social determinants of health, and racial equity frameworks to guide its collective work. The Health Equity Workgroup utilized a multi-phase, participatory consensus-building approach to: (1) identify recurrent themes in health and racial equity frameworks; (2) capture perspectives on and experiences with health equity research among CPCRN members through an online survey; (3) engage in activities to discuss and refine the guiding principles; and (4) collect case examples of operationalizing equity principles in cancer research. Representatives from all CPCRN centers endorsed nine core principles to guide the Network's strategic plan: (1) Engage in power-sharing and capacity building with partners; (2) Address community priorities through community engagement and co-creation of research; (3) Explore and address the systems and structural root causes of cancer disparities; (4) Build a system of accountability between research and community partners; (5) Establish transparent relationships with community partners; (6) Prioritize the sustainability of research benefits for community partners; (7) Center racial equity in cancer prevention and control research; (8) Engage in equitable data collection, analysis, interpretation, and dissemination practices; and (9) Integrate knowledge translation, implementation, and dissemination into research plans. Dissemination products, such as toolkits and technical assistance workshops, reflecting these principles will foster knowledge transfer to intentionally integrate health and racial equity principles in cancer prevention and control research.
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Affiliation(s)
- Perla Chebli
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA.
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Populations Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Julie Kranick
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy C Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Emily Bilenduke
- Department of Psychology Denver, University of Colorado Denver, Denver, CO, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Simona C Kwon
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
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Nash SH, Wahlen MM, Meisner ALW, Morawski BM. Choice of Survival Metric and Its Impacts on Cancer Survival Estimates for American Indian and Alaska Native People. Cancer Epidemiol Biomarkers Prev 2023; 32:398-405. [PMID: 36723409 PMCID: PMC9992150 DOI: 10.1158/1055-9965.epi-22-1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Different survival metrics have different applicability to clinical practice and research. We evaluated how choice of survival metric influences assessment of cancer survival among American Indian and Alaska Native (AIAN) people relative to non-Hispanic Whites (NHW). A secondary objective was to present variations in survival among AIAN people by age, sex, stage, and Indian Health Service (IHS) region. METHODS Five-year survival was calculated using the North American Association of Central Cancer Registries Cancer in North America dataset. We calculated survival among AIAN people, compared with NHW using four approaches: (i) observed (crude) survival, (ii) cause-specific survival, (iii) relative survival using age- and sex-adjusted lifetables, and (iv) relative survival using lifetables additionally adjusted for race, geography, and socioeconomic status. For AIAN people, we evaluated how survival varied by age, stage at diagnosis, and IHS region. RESULTS Observed survival methods produced the lowest estimates, and-excepting prostate cancer-cause-specific methods produced the highest survival estimates. Survival was lower among AIAN people than NHW for all methods. Among AIAN people, survival was higher among those 20-64 years, females, and tumors diagnosed at local stage. Survival varied by IHS region and cancer sites. CONCLUSIONS These results support the assertion that using the same methodology to compare survival estimates between racial and ethnic groups is of paramount importance, but that the choice of metric requires careful consideration of study objectives. IMPACT These findings have the potential to impact choice of survival metric to explore disparities among AIAN people.
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Affiliation(s)
- Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
- State Health Registry of Iowa, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Madison M Wahlen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Angela L W Meisner
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Bożena M Morawski
- Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, Idaho
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Kurumety SK, Howshar JT, Loving VA. Breast Cancer Screening and Outcomes Disparities Persist for Native American Women. JOURNAL OF BREAST IMAGING 2023; 5:3-10. [PMID: 38416957 DOI: 10.1093/jbi/wbac080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 03/01/2024]
Abstract
Over the past three decades, mortality rates from breast cancer have decreased for multiple racial groups but have remained constant for American Indian and Alaskan Native (AI/AN) women. Additionally, AI/AN women are less likely to receive timely breast cancer screening and are more likely to be diagnosed with advanced stage breast cancer at younger ages than their White counterparts. These disparities can be explained, in part, by the unique barriers to accessing care faced by AI/AN women. The Indian Health Service provides care to many AI/AN patients; however, their scope of practice is limited, and the service is chronically underfunded, leaving many women without appropriate and timely care. Additionally, geographic access to care is limited because of the sparsity of clinics and limited transportation resources. American Indian and Alaskan Native patients also harbor a history of mistrust in health care systems, and there is a paucity of culturally sensitive education regarding the importance of screening. There have been some grassroots efforts to address these barriers; however, large-scale coordinated efforts are lacking. In order to provide equitable breast health care, more awareness and widescale initiatives are needed and can be championed by breast radiologists.
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Affiliation(s)
- Sasha K Kurumety
- Houston Methodist Hospital, Department of Radiology, Houston, TX, USA
| | - Jacob T Howshar
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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17
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Sun-protective behaviors and skin cancer risk factors among American Indians and Alaskan Natives in the United States. J Am Acad Dermatol 2023; 88:488-490. [PMID: 35981930 DOI: 10.1016/j.jaad.2022.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023]
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Serchen J, Mathew S, Hilden D, Southworth M, Atiq O. Supporting the Health and Well-Being of Indigenous Communities: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1594-1597. [PMID: 36215716 DOI: 10.7326/m22-1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Molly Southworth
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, Alaska (M.S.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
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Pete D, Erickson SL, Jim MA, Hatcher SM, Echo-Hawk A, Dominguez AE. COVID-19 Among Non-Hispanic American Indian and Alaska Native People Residing in Urban Areas Before and After Vaccine Rollout-Selected States and Counties, United States, January 2020-October 2021. Am J Public Health 2022; 112:1489-1497. [PMID: 36103693 PMCID: PMC9480478 DOI: 10.2105/ajph.2022.306966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate COVID-19 disparities among non-Hispanic American Indian/Alaska Native (AI/AN) and non-Hispanic White persons in urban areas. Methods. Using COVID-19 case surveillance data, we calculated cumulative incidence rates and risk ratios (RRs) among non-Hispanic AI/AN and non-Hispanic White persons living in select urban counties in the United States by age and sex during January 22, 2020, to October 19, 2021. We separated cases into prevaccine (January 22, 2020-April 4, 2021) and postvaccine (April 5, 2021-October 19, 2021) periods. Results. Overall in urban areas, the COVID-19 age-adjusted rate among non-Hispanic AI/AN persons (n = 47 431) was 1.66 (95% confidence interval [CI] = 1.36, 2.01) times that of non-Hispanic White persons (n = 2 301 911). The COVID-19 prevaccine age-adjusted rate was higher (8227 per 100 000; 95% CI = 6283, 10 770) than was the postvaccine rate (3703 per 100 000; 95% CI = 3235, 4240) among non-Hispanic AI/AN compared with among non-Hispanic White persons (2819 per 100 000; 95% CI = 2527, 3144; RR = 1.31; 95% CI = 1.17, 1.48). Conclusions. This study highlights disparities in COVID-19 between non-Hispanic AI/AN and non-Hispanic White persons in urban areas. These findings suggest that COVID-19 vaccination and other public health efforts among urban AI/AN communities can reduce COVID-19 disparities in urban AI/AN populations. (Am J Public Health. 2022;112(10):1489-1497. https://doi.org/10.2105/AJPH.2022.306966).
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Affiliation(s)
- Dornell Pete
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Scott L Erickson
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Melissa A Jim
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Sarah M Hatcher
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Abigail Echo-Hawk
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Adrian E Dominguez
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
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Rookwood AC, Hudson L, Junk DJ, Berger NA, Vanderford NL. Early Cancer Research Education for Underrepresented Middle School Students: A Case Study of Experiences from Youth Enjoy Science Programs. JOURNAL OF STEM OUTREACH 2022; 5:1-12. [PMID: 36381604 PMCID: PMC9645771 DOI: 10.15695/jstem/v5i2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cancer is the second leading cause of death in the United States, and marginalized communities are disproportionately affected. There is a significant need to address cancer disparities and the determinants of health that are associated with those disparities. Increasing the diversity of the cancer research workforce is a potential mechanism to address health disparities. The National Cancer Institute's Youth Enjoy Science Research Education Program provides funding to engage middle school, high school, and undergraduate students from underrepresented student populations in cancer research education programming, conduct cancer education outreach to communities, and provide cancer research curricula to kindergarten through grade 12 educators. The ultimate goal of these programs is to motivate, prepare, and support students in pursuing cancer research careers. Herein, we describe how three academic institutions with YES Programs - the University of Kentucky, the University of Nebraska Medical Center, and Case Western Reserve University - provide cancer education programming to middle school students. Descriptions of each institutions' programing are provided. Common and unique elements were determined through an evaluation of the three programs. Although each program was developed independently, they have more common than unique elements. We provide insight into the development of middle school programs for other academic institutions.
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Affiliation(s)
- Aislinn C. Rookwood
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lauren Hudson
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Damian J. Junk
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nathan A. Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nathan L. Vanderford
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY, USA
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21
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Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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22
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Kidney Cancer Incidence and Mortality Disparities Involving American Indians/Alaska Natives: An Analysis of the Oklahoma Central Cancer Registry (OCCR). J Cancer Epidemiol 2022; 2022:2689386. [PMID: 35769890 PMCID: PMC9234047 DOI: 10.1155/2022/2689386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This cohort study describes the differences in kidney cancer age-adjusted incidence and mortality rates between American Indians/Alaskan Natives (AI/ANs) and Whites in Oklahoma. Additionally, rates for the U.S. are updated to establish an epidemiological comparison between Oklahoma and the rest of the country. Materials and Methods Kidney cancer age-adjusted incidence and mortality rates for Oklahoma were gathered using the Oklahoma Central Cancer Registry since 1999. National rates were obtained from the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database between 1997 and 2017. Rate ratios were used to compare incidence and mortality rates for AI/ANs and Whites within Oklahoma as well as the entire country. Joinpoint regression models were created to illustrate trends in kidney cancer incidence and mortality. Results The age-adjusted incidence rate of kidney cancer in Oklahoma for AI/ANs and Whites was 32.3 and 15.8 per 100,000, respectively, for an incidence rate ratio of 2.04. The national incidence rate ratio was 0.89. The age-adjusted mortality rate in Oklahoma for AI/ANs and Whites was 9.78 and 4.98 per 100,000, respectively, for a mortality rate ratio of 1.98. Oklahomans, irrespective of race, fare worse in terms of kidney cancer mortality compared to the rest of the country. Conclusions In Oklahoma, AI/ANs are more likely than Whites to have a kidney cancer diagnosis. AI/ANs are twice as likely to die from kidney cancer than Whites in Oklahoma. AI/AN populations in certain states may benefit from kidney cancer early screening initiatives.
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23
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Leader AE, McNair C, Yurick C, Huesser M, Schade E, Stimmel EE, Lerman C, Knudsen KE. Assessing the Coverage of US Cancer Center Primary Catchment Areas. Cancer Epidemiol Biomarkers Prev 2022; 31:955-964. [PMID: 35064067 PMCID: PMC9081121 DOI: 10.1158/1055-9965.epi-21-1097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/10/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cancer centers are expected to engage communities and reduce the burden of cancer in their catchment areas. However, the extent to which cancer centers adequately reach the entire US population is unknown. METHODS We surveyed all members of the Association of American Cancer Institutes (N = 102 cancer centers) to document and map each cancer center's primary catchment area. Catchment area descriptions were aggregated to the county level. Catchment area coverage scores were calculated for each county and choropleths generated representing coverage across the US. Similar analyses were used to overlay US population density, cancer incidence, and cancer-related mortality compared with each county's cancer center catchment area coverage. RESULTS Roughly 85% of US counties were included in at least one cancer center's primary catchment area. However, 15% of US counties, or roughly 25 million Americans, do not reside in a catchment area. When catchment area coverage was integrated with population density, cancer incidence, and cancer-related mortality metrics, geographical trends in both over- and undercoverage were apparent. CONCLUSIONS Geographic gaps in cancer center catchment area coverage exist and may be propagating cancer disparities. Efforts to ensure coverage to all Americans should be a priority of cancer center leadership. IMPACT This is the first known geographic analysis and interpretation of the primary catchment areas of all US-based cancer centers and identifies key geographic gaps important to target for disparities reduction. See related commentary by Lieberman-Cribbin and Taioli, p. 949.
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Affiliation(s)
- Amy E. Leader
- Division of Population Science, Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.,Corresponding Author: Amy E. Leader, Sidney Kimmel Cancer Center, Thomas Jefferson University, 834 Chestnut Street, Suite 314, Philadelphia, PA 19107. Phone: 215-955-7739; E-mail:
| | - Christopher McNair
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christina Yurick
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Huesser
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth Schade
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Emily E. Stimmel
- Association of American Cancer Institutes, Pittsburgh, Pennsylvania
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Karen E. Knudsen
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.,American Cancer Society, Atlanta, Georgia
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24
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Kills First CC, Sutton TL, Shannon J, Brody JR, Sheppard BC. Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs. Cancer 2022; 128:1560-1567. [PMID: 35132620 PMCID: PMC10257521 DOI: 10.1002/cncr.34118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/22/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.
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Affiliation(s)
| | | | | | - Jonathan R. Brody
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
| | - Brett C. Sheppard
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
- OHSU, Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Portland, OR, 97239
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25
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Melkonian SC, Jim MA, Pete D, Poel A, Dominguez AE, Echo-Hawk A, Zhang S, Wilson RJ, Haverkamp D, Petras L, Pohlenz A. Cancer disparities among non-Hispanic urban American Indian and Alaska Native populations in the United States, 1999-2017. Cancer 2022; 128:1626-1636. [PMID: 35119703 PMCID: PMC10929659 DOI: 10.1002/cncr.34122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Disparities in cancer incidence have not been described for urban American Indian/Alaska Native (AI/AN) populations. The purpose of the present study was to examine incidence rates (2008-2017) and trends (1999-2017) for leading cancers in urban non-Hispanic AI/AN (NH AI/AN) compared to non-Hispanic White (NHW) populations living in the same urban areas. METHODS Incident cases from population-based cancer registries were linked with the Indian Health Service patient registration database for improved racial classification of NH AI/AN populations. This study was limited to counties in Urban Indian Health Organization service areas. Analyses were conducted by geographic region. Age-adjusted rates (per 100,000) and trends (joinpoint regression) were calculated for leading cancers. RESULTS Rates of colorectal, liver, and kidney cancers were higher overall for urban NH AI/AN compared to urban NHW populations. By region, rates of these cancers were 10% to nearly 4 times higher in NH AI/AN compared to NHW populations. Rates for breast, prostate, and lung cancer were lower in urban NH AI/AN compared to urban NHW populations. Incidence rates for kidney, liver, pancreatic, and breast cancers increased from 2% to nearly 7% annually between 1999 to 2017 in urban NH AI/AN populations. CONCLUSIONS This study presents cancer incidence rates and trends for the leading cancers among urban NH AI/AN compared to urban NHW populations for the first time, by region, in the United States. Elevated risk of certain cancers among urban NH AI/AN populations and widening cancer disparities highlight important health inequities and missed opportunities for cancer prevention in this population.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Dornell Pete
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Amy Poel
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Adrian E. Dominguez
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Abigail Echo-Hawk
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | | | - Reda J. Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Lindsey Petras
- American Indian Cancer Foundation, Minneapolis, Minnesota
| | - Ashley Pohlenz
- American Indian Cancer Foundation, Minneapolis, Minnesota
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26
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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27
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Godfrey TM, Villavicencio EA, Barra K, Sanderson PR, Shea K, Sun X, Garcia DO. Advancing Liver Cancer Prevention for American Indian Populations in Arizona: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063268. [PMID: 35328956 PMCID: PMC8948724 DOI: 10.3390/ijerph19063268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a lack of empirical evidence on liver cancer prevention, treatment, and health interventions for American Indian populations in Arizona. Research is needed to evaluate the high rates of liver disease and cancer to inform culturally relevant interventions for liver cancer prevention. Community-engaged research that addresses structural inequality is a promising approach to improve inequities in liver cancer for American Indian people.
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Affiliation(s)
- Timian M. Godfrey
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA; (T.M.G.); (K.S.)
| | - Edgar A. Villavicencio
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
| | - Kimberly Barra
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ 85206, USA;
| | - Priscilla R. Sanderson
- College of Health and Human Services, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Kimberly Shea
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA; (T.M.G.); (K.S.)
| | - Xiaoxiao Sun
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
| | - David O. Garcia
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (E.A.V.); (X.S.)
- Correspondence:
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28
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Bradley CJ, Entwistle J, Sabik LM, Lindrooth RC, Perraillon M. Capitalizing on Central Registries for Expanded Cancer Surveillance and Research. Med Care 2022; 60:187-191. [PMID: 35030567 PMCID: PMC8820319 DOI: 10.1097/mlr.0000000000001675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND State central cancer registries are an essential component of cancer surveillance and research that can be enriched through linkages to other databases. This study identified and described state central registry linkages to external data sources and assessed the potential for a more comprehensive data infrastructure with registries at its core. METHODS We identified peer-reviewed papers describing linkages to state central cancer registries in all 50 states, Washington, DC, and Puerto Rico, published between 2010 and 2020. To complement the literature review, we surveyed registrars to learn about unpublished linkages. Linkages were grouped by medical claims (public and private insurers), medical records, other registries (eg, human immunodeficiency virus/acquired immunodeficiency syndrome registries, birth certificates, screening programs), and data from specific cohorts (eg, firefighters, teachers). RESULTS We identified 464 data linkages with state central cancer registries. Linkages to cohorts and other registries were most common. Registries in predominately rural states reported the fewest linkages. Most linkages are not ongoing, maintained, or available to researchers. A third of linkages reported by registrars did not result in published papers. CONCLUSIONS Central cancer registries, often in collaboration with researchers, have enriched their data through linkages. These linkages demonstrate registries' ability to contribute to a data infrastructure, but a coordinated and maintained approach is needed to leverage these data for research. Sparsely populated states reported the fewest linkages, suggesting possible gaps in our knowledge about cancer in these states. Many more linkages exist than have been reported in the literature, highlighting potential opportunities to further use the data for research purposes.
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Affiliation(s)
- Cathy J. Bradley
- University of Colorado Cancer Center, Aurora, CO
- Colorado School of Public Health, Aurora, CO
| | | | - Lindsay M. Sabik
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | - Marcelo Perraillon
- University of Colorado Cancer Center, Aurora, CO
- Colorado School of Public Health, Aurora, CO
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29
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Menon U, Lance P, Szalacha LA, Candito D, Bobyock EP, Yellowhair M, Hatcher J. Adaptation of colorectal cancer screening tailored navigation content for American Indian communities and early results using the intervention. Implement Sci Commun 2022; 3:6. [PMID: 35090575 PMCID: PMC8795961 DOI: 10.1186/s43058-022-00253-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/04/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND American Indians (AI) experience major colorectal cancer (CRC) screening disparities with commensurate inequity in CRC mortality and other outcomes. The purpose of this report is to describe the methods and early results of adapting a previously successful intervention for the AI community. METHODS The educational content and delivery strategy of the parent intervention were adapted for AIs guided by an adaptation framework and cultural consultations with the community and clinicians. As part of the environmental scanning, we identified the need to substantively revise our data entry, collection, and tracking system and develop a REDCap database for this purpose. In this study, we staggered the implementation of the intervention in each facility to inform the process from one clinic to the next, and assess both the clinical outcomes of the tailored intervention and the implementation processes across two clinic settings, Facilities A and B. RESULTS The REDCap database is an indispensable asset, and without it we would not have been able to obtain reliable aggregate screening data while improvements to facility electronic health records are in progress. Approximately 8% (n = 678) of screening-eligible patients have been exposed to the navigator intervention. Of those exposed to the navigator intervention, 37% completed screening. CONCLUSIONS With the small numbers of patients exposed so far to the intervention, it would be premature to draw any broad conclusions yet about intervention effects. However, early screening completion rates are substantial advances on existing rates, and we have demonstrated that a tailored navigator intervention for facilitating CRC screening was readily adapted with provider and community input for application to AIs. A REDCap database for tracking of CRC screening by navigators using tablets or laptops on- or offline is easy to use and allows for generation of aggregate, anonymized screening data. TRIAL REGISTRATION There was no health intervention meeting the criteria of a clinical trial. The University of Arizona Institutional Review Board granted exemption from obtaining informed consent from patients undergoing CRC screening after administration of the tailored navigation intervention as usual care.
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Affiliation(s)
- Usha Menon
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
| | - Peter Lance
- University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Laura A Szalacha
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.,Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Dianna Candito
- University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Emily P Bobyock
- University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Monica Yellowhair
- University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Jennifer Hatcher
- University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, AZ, 85724, USA
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30
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Harris RB, Brown HE, Begay RL, Sanderson PR, Chief C, Monroy FP, Oren E. Helicobacter pylori Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020797. [PMID: 35055622 PMCID: PMC8775467 DOI: 10.3390/ijerph19020797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4–66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50–53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05–10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.
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Affiliation(s)
- Robin B. Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
- Correspondence:
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
| | - Rachelle L. Begay
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
| | - Priscilla R. Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, SAS (Bldg 60), 1100 S. Beaver St., POB 15095, Flagstaff, AZ 86011, USA;
| | - Carmenlita Chief
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, 1395 South Knoles Drive, POB 4065, Flagstaff, AZ 86011, USA;
| | - Fernando P. Monroy
- Department of Biological Sciences, College of the Environment, Forestry and Natural Sciences, Northern Arizona University, 617 S. Beaver St., Flagstaff, AZ 86011, USA;
| | - Eyal Oren
- Division of Epidemiology & Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA;
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31
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Warren BR, Grandis JR, Johnson DE, Villa A. Head and Neck Cancer among American Indian and Alaska Native Populations in California, 2009-2018. Cancers (Basel) 2021; 13:cancers13205195. [PMID: 34680342 PMCID: PMC8534223 DOI: 10.3390/cancers13205195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary In the United States, it is estimated there will be 54,000 new cases of oral cavity and pharyngeal cancer in 2021. Tobacco exposure and drinking alcohol are the main causes of head and neck cancer (HNC). Human Papilloma Virus (HPV) is now increasing in prevalence and is the most common cause of oropharyngeal cancer in the United States. This study assessed the incidence of HNC and HPV status in American Indian/Alaska Native (AI/AN) populations in California and determined if incidence was higher among AI/ANs compared to other ethnicities. We found that AI/AN and White patients had the highest burden of late-stage HNC and HPV+ lip, oral cavity, and pharynx cancer compared to other ethnicities. In addition, AI/ANs had a decreased survival rate compared to White patients. These findings reveal ethnic or racial differences in incidence, presentation, and survival, and should inform future preventative care measures for the AI/AN population. Abstract The purpose of this study was to determine the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) head and neck cancer (HNC) in the American Indian/Alaska Native (AI/AN) population in California to assess whether incidence is higher among AI/ANs compared to other ethnicities. We analyzed data from the California Cancer Registry, which contains data reported to the Cancer Surveillance Section of the Department of Public Health. A total of 51,289 HNC patients were identified for the years 2009–2018. Outcomes of interest included sex, stage at presentation, 5-year survival rate, tobacco use, and HPV status. AI/AN and White patients had the highest burden of late stage HNC (AI/AN 6.3:100,000; 95% CI 5.3–7.4, White 5.8:100,000; 95% CI 5.7–5.9) compared to all ethnicities or races (Black: 5.2; 95% CI 4.9–5.5; Asian/Pacific Islander: 3.2; 95% CI 3–3.3; and Hispanic: 3.1; 95% CI 3–3.2 per 100,000). Additionally, AI/AN and White patients had the highest burden of HPV+ lip, oral cavity, and pharynx HNC (AI/AN 0.9:100,000; 95% CI 0.6–1.4, White 1.1:100,000; 95% CI 1–1.1) compared to all ethnicities or races (Black: 0.8:100,000; 95% CI 0.7–0.9; Asian/Pacific Islander: 0.4; 95% CI 0.4–0.5; and Hispanic: 0.6; 95% CI 0.5–0.6). AI/ANs had a decreased 5-year survival rate compared to White patients (AI/AN 59.9%; 95% CI 51.9–67.0% and White 67.7%; 95% CI 67.00–68.50%) and a higher incidence of HNC in former and current tobacco users. These findings underscore the disparities that exist in HNC for California AI/AN populations. Future studies should aim to elucidate why the unequal burden of HNC outcomes exists, how to address increased tobacco usage, and HPV vaccination patterns to create culturally and community-based interventions.
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Affiliation(s)
- Brooke R. Warren
- School of Medicine, University of California, San Francisco, CA 94143, USA;
| | - Jennifer R. Grandis
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Daniel E. Johnson
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; (J.R.G.); (D.E.J.)
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-476-2431
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Haverkamp D, Melkonian SC, Jim MA. Growing Disparity in the Incidence of Colorectal Cancer among Non-Hispanic American Indian and Alaska Native Populations-United States, 2013-2017. Cancer Epidemiol Biomarkers Prev 2021; 30:1799-1806. [PMID: 34341050 PMCID: PMC8590617 DOI: 10.1158/1055-9965.epi-21-0343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) populations have experienced regional variation and disparities in colorectal cancer incidence rates. METHODS We examined colorectal cancer incidence (2013-2017) and colorectal cancer incidence trends (1999-2017) among AI/AN persons. Incidence data were linked to Indian Health Service enrollment records, and analyses were restricted to Purchased/Referred Care Delivery Areas. Incidence rates of colorectal cancer among AI/AN and White persons were analyzed in six geographic regions; Hispanic persons were excluded. Incidence trends were analyzed using linear modeling. RESULTS During 2013-2017, colorectal cancer incidence was 41% higher among AI/AN than among White persons. AI/AN incidence rates per 100,000 varied regionally from 34.4 in the East to 96.1 in Alaska. Compared with White persons, AI/AN persons had higher colorectal cancer incidence rates among all age strata and were more likely to have late-stage diagnoses. Incidence rate trends indicated significant increases among both AI/AN and White persons ages <50 years and among AI/AN persons ages 50-64 years. The colorectal cancer incidence rate trend increased among AI/AN persons in the Southwest. CONCLUSIONS The disparity of colorectal cancer incidence rates between AI/AN and White persons has widened since 2005-2009. AI/AN populations have higher colorectal cancer incidence compared with White populations, especially in the Alaska region. IMPACT Our finding of increased colorectal cancer incidence disparities suggests that enhanced screening efforts and culturally appropriate clinical and public health interventions are needed among AI/AN persons overall, and especially in regions and age groups in which colorectal cancer rates are increasing.
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Affiliation(s)
- Donald Haverkamp
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, New Mexico.
| | - Stephanie C Melkonian
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Melissa A Jim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, New Mexico
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Gachupin FC, Ingram JC, Laurila KA, Lluria-Prevatt MC, Teufel-Shone NI, Briehl MM. NACP: Partnership for Native American Cancer Prevention. CANCER HEALTH DISPARITIES 2021; 5:164. [PMID: 36304439 PMCID: PMC9605604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cancer trends over a two-decade period show a greater reduction in cancer mortality rates for non-Hispanic Whites than for Native Americans. The Partnership for Native American Cancer Prevention (NACP) was established to address cancer health disparities that impact Native Americans. The partners are Northern Arizona University, the University of Arizona Cancer Center, Arizona's tribal communities and the National Cancer Institute. The activities include outreach, research and cancer education. Overall, NACP seeks to expand capacity for culturally-sensitive and community-relevant research on cancer, and to continue developing respectful collaborations that will empower sovereign Native American communities to define, implement, and achieve their goals for cancer health equity.
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Affiliation(s)
- Francine C Gachupin
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
| | - Jani C Ingram
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
| | - Kelly A Laurila
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
| | - Maria C Lluria-Prevatt
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
| | - Nicolette I Teufel-Shone
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
| | - Margaret M Briehl
- Department of Family & Community Medicine, University of Arizona, Department of Chemistry & Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University Department of Pathology, University of Arizona
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Kano M, Chen L, Boyce T, Gomez R, Gundelach AC, Jaffe SA, Sussman AL, Dayao ZR, Lobo J, Pestak CR, Rutledge TL. Characterizing Low-Risk Breast and Gynecological Cancer Patients for Transition into an Oncology/Primary Care Coordinated Care Model: Findings from a Survey of Diverse Survivors in a Rural U.S. State. Cancers (Basel) 2021; 13:cancers13174428. [PMID: 34503237 PMCID: PMC8431122 DOI: 10.3390/cancers13174428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a survey to characterize the key attributes of racial/ethnic and geographically diverse low-risk breast and gynecologic cancer patients. We collected data regarding patients' access to primary care (PC); compliance with screening recommendations; treatment for comorbidities; logistical barriers to clinic visits; and receipt of survivorship care documentation (SCD). Survey findings informed the development of an oncology/Primary Care Provider (PCP) care coordination intervention to improve care. We distributed a cross-sectional survey among a convenience sample of 150 cancer survivors. Responses were calculated using descriptive statistics and compared based on the distance participants traveled to their appointments at the cancer center (≤30 vs. >30 miles). Of the 150 respondents, 35% traveled >30 miles for follow-up care and 78% reported having one or more comorbid condition(s). PC utilization was high: 88% reported having a PCP, and 91% indicated ≤1 yearly follow-up visit. Participants traveling >30 miles reported higher rates of logistical challenges associated with cancer center visits compared to those traveling ≤30 miles. Nearly half of respondents (46%) had not received SCD. In conclusion, survey studies such as these allow for the systematic assessment of survivor behaviors and care utilization patterns to inform the development of care coordination interventions for diverse, low-risk cancer patients.
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Affiliation(s)
- Miria Kano
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Correspondence: ; Tel.: +1-(505)-925-1115
| | - Lu Chen
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch; Albuquerque, NM 77555, USA;
| | - Tawny Boyce
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Ricardo Gomez
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Amy C. Gundelach
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Shoshana Adler Jaffe
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
| | - Andrew L. Sussman
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Zoneddy R. Dayao
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jolene Lobo
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Claire R. Pestak
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (Z.R.D.); (C.R.P.)
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Teresa L. Rutledge
- The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA; (T.B.); (R.G.); (A.C.G.); (S.A.J.); (A.L.S.); (T.L.R.)
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
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Jack L. Advancing Health Equity, Eliminating Health Disparities, and Improving Population Health. Prev Chronic Dis 2021; 18:E79. [PMID: 34387187 PMCID: PMC8388204 DOI: 10.5888/pcd18.210264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Leonard Jack
- Office of Medicine and Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mailstop S107-8, Atlanta, GA 30341.
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Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis. Cancer Causes Control 2021; 32:1333-1345. [PMID: 34313875 DOI: 10.1007/s10552-021-01481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.
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Roubidoux MA, Richards B, Honey NE, Begay JA. Adherence to Screening Among American Indian Women Accessing a Mobile Mammography Unit. Acad Radiol 2021; 28:944-949. [PMID: 33896716 DOI: 10.1016/j.acra.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES Although screening mammography is essential to reducing breast cancer morbidity and mortality, barriers exist especially among underrepresented minority groups. There are few studies of mammogram screening among American Indian women, many of whom reside in rural areas where screening access is challenging. A mobile mammography unit served 24 Indian Health Service clinics during 2013-17. Screening mammography adherence was evaluated. MATERIALS AND METHODS Among mobile unit women, 'adherence to screening' was determined by the date of the most recent prior mammogram. Those having a prior mammogram 9-27 months ago were classified as 'adherent to screening'. Comparison screening data were obtained from the American College of Radiology National Mammography Database, consisting of screening cases occurring in year 2015. Additionally, among mobile unit women 'continued adherence to screening' was determined, defined as at least one repeat screening at the mobile unit within the subsequent 9-27 months after a screening there. RESULTS Among 1,615 mobile unit women, 624 (38.6%) were adherent to screening. Among 2,509,826 National Mammography Database women, 1,481,021 (59.0%) were adherent to screening. (p<0.0001) The prevalence of a >27-month interval between mammograms was 3.13 (95% CI 2.91-3.36) times greater among mobile unit women than National Mammography Database women. 'Continued adherence to screening' of mobile unit women was 428/1194 (35.9%). CONCLUSION Adherence to screening and continued adherence to screening were low among mobile unit women and time interval between screenings was longer than National Mammography Database women. Factors to improve screening adherence among these underserved women should be determined.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910 Box 5326; 1500 E. Ann Arbor Michigan.
| | | | | | - Joel A Begay
- Senior Research Assistant and Data Analyst Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Melkonian SC, Weir HK, Jim MA, Preikschat B, Haverkamp D, White MC. Incidence of and Trends in the Leading Cancers With Elevated Incidence Among American Indian and Alaska Native Populations, 2012-2016. Am J Epidemiol 2021; 190:528-538. [PMID: 33506248 PMCID: PMC8026484 DOI: 10.1093/aje/kwaa222] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer incidence varies among American Indian and Alaska Native (AI/AN) populations, as well as between AI/AN and White populations. This study examined trends for cancers with elevated incidence among AI/AN compared with non-Hispanic White populations and estimated potentially avoidable incident cases among AI/AN populations. Incident cases diagnosed during 2012-2016 were identified from population-based cancer registries and linked with the Indian Health Service patient registration databases to improve racial classification of AI/AN populations. Age-adjusted rates (per 100,000) and trends were calculated for cancers with elevated incidence among AI/AN compared with non-Hispanic White populations (rate ratio of >1.0) according to region. Trends were estimated using joinpoint regression analyses. Expected cancers were estimated by applying age-specific cancer incidence rates among non-Hispanic White populations to population estimates for AI/AN populations. Excess cancer cases among AI/AN populations were defined as observed minus expected cases. Liver, stomach, kidney, lung, colorectal, and female breast cancers had higher incidence rates among AI/AN populations across most regions. Between 2012 and 2016, nearly 5,200 excess cancers were diagnosed among AI/AN populations, with the largest number of excess cancers (1,925) occurring in the Southern Plains region. Culturally informed efforts could reduce cancer disparities associated with these and other cancers among AI/AN populations.
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Zahrieh D, Golafshar MA, Patel SH, DeWees TA. Quantification of Potential Inequities in Breast Cancer Incidence in New Mexico Through Bayesian Disease Mapping. Prev Chronic Dis 2021; 18:E23. [PMID: 33705303 PMCID: PMC7986972 DOI: 10.5888/pcd18.200468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The incidence of breast cancer among non-Hispanic American Indian and Alaska Native (AI/AN) women varies across the United States. We applied county-level Bayesian disease mapping to quantify potential inequities in 10-year breast cancer incidence in New Mexico to better inform health equity initiatives among its non-Hispanic at-risk AI/AN population. METHODS We used data from the Surveillance, Epidemiology, and End Results (SEER) program from 2005 through 2014 to identify new cases of breast cancer in New Mexico's 33 counties. To account for spatial variation, a county-level Area Deprivation Index, and the small area estimation problem inherent in these data, we borrowed strength globally and locally by applying Bayesian disease mapping to the counts of age-adjusted county-level breast cancer incidence. We quantified the disparity effect, as measured by the age-adjusted rate ratio, comparing the incidence of breast cancer between at-risk non-Hispanic AI/AN and non-Hispanic White women and assessed whether the ratio differed among counties. RESULTS Accounting for over-dispersion and spatial correlation among the 33 counties and a county-level Area Deprivation Index, the posterior mean of the overall age-adjusted rate ratio was 0.384 (95% credible interval, 0.253--0.546). The age-adjusted rate of breast cancer in non-Hispanic AI/AN women was 0.38 times the corresponding age-adjusted rate for non-Hispanic White women; however, a significant reduction in breast cancer incidence was observed in 16 of the 33 counties. CONCLUSION The application of Bayesian disease mapping to these data provided substantial evidence of an overall disparity in breast cancer incidence between at-risk non-Hispanic AI/AN and non-Hispanic White women in New Mexico, which was more marked than previously reported and limited to certain counties. Targeted statewide and county-level health-equity initiatives may lead to a reduction in these disparities.
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Affiliation(s)
- David Zahrieh
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic, Department of Quantitative Health Sciences, 200 First St SW, Rochester, MN 55905.
| | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Todd A DeWees
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Implementation of Cancer Plans in the United States: A Review. Healthcare (Basel) 2021; 9:healthcare9030291. [PMID: 33800077 PMCID: PMC8000996 DOI: 10.3390/healthcare9030291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
State cancer plans facilitate prioritization and stakeholder engagement in preventing and controlling cancer. Implementation plans further help stakeholders prioritize efforts, reduce redundancy, and find opportunities for work synergies. A review of cancer plan implementations plans was performed in the development of an implementation plan for the Florida Cancer Plan. This review sought to identify, characterize, and summarize the use of implementation plans that support comprehensive cancer control activities. Although 100% of states and territories published a cancer plan and 78% of states provided funding for implementing their state cancer plans, only 32% published an implementation plan. Commonalities and unique features of state cancer plan implementations are presented and discussed. An example implementation plan is provided for states without a plan to model.
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Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data. Cancers (Basel) 2021; 13:cancers13050990. [PMID: 33673457 PMCID: PMC7956712 DOI: 10.3390/cancers13050990] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary This study assessed renal cell carcinoma disparities in American Indians/Alaska Natives and Hispanic Americans using the National Cancer Database and the Arizona Cancer Registry, focusing on advanced-stage and mortality. Renal cell carcinoma disparities in American Indians/Alaska Natives have been partially explained by neighborhood socioeconomic factors and residence (rural or urban) pattern, but not in Hispanic Americans. Greater health disparities in renal cell carcinoma stage and mortality for Hispanic Americans and renal cell carcinoma mortality for American Indians/Alaska Natives were observed at the Arizona state level compared to national levels. Abstract Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.
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Montiel Ishino FA, Odame EA, Villalobos K, Liu X, Salmeron B, Mamudu H, Williams F. A National Study of Colorectal Cancer Survivorship Disparities: A Latent Class Analysis Using SEER (Surveillance, Epidemiology, and End Results) Registries. Front Public Health 2021; 9:628022. [PMID: 33718323 PMCID: PMC7946972 DOI: 10.3389/fpubh.2021.628022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/27/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction: Long-standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person-centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable-centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes. Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes. Results: A four-class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76-85 years-old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White. Conclusion: The use of a person-centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.
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Affiliation(s)
- Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Emmanuel A. Odame
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Xiaohui Liu
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Bonita Salmeron
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Hadii Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
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Minas TZ, Kiely M, Ajao A, Ambs S. An overview of cancer health disparities: new approaches and insights and why they matter. Carcinogenesis 2021; 42:2-13. [PMID: 33185680 PMCID: PMC7717137 DOI: 10.1093/carcin/bgaa121] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer health disparities remain stubbornly entrenched in the US health care system. The Affordable Care Act was legislation to target these disparities in health outcomes. Expanded access to health care, reduction in tobacco use, uptake of other preventive measures and cancer screening, and improved cancer therapies greatly reduced cancer mortality among women and men and underserved communities in this country. Yet, disparities in cancer outcomes remain. Underserved populations continue to experience an excessive cancer burden. This burden is largely explained by health care disparities, lifestyle factors, cultural barriers, and disparate exposures to carcinogens and pathogens, as exemplified by the COVID-19 epidemic. However, research also shows that comorbidities, social stress, ancestral and immunobiological factors, and the microbiome, may contribute to health disparities in cancer risk and survival. Recent studies revealed that comorbid conditions can induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. In this review, we will discuss unanswered questions and new opportunities in cancer health disparity research related to comorbid chronic diseases, stress signaling, the immune response, and the microbiome, and what contribution these factors may have as causes of cancer health disparities.
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Affiliation(s)
- Tsion Zewdu Minas
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maeve Kiely
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anuoluwapo Ajao
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Song D, Tian J, Hu Y, Wei Y, Lu H, Wang Y, Guan Q, Zhou Y. Identification of biomarkers associated with diagnosis and prognosis of gastroesophageal junction adenocarcinoma-a study based on integrated bioinformatics analysis in GEO and TCGA database. Medicine (Baltimore) 2020; 99:e23605. [PMID: 33371094 PMCID: PMC7748358 DOI: 10.1097/md.0000000000023605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
Gastroesophageal junction adenocarcinoma (GEJAC) is a malignant tumor with high mortality. Its incidence has increased sharply all over the world in recent years. The study aims to search for potential biomarkers for the diagnosis and prognosis of GEJAC based on the Gene Expression Omnibus database (GEO) database and The Cancer Genome Atlas (TCGA) database.Microarray dataset (GSE96668 and GSE74553) of GEJAC was downloaded from the GEO. After screening overlapping differentially expressed genes (DEGs) by GEO2R and Wayne map, functional enrichment analysis of the DEGs was performed by the DAVID database. Then, a protein-protein interaction (PPI) network was constructed, and the hub gene was identified by using STRING and Cytoscape, as well as the diagnostic value of hub genes was evaluated by the receiver operating characteristic (ROC) curves. Finally, the gene transcriptome profiles of gastric cancer named TCGA-STAD were downloaded from TCGA database to screen the potential prognostic genes and construct the prognostic risk model using Cox proportional hazards regression. Meanwhile, the Kaplan-Meier curve and time-dependent ROC curve were adopted to test the prognostic value of the prognostic gene signature.In this study, we identified 10 hub genes that might have high diagnostic value for GEJAC, and inferred that they might be involved in the occurrence and development of GEJAC. Moreover, we conducted a survival prediction model consisting of 6 genes and proved that they have value to some extent in predicting prognosis for GEJAC patients.
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Affiliation(s)
- Danlei Song
- The First Clinical Medical School of Lanzhou University
- Department of Gastroenterology
- Key Laboratory for Gastrointestinal Diseases of Gansu Province
| | - Jiming Tian
- The First Clinical Medical School of Lanzhou University
- Department of Obstetrics and Gynecology
| | - Yuping Hu
- The First Clinical Medical School of Lanzhou University
- Hospital of Reproductive Medicinal
| | - Yongjian Wei
- The First Clinical Medical School of Lanzhou University
- The Fifth Department of General Surgery
| | - Hong Lu
- Department of Gastroenterology
- Key Laboratory for Gastrointestinal Diseases of Gansu Province
| | - Yuping Wang
- Department of Gastroenterology
- Key Laboratory for Gastrointestinal Diseases of Gansu Province
| | - Quanlin Guan
- Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yongning Zhou
- Department of Gastroenterology
- Key Laboratory for Gastrointestinal Diseases of Gansu Province
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McKinley CE, Roh S, Lee YS, Liddell J. Family: The Bedrock of Support for American Indian Women Cancer Survivors. FAMILY & COMMUNITY HEALTH 2020; 43:246-254. [PMID: 32427672 PMCID: PMC8813328 DOI: 10.1097/fch.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Cancer disparities among American Indian (AI) women are alarming, yet a dearth of research focuses on the role of family support for such women. The purpose of this research was to examine the composition of AI women cancer survivors' family support networks and the types of support that they provided. We used a qualitative descriptive methodology with 43 AI women cancer survivors and qualitative content analysis, which indicated that 38 participants (approximately 90%) reported that their families provided integral and varied forms of support, especially instrumental support throughout cancer experiences. Families were the bedrock of support for AI women cancer survivors.
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Affiliation(s)
- Catherine E McKinley
- School of Social Work, Tulane University, New Orleans, Louisiana (Dr McKinley and Ms Liddell); Department of Social Work, University of South Dakota, Sioux Falls (Dr Roh); and School of Social Work, San Francisco State University, San Francisco, California (Dr Lee)
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Melkonian SC, Pete D, Jim MA, Haverkamp D, Wiggins CL, Bruce MG, White MC. Gastric Cancer Among American Indian and Alaska Native Populations in the United States, 2005-2016. Am J Gastroenterol 2020; 115:1989-1997. [PMID: 32740090 PMCID: PMC7710924 DOI: 10.14309/ajg.0000000000000748] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) populations have higher gastric cancer rates than the general US population. This study provides a comprehensive overview of incidence rates among AI/AN persons during 2005-2016 compared with non-Hispanic whites (whites). METHODS Population-based cancer registry data for 2005-2016 were linked with the Indian Health Service patient registration databases to address racial misclassification. Age-adjusted gastric cancer incidence rates were expressed per 100,000 per year. Incidence and trend analyses were restricted to purchased/referred care delivery area counties in 6 geographic regions, comparing gastric cancer incidence rates for AI/AN vs white populations in the United States. RESULTS Gastric cancer rates were higher in the AI/AN compared with white populations in nearly every US region. Incidence rates for central/distal portions of the stomach were higher in AI/AN individuals compared with whites. Rates of later stage gastric cancer were higher in AI/AN populations overall and in every region except the Pacific Coast and East. Incidence rates decreased significantly over time in both populations. Declining rates in the AI/AN populations were driven by changes in the Pacific Coast and Northern Plains regions. DISCUSSION AI/AN populations have a disproportionately high incidence of gastric cancer, especially in Alaska. High incidence in the central/distal portions of the stomach among AI/AN populations likely reflects a high prevalence of Helicobacter pylori infection in these populations. These data can be used to develop interventions to reduce risk factors and improve access to health services among AI/AN people at high risk for gastric cancer.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, USA
| | - Dornell Pete
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, USA
| | - Charles L. Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Michael G. Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Mary C. White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zahnd WE, Gomez SL, Steck SE, Brown MJ, Ganai S, Zhang J, Arp Adams S, Berger FG, Eberth JM. Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer. Cancer 2020; 127:239-248. [PMID: 33112412 DOI: 10.1002/cncr.33256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. METHODS Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. RESULTS EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. CONCLUSIONS EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J Brown
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Office of the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Franklin G Berger
- Colorectal Cancer Prevention Network, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Melkonian SC, Henley SJ, Senkomago V, Thomas CC, Jim MA, Apostolou A, Saraiya M. Cancers Associated with Human Papillomavirus in American Indian and Alaska Native Populations - United States, 2013-2017. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1283-1287. [PMID: 32941412 PMCID: PMC7498173 DOI: 10.15585/mmwr.mm6937a2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Human papillomavirus (HPV) causes most cervical cancers and some cancers of the penis, vulva, vagina, oropharynx, and anus. Cervical precancers can be detected through screening. HPV vaccination with the 9-valent HPV vaccine (9vHPV) can prevent approximately 92% of HPV-attributable cancers (1).* Previous studies have shown lower incidence of HPV-associated cancers in non-Hispanic American Indian and Alaska Native (AI/AN) populations compared with other racial subgroups (2); however, these rates might have been underestimated as a result of racial misclassification. Previous studies have shown that cancer registry data corrected for racial misclassification resulted in more accurate cancer incidence estimates for AI/AN populations (3,4). In addition, regional variations in cancer incidence among AI/AN populations suggest that nationally aggregated data might not adequately describe cancer outcomes within these populations (5). These variations might, in part, result from geographic disparities in the use of health services, such as cancer screening or vaccination (6). CDC analyzed data for 2013-2017 from central cancer registries linked with the Indian Health Service (IHS) patient registration database to assess the incidence of HPV-associated cancers and to estimate the number of cancers caused by HPV among AI/AN populations overall and by region. During 2013-2017, an estimated 1,030 HPV-associated cancers were reported in AI/AN populations. Of these cancers, 740 (72%) were determined to be attributable to HPV types targeted by 9vHPV; the majority were cervical cancers in females and oropharyngeal cancers in males. These data can help identify regions where AI/AN populations have disproportionately high rates of HPV-associated cancers and inform targeted regional vaccination and screening programs in AI/AN communities.
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Hatcher SM, Agnew-Brune C, Anderson M, Zambrano LD, Rose CE, Jim MA, Baugher A, Liu GS, Patel SV, Evans ME, Pindyck T, Dubray CL, Rainey JJ, Chen J, Sadowski C, Winglee K, Penman-Aguilar A, Dixit A, Claw E, Parshall C, Provost E, Ayala A, Gonzalez G, Ritchey J, Davis J, Warren-Mears V, Joshi S, Weiser T, Echo-Hawk A, Dominguez A, Poel A, Duke C, Ransby I, Apostolou A, McCollum J. COVID-19 Among American Indian and Alaska Native Persons - 23 States, January 31-July 3, 2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1166-1169. [PMID: 32853193 PMCID: PMC7451969 DOI: 10.15585/mmwr.mm6934e1] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22†-July 3, 2020 were analyzed. The analysis was limited to 23 states§ with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes.
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Iyengar S, Hall IJ, Sabatino SA. Racial/Ethnic Disparities in Prostate Cancer Incidence, Distant Stage Diagnosis, and Mortality by U.S. Census Region and Age Group, 2012-2015. Cancer Epidemiol Biomarkers Prev 2020; 29:1357-1364. [PMID: 32303533 DOI: 10.1158/1055-9965.epi-19-1344] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/12/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We sought to characterize recent prostate cancer incidence, distant stage diagnosis, and mortality rates by region, race/ethnicity, and age group. METHODS In SEER*Stat, we examined age-specific and age-adjusted prostate cancer incidence, distant stage diagnosis, and mortality rates by race/ethnicity, census region, and age group. Incidence and mortality analyses included men diagnosed with (n = 723,269) and dying of (n = 112,116) prostate cancer between 2012 and 2015. RESULTS Non-Hispanic black (NHB) and non-Hispanic Asian/Pacific Islander (NHAPI) men had the highest and lowest rates, respectively, for each indicator across regions and age groups. Hispanic men had lower incidence and mortality rates than non-Hispanic white (NHW) men in all regions except the Northeast where they had higher incidence [RR, 1.16; 95% confidence interval (CI), 1.14-1.19] and similar mortality. Hispanics had higher distant stage rates in the Northeast (RR, 1.18; 95% CI, 1.08-1.28) and South (RR, 1.22; 95% CI, 1.15-1.30), but similar rates in other regions. Non-Hispanic American Indian/Alaskan Native (NHAIAN) men had higher distant stage rates than NHWs in the West (RR, 1.38; 95% CI, 1.15-1.65). NHBs and Hispanics had higher distant stage rates than NHWs among those aged 55 to 69 years (RR, 2.91; 95% CI, 2.81-3.02 and 1.24; 95% CI, 1.18-1.31, respectively), despite lower overall incidence for Hispanics in this age group. CONCLUSIONS For Hispanic and NHAIAN men, prostate cancer indicators varied by region, while NHB and NHAPI men consistently had the highest and lowest rates, respectively, across regions. IMPACT Regional and age group differences in prostate cancer indicators between populations may improve understanding of prostate cancer risk and help inform screening decisions.
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Affiliation(s)
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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