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New Model for Cancer Screening in American Indian Women

  • James W. Hampton
    Correspondence
    Address reprint requests to Dr. J. W. Hampton, Troy & Dollie Smith Cancer Center, INTEGRIS Baptist Medical Center, 3300 Northwest Expressway Street, Oklahoma City, OK 73112
    Affiliations
    Troy & Dollie Smith Cancer Center, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
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      Breast cancer occurs with a lower frequency in southwestern American Indian women than in white non-Hispanic women.
      The lower survival rate of these women has been repeatedly described by the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute and may reflect a more advanced stage at detection of the cancer because of delay in diagnosis. Breast cancer may also be increasing in this population.
      • Frost F
      • Tollestrup K
      • Hunt WC
      • Glilliand F
      • Key CR
      • Urbina CE
      Breast cancer survival among New Mexico Hispanic, American Indian, and non-Hispanic white women (1973-1992).
      In an article in this issue of Mayo Clinic Proceedings (pages 815 to 823), Kottke and Trapp describe the death rates from breast cancer in American Indian women living on the Northern Plains in Nebraska, Iowa, and North and South Dakota to be almost equal to the US rates overall.
      They also indicated that death rates from cervical cancer have been found to be more than twice as high for Native American women in comparison with all women in the United States.
      Alaska Native women have a higher frequency of breast cancer than do southwestern American Indian women.
      The heterogeneity of the indigenous population of North America accounts for these differences both in heredity and in the influences of diverse cultural environments.
      • Hampton JW
      The heterogeneity of cancer in Native American populations.
      Remnants of more than 500 independent American Indian Nations have survived into the 20th century.
      Kottke and Trapp demonstrate that nurses can be trained to provide women with breast and cervical cancer screening to their satisfaction and with a quality of effort and outcome that should persuade even the severest critic. Older women, especially American Indian women, prefer female examiners, which is a cultural observation that has been made by American physicians since the beginning of the century.
      • Currier AF
      A study relative to the functions of the reproductive apparatus in American Indian women.
      Compliance of American Indian women with screening for breast and cervical cancer has been repeatedly found to be a problem in all studies undertaken. Older women beyond the childbearing age are the most reluctant to have cancer screening performed on themselves.
      The Breast and Cervical Cancer Mortality Prevention Act of 1990 (public law 101-354) provided for the establishment of a national public health program to increase access to breast and cervical cancer screening services for women who are medically underserved.
      • May DS
      • Lee NC
      • Nadel MR
      • Henson RM
      • Miller DS
      The National Breast and Cervical Cancer Early (Detection Program: report on the first 4 years of mammography provided to medically underserved women.
      The women, including American Indian women, with poor survival statistics are at higher risk for this disease to be diagnosed at a later stage. The women selected for high priority are older women with low income, underserved or uninsured women, and women in racial or ethnic minority groups.
      Cooperative agreements with state health departments and American Indian-Alaska Native programs to provide screening, referral, and follow-up services for underserved women have been established by the act and administered by the Centers for Disease Control and Prevention. An unpublished survey about cancer screening services in the medically underserved was undertaken by the Intercultural Cancer Council and revealed that this program-the National Breast and Cervical Cancer Early Detection Program-was the only service that the state departments of health offered to low-income racial or ethnic minority groups. This report offers a model for all agencies working under a cooperative agreement with the Centers for Disease Control and Prevention.
      The concept of a Circle of Life Clinic, as described by Kottke and Trapp, originated from the title of the film and video made by the Oklahoma Division of the American Cancer Society in 1995 to encourage American Indian women to practice breast self-examination. Patient demand for the clinic clearly supported the postulate that communities, especially of racial or ethnic minorities, do better and cooperate more fully if they have a voice in the planning and if the undertaking becomes a community effort. The Circle of Life Clinic can serve as the prototype for all outpatient clinics that serve American Indian-Alaska Native women, the “forgotten minority” in the United States.

      References

      1. Miller BA Kolonel LN Bernstein L Young Jr, JL Swanson CM West D Racial/Ethnic Patterns of Cancer in the United States, 1988-1992. National Cancer Institute. National Institutes of Health, Bethesda (MD)1996 (Publication No. NIH 96-4104)
        • Frost F
        • Tollestrup K
        • Hunt WC
        • Glilliand F
        • Key CR
        • Urbina CE
        Breast cancer survival among New Mexico Hispanic, American Indian, and non-Hispanic white women (1973-1992).
        Cancer Epidemiol Biomarkers Prev. 1996; 5: 861-866
      2. Valway S Cancer Mortality Among Native Americans in the United States: Regional Differences in Indian Health. 1984-88; Trends Over Time, 1968-1987. US Department of Health and Human Services. Public Health Service, Indian Health Service, Rochvilte (MD)1991: 39 (110)
        • Hampton JW
        The heterogeneity of cancer in Native American populations.
        in: Jones LA Minorities and Cancer. Springer-Verlag, New York1989: 45-53
        • Currier AF
        A study relative to the functions of the reproductive apparatus in American Indian women.
        Trans Am Gynecol Soc. 1891; 16: 264-294
        • May DS
        • Lee NC
        • Nadel MR
        • Henson RM
        • Miller DS
        The National Breast and Cervical Cancer Early (Detection Program: report on the first 4 years of mammography provided to medically underserved women.
        AJR Am J Roentgenol. 1998; 170: 97-104