Cancer is the leading cause of death among Alaska Native (AN) people. AN people and American Indians have cancer incidence and mortality rates different from other US populations and from each other."For the years 2009-2013, 2,123 cases of invasive cancer were diagnosed compared to 1,866 (a 13.8% increase) from the prior five-year period (2004-2008)."For the years 2009-2013, incidence rates among AN people exceeded those among US Whites for nasopharyngeal, stomach, colorectal, kidney, lung and liver cancer. In contrast, AN rates were lower than US Whites for melanoma, lymphocytic leukemia, prostate, urinary bladder and non-Hodgkin lymphoma."For the years 1992-2011, 2,784 AN deaths due to cancer were reported."Mortality rates among AN people exceeded those of US Whites for all sites combined, and for nasopharyngeal, stomach, kidney, colorectal, liver, esophageal, lung, and pancreatic cancer."Note: The next 5-year report (2013-2018) on AN cancer data will be published in spring 2021.The anticipated outcomes of this grant are to: reduce the number of preventable cancers, increase screening rates of screenable cancers, and provide an increased quality of life among AN cancer survivors. Alaska is a state with great distances between communities and villages, difficult terrain and extreme weather, and a very limited road system. The Alaska Tribal Health System is unique in the way it delivers health care to its people. Each of the 220 villages has a minimum of one Community Health Aide/Practitioner (CHA/P) who delivers primary care to the residents of that village. The CHA/P provides services ranging from well-baby checks, immunizations and school physicals, to acting as a first responder to accidents and major health events, including deaths. The villages typically are associated with one of six larger hub communities. Each hub community is responsible for providing health care services to as many as fifty villages. The six l
argest hub communities have a primary care hospital and a staff of physicians, nurses and other mid-level practitioners. Each can provide cervical screening, mammography and colorectal cancer screening. When a cancer is suspected, most patients need to travel to Anchorage for diagnosis and treatment. Depending upon the cancer and the chosen treatment, patients may need to stay in Anchorage for weeks or even months at a time since travel to and from their homes is difficult and expensive. The Cancer Program benefits from a SEER funded Alaska Native Tumor Registry (ANTR) dating back to 1969 and predating the CDC funded Alaska Cancer Registry. The two registries collaborate to produce data representing the entire state. The Cancer Program has strong partnerships with eight CDC funded Cancer Programs in the State: the Alaska CCC Program, five NBCCEDP programs (four tribal), the Alaska Cancer Registry and two Colorectal Cancer Programs. The program collaborates with tribal and non-tribal partners. This grant addresses the cancer disparities of the AN people in incidence and mortality due to cultural differences, geographic isolation, their status as medically underserved, and inherited differences. The work plan addresses the cancer care needs of AN people in the priority areas of prevention, early detection and survivorship across the State of Alaska. The Cancer Program collaborates closely with the State of Alaska NCCCP with joint statewide committees on Breast and Cervical Health, HPV, Colorectal Cancer, Patient Navigation and Survivorship. Within the Tribal Health System, the Cancer Program established a Chronic Disease Committee with membership that includes the tobacco cessation program, health promotion, diabetes, Alaska Native Epidemiology Center and other programs that share concerns about healthy lifestyle choices. The Cancer Program goals and objectives are located in the Alaska Tribal Health System Cancer Plan 2019-2024.