High Risk Groups

The American Indian and Alaska Native (AI/AN) population in the United States totals 3.2 million, and includes 561 federally-recognized 100 state-recognized tribes and bands. Only 1.8 million (56%) are served by Indian Health Service (IHS), tribal, or IHS urban clinics.
Primarily as a result of federal relocation programs in the 1950s, over 55% of AI/ANs live in urban areas. However, only 1% of the IHS budget is targeted to support urban health clinics.

AI/AN Colorectal Cancer (CRC) incidence varies 5-fold between the six IHS regions. The highest rates are in Alaska and the Northern Plains where they are 100% higher and 40% higher than rates experienced by Non-Hispanic Whites (NHWs) respectively. AI/AN rates are half those of NHWs in the Southwest.
The Colorectal cancer rate among the Minnesota American Indian population is 60% higher than that for the general population.
In all IHS areas, CRC is diagnosed at later stages compared to NHWs, leading to higher case-fatality rates.

Diabetes, obesity, diets low in fresh produce and high in animal fats, inactivity, and heavy tobacco use are more prevalent among many AI/AN communities.
CRC screening rates, especially endoscopic screening, appear to be significantly lower among AI/ANs in most areas. This is problematic as colonoscopic screening and surveillance can prevent up to 90% of CRC cases from occurring.

Systems Barriers: Low rates of physician recommendation, long distances to endoscopic services, acute-centered care systems, distrust and apprehension towards non-tribal health systems.
Financial Barriers: Under-funded Contract Care System, high poverty rates among most tribes, low rates of private insurance, co-pay costs, low Medicare enrollment due to beliefs care is a treaty-right, transportation.
Community Barriers: Unawareness of screening benefits, lack of culturally-specific public health messages, fear and misinformation, traditional beliefs.
There is a real paucity of information about colon cancer screening participation by American Indian and Alaska Native (AI/AN) elders, especially among urban populations.

*Information provided by David G. Perdue MD MSPH

03/13/2008