PATTERNS OF CANCER MORTALITY AMONG NATIVE-AMERICANS

BACKGROUND. Native Americans have been reported to have lower cancer i ncidence and mortality than other racial groups in the U.S., although some have questioned whether this was due to racial misclassification. This study provides improved estimates of cancer mortality, determine d from a sampling of people who live on Indian reservations. METHODS. The authors reviewed death certificates from U.S. counties that contai n Indian lands, excluding certain areas with known problems of racial misclassification. Age-adjusted mortality rates for specific types of cancer were calculated using U.S. Census population figures, and these rates were compared with rates for all races in the U.S. RESULTS. Thi s sample included 38% of the American Indian and Alaska Native populat ions. The age-adjusted annual mortality rate for all cancers combined was 148.2 per 100,000 for both genders, 133.1 for females, and 167.2 f or males. The rates for males and for both genders combined, but not f or females, were significantly lower than the U.S. rates for all races (P < 0.05). Females had significantly lower rates of death from carci noma of the lung and breast and significantly higher rates of death fr om carcinoma of the cervix and gallbladder (P < 0.05). Males had signi ficantly lower rates of death from carcinoma of the lung, colon, and p rostate, and significantly higher rates of liver carcinoma. Both gende rs combined had significantly lower rates of death from lung and colon carcinoma and significantly higher rates of death from stomach, liver , kidney, and gallbladder carcinoma. Geographic differences were subst antial, with the Northern and Plains regions experiencing much higher mortality from lung, colon, and breast carcinoma than the Southwest re gion. CONCLUSIONS. Compared with the general U.S. population, Native A mericans experience quite different patterns of cancer mortality. Canc er prevention and control programs should be designed specifically for this minority population. (C) 1998 American Cancer Society.