Native American and Alaskan Native populations face many health disparities, including breast cancer mortality. This article summarizes how these disparities have evolved over time and how they persist in screening and overall outcomes.
Although mortality and incidence rates for breast cancer have declined for many racial groups, they have remained constant for American Indian and Alaskan Native (AIAN) populations. These disparities extend to many areas, including delayed screening and advanced cancer diagnosis at younger ages, when compared to their White counterparts.
While they can be partially understood to be the result of barriers to accessing care in AIAN communities, there are many reasons why these disparities persist, as well as why they are geographically distributed as they are. The breast cancer mortality rate for White women has decreased by 40% since 1990 but has remained unchanged in AIAN women. Additionally, the incidence of invasive breast cancer has risen among AIAN women.
This study, published in the Journal of Breast Imaging, analyzes the disparities in both screening and outcomes in this population.
Lower Overall Cancer Rates, but Worse Prognoses
Overall, the incidence rate of breast cancer in Native American women is lower (94.7 per 100,000) than it is in non-Hispanic White and Black Women (130.8 and 126.7 per 100,000, respectively). Since 2012, the rate of breast cancer has risen more rapidly among Native American women compared to other groups, and Native American women have remained younger at diagnosis, at 59 years, versus 61 years for White women.
Although Native American women exhibit lower incidence rates, the prognosis after diagnosis is worse in Native American women than in White women. Data from 2018 showed that 66% of Native American women between the ages of 50 and 74 underwent mammographic screening over the past two years, compared to 71–73% of other races. This lack of screening often results in breast cancer being identified at later stages than in other women, resulting in a worse prognosis.
Geographic and cultural barriers may contribute to the observed disparities. Many Native American women live in rural areas, and only 46 Indian Health Service hospitals serve the 574 federally recognized tribes in the United States. Patients must travel long distances to access health care. Nearly a third of Native Americans residing on reservations live below the poverty line, which can make lengthy travel, as well as treatment compliance, significantly more difficult. Additionally, low health literacy rates and cultural barriers to care compound the difficulties associated with screening and compliance.
Very few programs address the current health disparities faced by Native Americans caused by these economic, geographic, and cultural barriers, and additional advocacy programs are needed. Physicians living in areas with high Native American populations are urged to advocate on behalf of these patients.
Kurumety, S., Howshar, J. T., & Loving, V. A. (2022). Breast Cancer Screening and Outcomes Disparities Persist for Native American Women. Journal of Breast Imaging, 5(1), 3–10. https://doi.org/10.1093/jbi/wbac080