AI/AN Cancer Burden

1. AI/AN Cancer Burden Cancer 101Learning Module 1

2. Learning Objectives At the completion of learning Module 1, you will be able to: • Give two reasons why cancer is a growing concern in AI/AN communities • Discuss two facts about how data contributes to our understanding about the cancer health concern for AI/AN • Discuss two facts contributing to poor survival of AI/AN diagnosed with cancer • Describe two factors likely to improve cancer survival for AI/AN

3. Cancer Background • Cancer is a growing health concern among AI/AN due to: • Increased life expectancy • Lifestyle changes • Other factors?

4. Data Tell Us • Cancer is the second leading cause of death for Northern Plains American Indians • The leading cause of death for Alaska Natives

5. Data Tell Us • Cancer rates, previously reported as being lower in AI/AN, are on the increase • Patterns for certain types of cancer vary among AI/AN when compared to whites and other ethnic groups in the U.S.

6. Data Tell Us • Patterns of certain types of cancer vary among AI/AN in different geographic regions in the U.S. Chart Source: Haverkamp D, Espey D , Paisano R, Cobb N. Cancer Mortality Among American Indians and Alaska Natives: Regional Differences, 1999–2003. Indian Health Service. Rockville, MD, February 2 008.

7. Limitations of the Data • Racial misclassification • Undercounting • Coding errors • Not enough numbers to form a conclusion • Cannot be generalized to Peoples of other areas

8. Common Cancers Source: Espey, et al. Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives. Cancer 2007; 110: 119-52.

9. Common Cancers Source: Espey, et al. Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives. Cancer 2007; 110: 119-52.

10. Cancer Deaths Northern Plains AI/AN (1994-2003) Source: SEER Program

11. Cancer Survival among AI/AN • AI/AN have the lowest five-year relative survival rate of all U.S. populations.

12. Cancer Survival among AI/AN Potential contributing factors: • Late detection of cancer • Genetic risk factors • Challenges related to completing treatment as recommended • Presence of other disease conditions • Lack of timely access to state-of-the-art diagnostic and treatment methods

13. Cancer Survival among AI/AN Barriers to care: • Lack of materials and programsthat are culturally relevant • Lack of AI/AN health providers • Lack of education and training opportunities

14. Cancer Survival among AI/AN Barriers to care: • English as a second language • Poverty • Transportation • Cultural beliefs surrounding cancer

15. Cancer Survival among AI/AN Survival can be improved by: • Improving healthy lifestyles • Increasing participation in regular screening and early detection services • Reducing barriers to care

16. In Summary You now have an understanding of: • How data affects our understanding of cancer health concerns for AI/AN • Facts that contribute to poor survival for AI/AN • Factors that are likely to improve cancer survival for AI/AN

17. THANK YOU! Cancer 101Learning Module 1

18. What Is Cancer? Cancer 101Learning Module 2

19. Learning Objectives At the completion of learning Module 2, you will be able to: • Describe the process through which normal cellsbecome cancerous • Describe the difference between benignand malignant tumors • Describe two types of cancer and where they occur in the body

20. What Is Cancer? • The term “cancer” refers to more than 100 different diseases that begin in the cells, the body’s basic unit of life.

21. Normal Tissue

22. Beginning of Cancerous Growth

23. Cancerous Tumor

24. What Is Cancer? • Cancer develops when cells grow and form more cells without order or control. • Under normal circumstances, new cell growth and old cell death are kept in balance. • In cancer, this balance is disrupted.

25. Benign versus Malignant Tumors Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis

26. Benign versus Malignant Tumors • Malignant tumors are cancer. • Cells in malignant tumors can grow without control and invade or damage other parts of the body. • When cancer (malignant tumor) spreadsfrom the original site to another part of the body it is called metastasis.

27. Types of Cancer • There are over 100 different types of cancer. • Treatment decisions are based on knowing the type of cancer involved.

28. Types of Cancer Cancers are divided into five main groups: 1.Carcinomasare cancers that begin with skin or tissues that line the internal organs. 2. Sarcomas are cancers that start in bone, fat, muscle, joint, nerve, blood vessel or deep skin tissues.

29. Types of Cancer 3.Lymphomas are cancers that start in lymph nodes or lymphoid tissues (tissues of the body’s immune system). 4. Leukemias are cancers of the white blood cells. 5. Myelomas are cancers that start in plasma cells found in the bone marrow.

30. Types of Cancer • Doctors use different prefixes to help distinguish among the different types of cancer. For example: Osteo means bone. Osteosarcoma means a sarcoma arising in the bone.

31. In Summary You now have an understanding of: • The meaning of the word cancer • The difference between benign and malignant tumors • The process by which cancer spreads • The different types of cancer

32. THANK YOU! Cancer 101Learning Module 2

33. Cancer Prevention and Healthy Lifestyles Cancer 101Learning Module 3

34. Learning Objectives At the completion of learning Module 3, you will be able to: • Describe the meaning of risk factors • Describe two risk factors that influence the development of cancer • Describe two ways to take personal action to reduce cancer risk

35. What is a risk factor? • Risk factors are conditions that increase the chance that cancer might occur. • The conditions that influence the development of cancer are related to heredity, lifestyle, and the environment.

36. What is a risk factor? • Heredity: This refers to genes that are passed from parent to child. • Lifestyle: Some types of cancer are related to how we live. • Environment: Some types of cancer are related to where we work and live.

37. What is a risk factor? • Approximately one third of all cancers diagnosed in 2001 were related to nutrition, physical activity and other lifestyle factors. • Approximately 30% of all cancerdeaths were related to commercial tobacco use* *Source: Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975–2001, National Cancer Institute. Bethesda, MD, 2004 Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975–2001, National Cancer Institute. Bethesda, MD, 2004

38. Northern Plains AI Tobacco Use Northern Plains American Indian tobacco use rates are around 40-50%, which is double the rates of the national average of 20.5%

39. Cancer Prevention Ways to reduce cancer risk and prevent more cancers include: • Health Education • Individuals living healthy lifestyles and supporting others to do so • Routine screening for early detection • Involve individuals and community members in health advocacy

40. Healthy Lifestyles Ways an individual can lead healthy lifestyles: • Maintain a healthy weight • Be physical activity every day • Don’t smoke or use commercial tobacco

41. Healthy Lifestyles • Eat healthy foods • Limit alcohol consumption • Protect yourself from the sun • Protect yourself and your partner from sexually transmitted diseases

42. Learn about Breast and Colon Cancer Risk • Native American Cancer Research Online Tool: • www.natamcancer.org • Bottom Right “Free Resources” • “Breast Cancer Risk Factors” • “Colon Cancer Risk Factors”

43. In Summary You now have an understanding of: • Cancer risk factors • How to reduce risks associated with cancer

44. THANK YOU! Cancer 101Learning Module 3

45. HPV and Cervical Cancer Information for this module is from the CDC Fact Sheet on Genital HPV Infection and the HPV Vaccine: http://www.cdc.gov/std/HPV/STDFact-HPV.htm & http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm Cancer 101Learning Module 4

46. Learning Objectives At the completion of learning Module 4, you will be able to: • Describe the different types of the Human Papillomavirus (HPV) • Describe who can get the HPV vaccine • Describe what the HPV vaccine protects women from

47. Human Papilloma Virus (HPV) • HPV is the name for a group of viruses • There are more than 100 different strains or types of this virus • More than 30 of these viruses are sexually transmitted

48. Genital HPV Types • Many types of HPV will not cause any symptoms and the person will get rid of the virus on their own (immune system) • “Low-Risk” – the types of HPV that may cause mild abnormalities or genital warts • “High-Risk” – the types of HPV that may lead to cancer (including cervical)

49. How common is Genital HPV? • At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives • By age 50 at least 80% of women will have acquired genital HPV infection

50. Signs and Symptoms of Genital HPV • Most people who have a genital HPV infection do not know they are infected! • Some people get visible genital warts • Some people will have changes to the cells in parts of their body that could potentially become cancer (e.g., their cervix, vulva, anus, or penis) • For women, regular Pap tests and follow-up can prevent most cases of cancer by detecting and treating these changes