Tribal Cancer Control Education

1. Tribal Cancer Control Education Eric Vinson Northwest Tribal Comprehensive Cancer Program May 4, 2010 Risky Business Training Supported by CDC Grant #1 U58 DP000786-3

2. Organizational Chart Northwest Portland Area Indian Health Board

3. Northwest Tribal Cancer Control Project (NTCCP) July 1998 Northwest Portland Area Indian Health Board Delegates resolved to form the Northwest Tribal Cancer Coalition and the Northwest Tribal Cancer Control Project Northwest Portland Area Indian Health Board

4. NTCCP Mission To envision and work toward cancer-free tribal communities by taking an integrated and coordinated approach to cancer control Northwest Portland Area Indian Health Board

5. NTCCP 20 Year Plan An integrated and coordinated approach towards preventing and controlling cancer in tribal communities To reduce cancer incidence, mortality, and morbidity among American Indians and Alaskan Natives (AI/AN) in Northwest tribal communities Northwest Portland Area Indian Health Board

6. NTCCP Goals • Facilitate a process for Northwest tribes to promote cancer risk reduction strategies. • Provide information on the most current early detection, screening and treatment practices through education and resource materials. • Provide education regarding quality of life for cancer patients, their families and caregivers. • Coordinate and collaborate with local and national cancer organizations and individuals. • Improve Indian-specific cancer control data. Northwest Portland Area Indian Health Board

7. Cancer 101:6 Lessons to help Us Understand Cancer • Cancer among American Indians and Alaskan Natives • What is Cancer? • Screening and Early Detection • Risk Factors and Risk Reduction • Diagnosis and Treatment • Support for Patients and Caregivers Northwest Portland Area Indian Health Board

8. 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. • 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. Northwest Portland Area Indian Health Board

9. Normal vs Cancerous Cells Northwest Portland Area Indian Health Board

10. Ca 101 Learning Module 1 Cancer among American Indians And Alaskan Natives Goal: Understand the growing health concern of cancer among AI/AN. Northwest Portland Area Indian Health Board

11. Cancer Background Lifestyles : Traditional and Western • Dietary changes • Decrease in exercise • Personal vs. traditional use of tobacco Northwest Portland Area Indian Health Board

12. Cancer Survival Rates AI/AN have the lowest five-year survival rate for all cancer sites combined of any racial group in the U.S. Northwest Portland Area Indian Health Board

13. Cancer Survival Rates Contributing factors: • Late detection • Treatment compliance • Concurrent disease • Access to care • Barriers to care Northwest Portland Area Indian Health Board

14. Improving Survival Rates • Reduce barriers to care • Increase participation in screening and early detection services • Chance for survival is better if cancer is found early. Northwest Portland Area Indian Health Board

15. Breast and Cervical Cancer 101 Adapted from Modules 3&4 Risk Factors and Risk Reduction Screening and Early Detection Goals: Understand breast and cervical cancer risk factors and how to reduce risks associated with cancer. Understand breast and cervical cancer screening and early detection and why it is important. Northwest Portland Area Indian Health Board

16. Am I at risk for breast cancer? Research has shown that these factors increase your risk: • Gender (Female) • HRT • Age •Alcohol • Family History •Personal history • Genetic alternations •Diet • Benign breast disease •Obesity • Early Menstruation •Radiation • Not Having Children •Aging Northwest Portland Area Indian Health Board

17. Can I do anything to reduce my risk for breast cancer? • Regular exercise • Breastfeeding during pregnancy • Maintain a healthy diet • Maintain a healthy weight • Limit alcohol consumption • Consult with your clinician regarding menopausal hormone use Northwest Portland Area Indian Health Board

18. What are the symptoms of Breast Cancer? • A lump or thickening in or near the breast or underarm • A change in the size or shape of the breast • Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast • Ridges or pitting of the breast (the skin looks like the skin of an orange • A change in the way the skin of the breast, areola, or nipple looks or feels Northwest Portland Area Indian Health Board

19. Screening for Breast Cancer • Breast Self Exam (BSE): • DO NOT substitute BSE for regularly scheduled mammograms and clinical breast exams. • Clinical Breast Exam (CBE): • Performed by a healthcare professional. • Mammogram: • A special kind of x-ray image of the breasts. • Women in their 40’s and older should have a mammogram regularly, every 1 to 2 years Northwest Portland Area Indian Health Board

20. Am I at risk for Cervical Cancer? You are at risk if you… • Are a women • Sexually active before age 16 • Many sexual partners • No regular Pap tests • Weakened immune system • Over age 40 • Smoke cigarettes Northwest Portland Area Indian Health Board

21. What causes Cervical Cancer? • Human papillomavirus (HPV) • Very common virus – over 100 types! • About 15 types cause cervical cancer • Other types cause warts, but not cancer • Other factors may work with HPV to increase your risk of developing cervical cancer: • Use of birth control pills more than 5 years • Having 7 or more children • Smoking cigarettes Northwest Portland Area Indian Health Board

22. Prevention and Early Detection Pap Test (or Pap Smear) • Performed in a doctor’s office or clinic during a pelvic exam • Looks at cervical cells • Is used to detect cancer or changes that may lead to cancer • Can show non-cancerous conditions Northwest Portland Area Indian Health Board

23. How often should women have Pap tests? Doctors generally recommend that women: • Should begin having Pap tests 3 years after they begin having sexual intercourse or when they turn 21 • Should have a Pap test at least once every 3 years • Who have had a total hysterectomy do not need to have cervical cancer screening, except if they had cervical cancer Northwest Portland Area Indian Health Board

24. Questions What are the three recommended screenings for Breast Cancer? • Breast Self-Exam (BSE) • Clinical Breast Exam (CBE) • Mammography or Mammogram Northwest Portland Area Indian Health Board

25. Cancer 101 Learning Module 6 Support for Patients and Caregivers Goal: Understand the psychological and social issues that affect cancer patients and their caregivers. Northwest Portland Area Indian Health Board

26. Coping with feelings Common emotions after diagnosis: Denial Anger Stress Anxiety Depression Northwest Portland Area Indian Health Board

27. Support for the Patient Do: • Treat me like you always have • Be there for me • Share emotions with me • Help my family • Ask if I’d like to talk • Listen Northwest Portland Area Indian Health Board

28. Support for the Patient • Remember now more than ever before, people are surviving after a Cancer diagnosis. Northwest Portland Area Indian Health Board

29. Support for the Caregiver Caregiving can be made less stressful by: • Setting realistic limits • Offer periodic breaks • Support groups • Use community and volunteer resources Northwest Portland Area Indian Health Board

30. The Path to Recovery Facing a cancer diagnosis and surviving cancer treatment may be the greatest challenge a person will face in their lifetime. Northwest Portland Area Indian Health Board

31. Path to Recovery • How we become well again: • Attain and maintain balance • Find a sense of purpose • Keep physical & emotional defenses strong • Share stories of survival Northwest Portland Area Indian Health Board

32. Question What are some ways to support caregivers? • Set realistic limits • Offer periodic breaks • Support groups • Use community and volunteer resources Northwest Portland Area Indian Health Board

33. Tribal Cancer Action Planning Cancer Control in Northwest Tribal Communities • Prevention • Screening & Early Detection • Treatment • Survivorship • Rehabilitation • Palliation Northwest Portland Area Indian Health Board

34. Cancer Prevention through Education and Outreach Women’s Health Example Northwest Portland Area Indian Health Board

35. Tribal Action Plans Planning to achieve a specific objective. Includes: • Who will conduct each component of the activity • When actions are to be carried out • What resources need to be allocated • What outcomes are anticipated • What evaluation is needed to determine success Northwest Portland Area Indian Health Board

36. Sample Tribal Action Plan

37. Yakama ONCS Mural Walk/Ride 2005

38. Successful Strategies for Developing Partnerships • Use partnerships to extend resources and delivery • Partner with providers and other clinical staff • Consult with other tribal programs • Partner with state programs for services and training • Use advisors to provide clinical guidance and test new ideas Northwest Portland Area Indian Health Board

39. Partners Foundations and Non-Profits American Indian and Alaska Native Organizations State and Federal Organizations

40. Upcoming Activities June 14 – July 1, 2010 • Summer Research Training Institute For American Indian and Alaska Native Heath Professionals Northwest Portland Area Indian Health Board

41. Contact Information Northwest Tribal Comprehensive Cancer Program Kerri Lopez (Tolowa), Project Director Eric Vinson (Cherokee), Project Coordinator Tom Becker, MD, PhD, Medical Epidemiologist Northwest Tribal Registry Project Megan Hoopes, MPH, Project Director Phone: 503-416-3301 Email: klopez@npaihb.org Northwest Portland Area Indian Health Board