Incidence of and Trends in the Leading Cancers With Elevated Incidence Among American Indian and Alaska Native Populations, 2012–2016

Stephanie C. Melkonian; Hannah K. Weir; Melissa A. Jim; Bailey Preikschat; Donald Haverkamp; Mary C. White

Disclosures

Am J Epidemiol. 2021;190(4):528-538. 

In This Article

Results

Cancer incidence rates for the 15 most common cancers among AI/AN men and women compared with the White population, and their corresponding rate ratios, are shown in Web Tables 1 and 2. The leading cancers with elevated cancer incidence were selected on the basis of the rate ratio comparing AI/AN versus White incidence rates according to sex. Among AI/AN men, the leading cancer sites with elevated incidence were liver, stomach, kidney, colorectal, myeloma, and lung (Figure 1A, Web Table 1). The leading cancers with elevated incidence among AI/AN women included these sites, except for myeloma, and including cervical cancers (Figure 1B, Web Table 2). Rate ratios ranged from 1.09 (lung) to 2.37 (liver) among AI/AN men and 1.06 (lung) to 3.03 (liver) among AI/AN women. The incidence rates were higher among AI/AN men compared with women, ranging from 23% higher for lung cancer to 129% higher for liver cancer (Figure 2).

Figure 1.

Leading cancers with elevated incidence ranked by rate ratio (American Indian/Alaska Native (AI/AN) versus White) among AI/AN men (A) and women (B), purchased/referred care delivery areas, United States, 2012–2016. Includes only AI/AN of non-Hispanic origin. Leading cancers with elevated incidence selected from 15 most common cancers. See Web Tables 1 and 2. Source: Cancer registries in the Centers for Disease Control and Prevention's National Program of Cancer Registries and/or the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Rate ratios are AI/AN versus White and were calculated in SEER*Stat prior to rounding of rates; they might not equal the rate ratio calculated from the rates presented in the table. All excess-burden cancers shown here are significantly higher among the AI/AN versus White populations (P < 0.05).

Figure 2.

Male versus female rate ratios for leading cancers with elevated incidence among American Indians/Alaska Native (AI/AN) populations, purchased/referred care delivery areas, United States, 2012–2016. Leading cancers with elevated incidence selected from 15 leading cancers. See Web Tables 1 and 2. Source: Cancer registries in the Centers for Disease Control and Prevention's National Program of Cancer Registries and/or the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER). Rate ratios are AI/AN versus White and were calculated in SEER*Stat prior to rounding of rates; they might not equal the rate ratio calculated from the rates presented in the table. Only leading causes of excess cancer burden that were common between men and women, and significantly greater than the White population are shown in this graph.

Among AI/AN men, the number and type of cancers with elevated incidence varied by region (Table 1). Alaska, the Southern Plains, Southwest, and the Northern Plains had the highest number of cancer types with elevated incidence among the AI/AN population. Rate ratios for cancers with elevated incidence ranged from 1.14 (colorectal cancer in the Southwest) to 4.36 (stomach cancer in Alaska). Liver, stomach, kidney, lung, and colorectal cancers were elevated in most regions, except for lung cancer in the Southwest and liver cancer in Alaska. In the East, only liver cancer was significantly higher among AI/AN men compared with White men. Liver cancer was the leading site with elevated incidence in 4 of 6 regions.

Among AI/AN men, the incidence rate of several cancers increased during the study period (Table 1), with some of the largest increases occurring in liver cancers in the East (AAPC = 8.1), Southern Plains (AAPC = 6.2), Pacific Coast (AAPC = 4.8), and Northern Plains (AAPC = 4.5), and kidney cancers in the Northern Plains (AAPC = 2.9) and Southern Plains (AAPC = 3.1). Significant decreases were observed in colorectal cancer incidence rates in the Northern Plains (AAPC = −1.7) and Pacific Coast (AAPC = −2.0).

Among AI/AN women, the Southern Plains, Northern Plains, Alaska, and the Pacific Coast had the most types of cancer with elevated incidence (Table 2). Rate ratios for elevated incidence cancers ranged from 1.15 (corpus and uterus in the Pacific Coast) to 4.07 (stomach in Alaska). Rate ratios for liver cancer ranged from 2.17 in the East and Alaska to 3.63 in the Southwest. Stomach cancer was elevated in every region. Kidney cancer was elevated in 5 of 6 regions (except the East); the highest rate ratio occurred in the Northern Plains (rate ratio = 2.12).

During 2012–2016, stomach cancer incidence rates decreased significantly among AI/AN women in the Northern Plains (AAPC = −4.3) (Table 2). Incidence rates of liver cancer increased significantly in the Southern Plains (AAPC = 4.8) and Southwest (AAPC = 3.6). Rates of kidney cancer also increased significantly in the Southern Plains (AAPC = 2.7) and Southwest (AAPC = 2.1). Cancers of the pancreas (AAPC = 2.9), corpus and uterus (AAPC = 1.6), and thyroid (AAPC = 6.6) increased significantly in the Southern Plains; and stomach cancer increased in the East (AAPC = 4.4). Rates of breast cancer also increased in the Southern Plains (AAPC = 1.0).

For the leading sites with elevated incidence among AI/AN men (Table 3), the observed-to-expected ratios ranged from 1.14 for colorectal cancer in the Pacific Coast to 5.33 for stomach cancer in Alaska. An estimated 2,450 excess cancers were diagnosed among AI/AN men. The largest number of excess cancers among AI/AN men occurred in Southern Plains (727), and some of the highest numbers of excess cancers were attributable to colorectal, lung, and liver cancers.

Among AI/AN women, the observed-to-expected ratios for the leading causes of elevated cancer incidence (Table 4) ranged from 1.14 (corpus and uterus in the Pacific Coast) to 4.13 (stomach in Alaska). Overall, 2,732 excess cancers were diagnosed among AI/AN women in these 6 regions. The largest number of excess cancers among AI/AN women occurred in the Southern Plains (1,198).

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