CHANGING CANCER PATTERNS IN NATIVE AMERICAN COMMUNITIES HISTORY OF CANCER RESEARCH

Transcription

1 CHANGING CANCER PATTERNS IN NATIVE AMERICAN COMMUNITIES JUDITH SALMON KAUR, M.D. MAYO CLINIC HISTORY OF CANCER RESEARCH 1937: NATIONAL CANCER INSTITUTE ACT SIGNED INTO LAW 1971: NIXON S WAR ON CANCER BEGINS/SEER ESTABLISHED 1984: HECKLER REPORT IDENTIFIES DISPARITIES 1990: OFFICE OF MINORITY HEALTH 1

2 HEALTH DISPARITIES : LEADERSHIP INITIATIVES DEVELOPED BY CONGRESS 1999: IOM REPORT TO CONGRESS 2000: RFA FOR SPECIAL POPULATIONS NETWORKS 2001: CENTER TO REDUCE CANCER HEALTH DISPARITIES UNEQUAL BURDEN What are the most common cancers? How many new cancers each type/each year Are numbers (incidence) high or low? Are #s increasing? Are screening programs working? What treatments are patients receiving? Do any groups have unique cancer risks? 2

3 Breast Cancer Mortality Rates Females, Southwest East Pacific Coast All IHS (14.1) * All US (24.2) Alaska No. Plains Rate per 100,000 per year, adjusted to 1970 U.S. population ** Denotes a rate significantly higher (* lower) than the U.S. rate. All Sites Cancer Mortality Rates, Both Sexes, Southwest Pacific Coast East All IHS (129.4) * All US (165.7) Alaska No. Plains Rate per 100,000 per year, adjusted to 1970 U.S. population ** Denotes a rate significantly higher (* lower) than the U.S. rate. 3

4 Lung Cancer Mortality Rates Both Sexes, Southwest East Pacific Coast All IHS (33.7) * All US (48.3) Alaska No. Plains Rate per 100,000 per year, adjusted to 1970 U.S. population ** Denotes a rate significantly higher (* lower) than the U.S. rate. 4

5 SPECIAL POPULATIONS NETWORKS 18 FUNDED ORIGINALLY MAYO S SPIRIT OF EAGLES BUILDING INFRASTRUCTURE INCREASING MINORITY RESEARCHERS PARTICIPATORY RESEARCH COMMUNITY NETWORKS PROGRAMS NCI COOPERATIVE AGREEMENTS NATIONAL, REGIONAL AND LOCAL PROGRAMS FUNDED (TOTAL 25 NATIONWIDE) CBPR IS THE CORNERSTONE 5

6 PRIMARY PREVENTION AVOIDANCE OF HARMFUL CARCINOGENS (TOBACCO, ASBESTOS) VACCINES: HEPATITIS B, HPV AGE GROUP MOST EFFECTED: YOUNG ADULTS The HPV Vaccine HPV L1 major capsid protein of the virus is antigen used for immunization HPV VLP Expression of L1 protein uses recombinant technology L1 proteins self-assemble into viruslike particles (VLP) 6

7 PAST SUCCESS BIOLOGIC BASIS OF CERVICAL CANCER DEVELOPMENT OF A SCREENING TEST INFRASTRUCTURE BUILDING TO MAXIMIZE SCREENING FURTHER RESEARCH TO DEVELOP VACCINE NCI

8 DEMOGRAPHICS COUNT! HIGH PREVENTION POTENTIAL 8

9 SECONDARY PREVENTION SCREENING: BREAST, COLORECTAL, PAP,? PROSTATE DEPENDENT ON PUBLIC ACCEPTANCE LIMITED BY ACCESS TO CARE AGE GROUP FOCUS: >AGE 40 GAO Report, August 2006 : Barriers to mammography in rural, some urban areas Mammo Closures >>Openings, : Access Problems: ¼ of US counties, and 60% of North Dakota counties: no mammography 9

10 AAIHS is providing by mobile unit with telemammography to improve screening mammography access call-back problems by providing real-time interpretations on-site additional mammogram views This is the first and only mobile telemammography clinical operation in the US. Telemammography 10

11 Community Partners COLORECTAL CANCER BIOLOGIC BASIS OF DISEASE UNDERSTOOD SCREENING DEVELOPED INFRASTRUCTURE NEEDED TO CONTINUE DECLINE IN DEATH RATES 11

12 TERTIARY PREVENTION ACCESS TO STATE OF THE ART CANCER TX (SURGERY, RADIATION, CHEMO, HORMONAL) ACCESS TO CLINICAL TRIALS PROVISION OF COMPASSIONATE END OF LIFE CARE 12

13 CLINICAL TRIALS REPRESENT STATE OF THE ART NEED TO INCREASE MINORITY ACCRUAL NEED TO BUILD TRUST FACTOR WITH COMMUNITIES ANNUAL REPORT TO THE NATION 2006 SPECIAL FOCUS ON LATINOS 2007 SPECIAL FOCUS ON AI/AN HIGHLIGHTS SUBPOPULATION ISSUES DELINEATES REGIONAL PATTERNS IN AI/AN 13

14 CHANGING CANCER PATTERNS IN MINORITIES STILL EXCESS OF CANCERS RELATED TO INFECTIOUS ETIOLOGIES (CX, GASTRIC, LIVER) INCREASING RATES OF THE MOST COMMON CANCERS (BREAST, COLON, LUNG) 14

15 RESEARCH NEEDS BIOLOGICAL PSYCHOLOGICAL SOCIAL Sometimes this is how we feel 15

16 FUTURE NEEDS AND DIRECTION INFRASTRUCTURE BUILDING IMAGING RESEARCH TO BRING AFFORDABLE AND ACCESSIBLE SCREENING RESEARCH ON MODELS OF CARE DATA TO INFORM COMMUNITIES FOR PRIORITIZATION 16

17 ARE WE MOVING FORWARD? 17