Potentially preventable cancers among Alaska Native people

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1 Potentially preventable cancers among Alaska Native people Sarah Nash Cancer Surveillance Director, Alaska Native Tumor Registry Diana Redwood, Ellen Provost Alaska Native Epidemiology Center

2 Cancer is a leading cause of morbidity among AN people 24% 24% 2% 2% 2% 2% 4% 4% 11% 12% 13% Years of Potential Life Lost among Alaska Native people, Unintentional Injury Suicide Cancer Heart disease Chronic Liver disease Homicide Alcohol Abuse Perinatal conditions Congenital Malformations Pneumonia & Influenza Other causes Source: State of Alaska Bureau of Vital Statistics; Alaska Native EpiCenter Alaska Native Mortality Update

3 Cancer is the leading cause of mortality among Alaska Native people 21% 26% 2% 2% 2% 3% 4% 5% 6% 13% 16% Between , cancer accounted for over 1/5 of all deaths among AN people Cancer Heart disease Unintentional Injury Suicide COPD Cerebrovascular disease Chronic Liver disease Pneumonia & Influenza Diabetes Alcohol Abuse Other causes Source: State of Alaska Bureau of Vital Statistics; Alaska Native EpiCenter Alaska Native Mortality Update

4 Can we reduce cancer risk among AN people? Tribal Health Leaders expressed interest in knowing the burden of cancers attributable to modifiable risk factors among AN people Cancer prevention programs

5 Modifiable risk factors for cancer Source: American Association of Cancer Research, Cancer Progress Report 2014

6 Study Aim To determine the proportion and number of cancers potentially attributable to the following modifiable risk factors among AN people: obesity smoking physical inactivity alcohol use (moderate/heavy)

7 Methods: Study Population and Data Sources Alaska Native people 144,274 AI/AN people reside in Alaska Over 90% identify as Alaska Native Healthcare provided by over 32 tribal healthcare corporations, and ANTHC Cancer case counts, SEER Alaska Native Tumor Registry Record cancer information for all AI/AN IHS beneficiaries resident in AK at time of diagnosis

8 Methods: Data Sources and Definitions Risk Factor Prevalence, Alaska Behavioral Risk Factor Surveillance Survey (BRFSS) (Alaska DHSS, CDC) Current smokers: smoked >100 cigarettes, and current smoking Obesity: body mass index (BMI) 30kg/m 2 Physical inactivity: not meeting the CDC-recommended 150 minute/week of aerobic activity. 2011, 2013, and 2015 surveys only. Alcohol intake*: moderate drinking = g (1-4 drinks)/d heavy drinking = >50 g (4 drinks)/d *Bagnardi et al 2015

9 Methods: Cancer Sites Smoking*: acute myeloid leukemia (AML), bladder, colon and rectum, esophagus, kidney, larynx, liver, lung, oral cavity, pancreas, stomach, and uterine cervix Obesity**: esophagus, stomach, colon and rectum, liver, gallbladder, pancreas, postmenopausal breast, kidney, advanced prostate, thyroid, and endometrium Physical inactivity***: colon, lung, prostate, breast, endometrium, and ovaries Moderate/heavy alcohol use****: colorectal, esophageal squamous cell carcinoma, gallbladder, larynx, liver, lung, oral cavity, stomach, prostate, and breast * Surgeon General s 2014 Report on Smoking and Cancer ** WCRF 2010 Obesity and Cancer Report ***Friedenreich et al 2010, ****Bagnardi et al 2015

10 Methods: Proportion and number of potentially preventable cases Population attributable risk (PAR) estimated using Levin s formula: PAR = [P pop x (RR-1)]/[P pop x (RR-1) +1] where P pop = risk factor prevalence, RR = relative risk (estimates from recent meta-analyses) Estimated preventable cancers (EPC) estimated as: PAR* (Number of cases, AN people, )

11 Risk Factor Prevalence Physical Inactivity (%) Current drinking Moderate (%) Heavy (%) Obesity (%) Smoking (%) Yes (%) Total Sex Male Female Age (y)

12 Tobacco was the leading modifiable risk factor for cancer among AN people Tobacco Male Female PAR (%) EPC PAR (%) EPC Acute Myeloid Leukemia Bladder Colorectal Esophagus Kidney and Renal Pelvis Larynx Liver Lung Oral Cavity Pancreas Stomach Female only cancers Uterine cervix Total

13 A substantial number of cancer may be prevented by promoting physical activity Physical inactivity Male Female PAR (%) EPC PAR (%) EPC Colon Lung Male only cancers Prostate Female only cancers Breast Endometrium Ovarian Total

14 Obesity was associated with a smaller, but still substantial, proportion of cancers Obesity Male Female PAR (%) EPC PAR (%) EPC Colon Rectum Esophagus Gallbladder Kidney and Renal Pelvis Liver Pancreas Stomach Thyroid Male only cancers Advanced prostate Female only cancers Postmenopausal breast Endometrium Total

15 Finally, alcohol use may also be a target for cancer prevention strategies Moderate drinking Heavy drinking Males Females Males Females Cancer site PAR (%) EPC PAR (%) EPC PAR (%) EPC PAR (%) EPC Colorectal Esophageal SCC Gallbladder Larynx Liver Lung Oral cavity Stomach Female only cancers Breast Total

16 Putting these results in context Between , 2179 cancers were diagnosed among Alaska Native people These results suggest that up to 70% cancers could be prevented by eliminating exposure to tobacco, physical inactivity, obesity, and alcohol use

17 Summary Our results confirm the importance of ANTHC s focus on tobacco prevention and cessation However, we also demonstrated the potential for obesity, alcohol use, and physical inactivity prevention programs Our results suggest a comprehensive approach to primary prevention is warranted Such an approach would also benefit incidence of other chronic diseases!

18 Strengths and Limitations Strengths: Novel use of registry data to answer questions of relevance to Tribal stakeholders High-quality SEER registry data Limitations: No AN-specific relative risk estimates Risk factors not mutually exclusive Self-reported prevalence data may result in misclassification of exposure status

19 Sarah Nash, PhD MPH CPH Cancer Surveillance Director TEL:

20 Relative Risk Estimates Cancer Site Smoking Obesity Physical Inactivity Moderate alcohol use Heavy alcohol use Male Female Male Female Male Female Male Female Male Female Acute Myeloid Leukemia Bladder Colorectal Colon Rectum Esophagus Esophageal SCC Gallbladder Kidney and Renal Pelvis Larynx Liver Lung Oral Cavity

21 Relative Risk Estimates Cancer Site Smoking Obesity Physical Inactivity Moderate alcohol use Heavy alcohol use Male Female Male Female Male Female Male Female Male Female Pancreas Stomach Thyroid Male Prostate Advanced prostate Female Breast Postmenopausal breast Endometrium Ovarian Uterine cervix