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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Division of Epidemiology and Disease Prevention
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Health Issues - Cancer

Current Projects

Colorectal Cancer Screening

Though colorectal cancer (CRC) screening saves lives, it is not yet being delivered effectively to rural Alaska Native people who have the highest burden of CRC of any racial and/or ethnic group in the US. This population resides in remote communities distributed over a vast state. Though health care facilities serving these populations sometimes have medical staff capable of performing screening flexible sigmoidoscopy or colonoscopy, they are unable to dedicate adequate time to routine screening.

With funding from the CDC Division of Cancer Prevention and Control and technical support from the IHS Division of Epidemiology, the Alaska Native Tribal Health Consortium's Alaska Native Epidemiology Center is leading a variety of projects aimed at increasing CRC screening among Alaska Natives.

To find out more, please visit the Alaska Native Epidemiology Center. Exit Disclaimer: You Are Leaving

To address the need to increase CRC screening awareness among AI/AN in other regions, the Tribal Colorectal Health Program has been established, through a collaboration with the Albuquerque Area Indian Health Board.

The primary objectives of this program are to:

  • Build knowledge and skills among tribal community health representatives (CHRs) to bolster their involvement in colorectal health education, outreach and navigational services in the seven AAIHB consortium tribes, and
  • Develop multidisciplinary colorectal health workgroups in participating AAIHB communities to strengthen collaboration between CHRs, clinic providers and other community health providers/programs and expand tribal community colorectal cancer control efforts, and
  • Share successful strategies, materials and lessons learned with tribal communities throughout the country to strengthen local colorectal cancer control efforts.

Linkage Projects

Cancer Registry Linkages

In order to address underreporting of cancer for American Indian/Alaska Native (AI/AN) populations, the CDC has an interagency agreement with the Indian Health Service (IHS) to conduct a special cancer data linkage project that began in 2004. The objective was to improve AI/AN cancer surveillance data in central cancer registries supported by CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program by implementing routine data linkages with the IHS patient registration database.

Results from the linkages are routinely captured in the NAACCR record layout as data item #192 (IHS Link). Central cancer registries that have at least one IHS Contract Health Service Delivery Area (CHSDA) county are required to link to IHS every year and central cancer registries that do not have an IHS CHSDA county are required to link every 5 years.

The IHS linkage data were used in the "Annual Report to the Nation on the Status of Cancer, 1975-2004, Featuring Cancer in American Indians and Alaska Natives", in a supplement to Cancer (An Update on Cancer in American Indians and Alaska Natives, 1999-2004), and in the June 2014 supplement to the American Journal of Public Health (American Indian and Alaska Native Mortality). Although the linkage allows for a better assessment of cancer incidence in the AI/AN population, incidence rates still do not include the AI/AN population that are not members of federally recognized tribes.


National Death Index Linkage

Coding of American Indian and Alaska Native (AI/AN) status on death certificates has been shown to be inaccurate. A study performed by the National Center for Health Statistics, linking self-report of race at census/census survey to that reported by the funeral home director when a person dies, reveals as much as 40 percent of AI/AN deaths are not recorded as native. Results for this study can be found in this article, "The Validity of Race and Hispanic Origin Reporting on Death Certificates in the United States" Exit Disclaimer: You Are Leaving [PDF].

As a way to minimize the effects of racial misclassification and provide improved estimates of mortality among AI/AN, the Indian Health Service (IHS) and CDC supported a linkage between the IHS registration records and the National Death Index (NDI). The resulting analytic file will provide the opportunity to improve mortality reporting for AI/AN.

These data will likely be the most current and accurate mortality data for AI/AN, a group of Americans with generally unfavorable health profiles. The data and publications should be a resource for health planning in a context of renewed attention on health disparities. The NDI-IHS linkage data were used in the American Journal of Public Health (American Indian and Alaska Native Mortality).