(1975 through 2004) and fixed-interval (1995 through 2004) incidence and mortality trends were evaluated by annual percent change using regression analyses (2-sided P < .05). Cancer screening, risk factors, socioeconomic characteristics, incidence data, and stage were compiled for non-Hispanic whites (NHW) and AI/AN across 6 regions of the U.S.We thank Andrew Lake, Rick Firth, Danielle Melbert, and Martin Krapcho of Information Management Services, Inc. for assisting in statistical analyses.We also thank Tom Richards and Mary White, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia for assistance with graphics and their helpful comments on the article. Phyllis A. Wingo was under contract with the Indian Health Service for a portion of her work on this manuscript. This article was originally published online on October 15, 2007, and it is presented here with the following modifications: Dr. Wu's degree appears correctly above, and some data was realigned in the tables to improve the readability of the data being presented. The changes do not affect the core data or the conclusions of the article in any way. The publisher apologizes for this oversight and any confusion that may have ensued. Among women, lung cancer incidence rates no longer were increasing and death rates, although they still were increasing slightly, were increasing at a much slower rate than in the past. Breast cancer incidence rates in women decreased CONCLUSIONS. For all races/ethnicities combined in the U.S., favorable trends in incidence and mortality were noted for lung and colorectal cancer in men and women and for breast cancer in women. For the AI/AN population, lower overall cancer incidence and death rates obscured important variations by geographic regions and less favorable healthcare access and socioeconomic status. T he American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to assess the cancer burden in the U.S. The 1998 report documented the first sustained decline in cancer death rates since the 1930s.1 Subsequent reports updated information on trends in incidence and death rates and featured timely, in-depth analyses of selected topics. 2-9 The American Indian and Alaska Native (AI/AN) cancer experience has not been described well except for a few geographic areas. This 2007 report updates the cancer profile for the U.S. and describes regional patterns of cancer in AI/AN using methods that mitigate the effects of race misclassification. MATERIALS AND METHODSCancer Cases, Cancer Deaths, and Population Estimates U.S. cancer deaths, reported to state vital statistics offices and consolidated through CDC's National Vital Statistics System, 12 were coded using the version of the ICD in use at the time of death. [13][14][15][16] Underlying causes of cancer death were grouped according to the SEER cause of death recode f...

AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.

These behavioral risk factors were consistent with observed patterns of mortality and chronic disease among AI/AN persons. All are amenable to public health intervention.

BACKGROUNDNational estimates of cancer mortality indicate relatively low rates for American Indians (AIs) and Alaska Natives (ANs). However, these rates are derived from state vital records in which racial misclassification is known to exist.METHODSIn this cross‐sectional study of cancer mortality among AIs and ANs living in counties on or near reservations, the authors used death records and census population estimates to calculate annualized, age‐adjusted mortality rates for key cancer types for the period 1996–2001 for 5 geographic regions: East (E), Northern Plains (NP), Southwest (SW), Pacific Coast (PC), and Alaska (AK). Mortality rate ratios (MRRs) and 95% confidence intervals (95% CIs) also were calculated to compare rates with those in the general United States population (USG) for the same period. To examine temporal trends, MRRs for 1996–2001 were compared with MMRs for 1990–1995.RESULTSThe overall cancer mortality rate was lower in AIs and ANs (165.6 per 100,000 population; 95% CI, 161.7–169.5) than in the USG (200.9 per 100,000 population; 95% CI, 200.7–201.2). In the regional analysis, however, cancer mortality was higher in AK (MRR = 1.26; 95% CI, 1.17–1.36) and in the NP (MMR = 1.37; 95% CI, 1.31–1.44) than in the USG. In both regions, the excess mortality was attributed to cancer of the lung, colorectum, liver, stomach, and kidney. In the SW, the mortality rate for cancer of the liver and stomach was higher than the rate in the USG, in contrast with that region's nearly 4‐fold lower mortality rate for lung cancer (MRR = 0.23; 95% CI, 0.19–0.27). Rates of cervical cancer mortality were higher among AIs and ANs (MRR = 1.35; 95% CI, 1.13–1.62), notably in the NP and SW. Rates of breast cancer mortality generally were lower (MRR = 0.60; 95% CI, 0.55–0.66), notably in the PC, SW, and E. Cancer mortality increased by 5% in AIs and ANs (MRR for 1996–2001 compared with 1990–1995: 1.05; 95% CI, 1.01–1.08), whereas it decreased by 6% in the USG (MMR = 0.94; 95% CI, 0.94–0.94).CONCLUSIONSRegional data should guide local cancer prevention and control activities in AIs and ANs. The disparity in temporal trends in cancer mortality between AIs and ANs and the USG gives urgency to improving cancer control in this population. Cancer 2005. Published 2005 by the American Cancer Society.