Elevated colorectal cancer incidence among American Indian/Alaska Native persons in Alaska compared to other populations worldwide

Abstract

Colorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease.

Clinical Outcomes from the Alaska Native Tribal Health Consortium Colorectal Cancer Control Program: 2009–2015

“…Alaska Native Tribal health organizations, collectively called the Alaska Tribal Health System, have recognized colorectal cancer (CRC) as a major health priority and as a result have focused substantial attention on increasing awareness of, access to, and use of CRC screening [1][2][3]. This focus is driven by the disproportionately high incidence of CRC among Alaska Native peoples [4], who also have a high prevalence of precancerous colorectal polyps [5,6]. CRC is particularly suitable for population-based screening because most cases develop from pre-malignant polyps which slowly develop into CRC over a period of 10-15 years [7].…”

Comparing ancestry calibration approaches for a trans-ancestry colorectal cancer polygenic risk score

“…CRC risk may be attributable to social determinants of health such as socioeconomic status, health care access, and food security, which are known to be associated with race 2 . Individuals who self-report as Black or Native American/Alaskan Native have the highest lifetime risk for CRC as well as higher mortality rates 1,3,4 . Additionally, risk for CRC is affected by other environmental factors such as diet, smoking and physical activity, as well as genetics 5 .…”

“…. Individuals who self-report as Black or Native American/Alaskan Native have the highest lifetime risk for CRC as well as higher mortality rates 1,3,4 . Additionally, risk for CRC is affected by other environmental factors such as diet, smoking and physical activity, as well as genetics 5…”

Cancer Screening Prevalence among Participants in the Southcentral Alaska Education and Research towards Health (EARTH) Study at Baseline and Follow-Up

“…The incidence of cancers that are detectable by regular age-appropriate screening among Alaska Native people during the most recent five-year period is as follows: colorectal cancer (CRC; 87.6 per 100,000), cervical cancer (12.4 per 100,000), and breast cancer (130.8 per 100,000) (2014–2018) [ 6 ]. Alaska Native people experience a disproportionate burden of these cancers: Alaska Native CRC rates are the highest in the world, over 2-fold higher than U.S. whites [ 6 , 7 ], and Alaska Native women are at nearly twice the risk for cervical cancer as U.S. white women [ 6 ]. However, breast cancer incidence among Alaska Native women is similar to that among U.S. white women [ 1 , 6 ].…”

“…A continued focus on screening and early detection can help reduce the burden of this disease [ 8 ]. Reasons for high CRC and breast cancer incidence among Alaska Native people are not well understood and may be related to behavioral factors and additional environmental factors associated with higher risk or needing a longer time horizon to see improvements in morbidity and mortality resulting from the recent increases in cancer screening [ 3 , 7 ].…”