Progress in addressing disparities through comprehensive cancer control.

Cancer-related disparities are the significant differences in cancer incidence, cancer prevalence, cancer death, cancer survivorship, and burden of cancer or related health conditions that exist disproportionately in certain populations compared with the general population with respect to variables like race, ethnicity, and geography. The emergence of comprehensive cancer control efforts provides a framework to address the unequal disease burden felt by these groups. This article illustrates four distinct programs uniquely designed to fit at-risk populations. Specific examples are given that demonstrate a significant impact on the full range of the cancer care continuum. Although measureable progress has been made to improve prevention, detection, and treatment of cancer throughout the United States, many populations remain underserved, impeding our ability to achieve national healthcare goals. Here, we reemphasize the need to sustain this progress through use of partnerships, technology, and policy.

Lung cancer incidence among American Indians and Alaska Natives in the United States, 1999-2004.

BACKGROUND: Lung cancer incidence rates among American Indians and Alaska Natives (AI/ANs) in the United States have not been described well, primarily because of race misclassification and, until the 1990s, incomplete coverage of their population by cancer registries. Smoking, the predominant cause of lung cancer, is particularly prevalent among this population. METHODS: Data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted incidence rates of lung cancer during 1999 through 2004. Cases were linked to Indian Health Service (IHS) registration databases to identify AI/ANs whose race may have been misclassified. Age-adjusted rates were calculated for Contract Health Service Delivery Area (CHSDA) counties and for all counties by IHS region, and comparisons were made between AI/ANs and non-Hispanic whites (NHWs). RESULTS: Among populations living in CHSDA counties, NHWs overall had higher rates of lung cancer than AI/ANs. However, the rates (per 100,000 population) among AI/ANs varied substantially between IHS regions from 14.9 (Southwest) to 87.1 (Southern Plains), 93.2 (Alaska), and 104.3 (Northern Plains). Approximately 41.6% of AI/AN lung cancer cases were diagnosed before age 65 years compared with approximately 29.8% of NHW lung cancer cases. The overall percentage stage distribution was not different between AI/ANs and NHWs. Squamous cell carcinomas were slightly more common and adenocarcinomas were less common among AI/ANs than among NHWs. Lung cancer rates were not decreasing for AI/ANs as they were for NHWs. CONCLUSIONS: Data from this study clarified the need for culturally appropriate tobacco prevention and control policies and resources for AI/ANs in all regions, and especially in the Plains and Alaska.