Incidence Rates and Rate Ratios of the Top 25 Cancers for American Indian/Alaska Natives compared with non-Hispanic Whites by Indian Health Service Region, CHSDA Counties, United States, Both Sexes, 1999–2004

All Regions Combined and Northern Plains Region

Type of Cancer	All regions combined						Northern Plains
	AI/AN		NHW		Ratio AI/AN to NHW		AI/AN		NHW		Ratio AI/AN to NHW
	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI
All Sites / Types	None	368.4	None	476.0	0.77b	0.76–0.78	None	538.1	None	464.8	1.16b	1.12–1.20
Prostate	1	105.6	1	154.4	0.68b	0.66–0.71	1	174.6	1	162.2	1.08	0.97–1.19
Female Breast	2	85.3	2	134.4	0.63b	0.61–0.66	2	115.9	2	130.3	0.89b	0.81–0.97
Lung and Bronchus	3	57.4	3	70.3	0.82b	0.79–0.85	3	104.3	3	65.5	1.59b	1.47–1.72
Colon and Rectum	4	46.3	4	50.8	0.91b	0.87–0.95	4	72.5	4	52.3	1.39b	1.26–1.52
Kidney / Renal Pelvis	5	18.2	10	12.6	1.45b	1.36–1.54	5	24.1	10	12.9	1.88b	1.61–2.17
Corpus / Uterus, not otherwise specified	6	18.1	6	23.6	0.77b	0.71–0.83	6	19.5	5	26.6	0.74b	0.58–0.92
Non-Hodgkin Lymphoma	7	14.1	8	19.4	0.73b	0.67–0.78	7	18.5	7	19.4	0.95	0.79–1.14
Ovary	8	11.5	9	14.4	0.80b	0.72–0.88	14	11.0	9	14.0	0.79	0.57–1.04
Stomach	9	10.9	18	5.8	1.88b	1.72–2.05	11	13.2	18	5.6	2.35b	1.86–2.91
Pancreas	10	9.9	13	10.8	0.91b	0.83–1.00	13	11.1	13	10.2	1.10	0.86–1.38
Urinary Bladder	11	9.6	5	23.9	0.40b	0.37–0.44	8	14.8	6	22.9	0.65b	0.51–0.80
Cervix Uteri	12	9.4	15	7.4	1.28b	1.15–1.42	12	12.5	15	7.4	1.69b	1.29–2.18
Leukemia	13	9.4	11	12.6	0.75b	0.69–0.81	10	13.5	11	12.7	1.06	0.85–1.30
Liver / Intrahepatic Bile Ducts	14	9.0	21	4.3	2.11b	1.92–2.32	15	10.9	22	3.7	2.97b	2.29–3.78
Oral Cavity / Pharynx	15	8.5	12	11.0	0.77b	0.70–0.84	9	13.9	12	10.5	1.32b	1.06–1.62
Myeloma	16	6.2	20	4.9	1.27b	1.14–1.42	18	7.2	20	5.1	1.41b	1.04–1.85
Thyroid	17	5.6	14	8.3	0.67b	0.61–0.74	17	7.3	14	7.9	0.92	0.71–1.18
Melanoma–Skin	18	4.8	7	21.7	0.22b	0.20–0.25	21	4.6	8	15.9	0.29b	0.20–0.41
Esophagus	19	4.4	19	5.1	0.87b	0.76–0.99	16	8.2	19	5.3	1.55b	1.14–2.05
Testis	20	4.1	17	6.7	0.61b	0.53–0.70	19	5.1	17	6.6	0.77	0.53–1.11
Brain	21	3.6	16	6.9	0.53b	0.46–0.59	22	3.7	16	6.6	0.55b	0.38–0.78
Gallbladder	22	3.3	32	0.9	3.59b	3.04–4.22	25	2.6	31	1.1	2.48b	1.49–3.86
Larynx	23	3.1	22	3.8	0.81b	0.69–0.94	20	5.0	21	3.8	1.33	0.92–1.84
Other Biliary	24	2.2	29	1.5	1.48b	1.21–1.80	33	1.0	27	1.5	0.67	0.22–1.47
Soft Tissues including Heart	25	2.1	23	3.0	0.70b	0.59–0.84	24	2.8	24	2.7	1.02	0.61–1.58

Alaska and Southern Plains Regions

Type of Cancer	Alaska						Southern Plains
	AI/AN		NHW		Ratio AI/AN to NHW		AI/AN		NHW		Ratio AI/AN to NHW
	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI
All Sites / Types	None	511.0	None	486.8	1.05	1.00–1.11	None	492.6	None	461.2	1.07b	1.04–1.10
Prostate	4	78.3	1	180.7	0.43b	0.35–0.53	1	156.7	1	146.5	1.07	0.99–1.15
Female Breast	1	134.9	2	136.5	0.99	0.87–1.12	2	115.7	2	129.7	0.89b	0.83–0.96
Lung and Bronchus	3	93.2	3	71.6	1.30b	1.14–1.48	3	87.1	3	82.2	1.06	1.00–1.13
Colon and Rectum	2	102.6	4	50.6	2.03b	1.78–2.31	4	60.2	4	51.8	1.16b	1.08–1.25
Kidney / Renal Pelvis	6	19.6	10	13.5	1.46b	1.10–1.91	6	21.5	10	13.0	1.66b	1.46–1.87
Corpus / Uterus, not otherwise specified	9	13.6	6	22.8	0.60b	0.39–0.88	5	22.4	6	19.4	1.16	0.98–1.36
Non-Hodgkin Lymphoma	11	11.7	7	21.6	0.54b	0.39–0.74	7	20.9	7	18.5	1.13	0.99–1.28
Ovary	16	7.3	9	13.5	0.54b	0.29–0.92	8	14.7	9	14.0	1.05	0.86–1.28
Stomach	5	24.5	20	5.3	4.61b	3.34–6.38	15	9.0	18	5.1	1.77b	1.44–2.15
Pancreas	8	16.0	13	10.2	1.57b	1.13–2.15	13	11.0	13	10.6	1.04	0.87–1.24
Urinary Bladder	10	13.5	5	26.9	0.50b	0.35–0.69	9	14.6	5	19.7	0.74b	0.64–0.86
Cervix Uteri	14	8.5	17	6.2	1.37	0.77–2.29	10	14.1	14	9.2	1.54b	1.25–1.87
Leukemia	17	6.9	11	13.1	0.53b	0.35–0.78	11	13.2	11	12.5	1.06	0.91–1.23
Liver / Intrahepatic Bile Ducts	12	11.0	19	5.5	2.02b	1.33–2.99	16	8.1	22	4.3	1.88b	1.51–2.31
Oral Cavity / Pharynx	7	16.3	12	10.6	1.53b	1.12–2.05	12	11.4	12	11.7	0.98	0.83–1.15
Myeloma	20	5.2	21	5.2	1.01	0.58–1.66	17	7.4	19	4.6	1.62b	1.29–2.00
Thyroid	15	7.4	14	8.5	0.87	0.60–1.23	19	5.5	16	5.6	0.98	0.78–1.22
Melanoma–Skin	30	1.3	8	14.5	0.09b	0.03–0.20	14	9.6	8	15.8	0.61b	0.50–0.72
Esophagus	13	9.5	18	5.7	1.66b	1.05–2.51	21	4.4	21	4.3	1.01	0.76–1.32
Testis	18	6.2	15	7.1	0.86	0.50–1.48	22	3.4	17	5.6	0.62b	0.42–0.89
Brain	24	2.9	16	7.0	0.41b	0.22–0.73	18	6.1	15	6.9	0.88	0.70–1.08
Gallbladder	19	5.6	35	0.8	6.65b	2.94–55.85	26	2.1	34	0.8	2.48b	1.54–3.78
Larynx	22	3.5	23	3.3	1.07	0.56–1.92	20	5.0	20	4.5	1.13	0.87–1.44
Other Biliary	21	4.9	29	1.4	3.47b	1.63–7.23	25	2.1	28	1.4	1.55	1.00–2.30
Soft Tissues including Heart	27	1.8	24	3.1	0.57	0.23–1.23	23	3.0	25	2.4	1.24	0.89–1.69

Pacific Coast and East Regions

Type of Cancer	Pacific Coast						East
	AI/AN		NHW		Ratio AI/AN to NHW		AI/AN		NHW		Ratio AI/AN to NHW
	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI
All Sites / Types	None	312.7	None	488.0	0.64b	0.62–0.66	None	286.1	None	492.9	0.58b	0.54–0.62
Prostate	1	83.2	1	160.8	0.52b	0.47–0.57	1	83.9	1	155.9	0.54b	0.44–0.65
Female Breast	2	74.7	2	142.6	0.52b	0.48–0.57	2	71.4	2	133.6	0.53b	0.45–0.63
Lung and Bronchus	3	51.8	3	70.1	0.74b	0.68–0.80	3	46.8	3	74.2	0.63b	0.53–0.75
Colon and Rectum	4	38.7	4	48.5	0.80b	0.72–0.88	4	36.0	4	55.2	0.65b	0.53–0.79
Kidney / Renal Pelvis	7	12.5	11	12.2	1.02	0.86–1.20	6	14.4	10	13.4	1.07	0.78–1.43
Corpus / Uterus, not otherwise specified	5	16.7	7	23.6	0.71b	0.58–0.85	5	15.2	6	25.4	0.60b	0.40–0.86
Non-Hodgkin Lymphoma	6	12.6	8	20.1	0.62b	0.53–0.74	9	7.7	8	20.0	0.38b	0.24–0.57
Ovary	8	10.0	9	14.9	0.67b	0.52–0.85	14	5.9	9	14.8	0.40b	0.19–0.72
Stomach	13	7.9	18	5.6	1.40b	1.11–1.75	13	6.1	16	6.9	0.88	0.52–1.38
Pancreas	9	9.3	13	11.1	0.84	0.68–1.02	10	7.5	12	11.6	0.65b	0.38–1.00
Urinary Bladder	11	8.6	6	24.0	0.36b	0.29–0.44	7	11.9	5	25.8	0.46b	0.32–0.64
Cervix Uteri	15	6.9	17	7.0	0.98	0.74–1.27	12	7.1	15	7.3	0.97	0.53–1.62
Leukemia	12	8.6	10	12.8	0.67b	0.55–0.82	8	8.1	11	13.0	0.62b	0.40–0.92
Liver / Intrahepatic Bile Ducts	10	9.2	21	4.5	2.06b	1.68–2.49	15	5.7	22	4.4	1.29	0.76–2.03
Oral Cavity / Pharynx	14	7.7	12	11.6	0.66b	0.54–0.80	10	7.5	13	11.0	0.68	0.44–1.00
Myeloma	17	4.5	20	5.0	0.90	0.66–1.19	16	4.4	20	5.1	0.87	0.48–1.45
Thyroid	18	4.4	14	7.6	0.57b	0.44–0.73	18	4.2	14	9.3	0.45b	0.26–0.74
Melanoma–Skin	16	4.9	5	26.6	0.19b	0.14–0.24	21	2.8	7	20.5	0.14b	0.07–0.24
Esophagus	19	3.9	19	5.2	0.76	0.55–1.02	17	4.4	19	5.2	0.84	0.45–1.42
Testis	20	3.8	16	7.2	0.53b	0.38–0.72	25	1.5	18	6.5	0.23b	0.06–0.69
Brain	21	3.2	15	7.3	0.43b	0.32–0.57	20	3.4	17	6.9	0.50b	0.28–0.84
Gallbladder	25	1.5	33	0.9	1.72	0.95–2.79	24	1.6	31	1.0	1.65	0.42–4.06
Larynx	22	2.5	22	3.4	0.76	0.51–1.07	19	3.8	21	4.5	0.84	0.43–1.46
Other Biliary	24	1.6	29	1.5	1.11	0.63–1.78	34	0.6	27	1.6	0.37	0.04–1.33
Soft Tissues including Heart	26	1.5	23	3.1	0.46b	0.29–0.70	27	0.9	24	3.0	0.29b	0.05–0.86

Southwest Region

Type of Cancer	AI/AN		NHW		Ratio AI/AN to NHW
	Rank	Ratea	Rank	Ratea	Rate Ratio	95% CI
All Sites / Types	None	232.9	None	445.1	0.52b	0.51–0.54
Prostate	1	65.7	1	133.8	0.49b	0.44–0.54
Female Breast	2	50.8	2	125.2	0.41b	0.37–0.44
Lung and Bronchus	6	14.9	3	65.6	0.23b	0.20–0.26
Colon and Rectum	3	21.0	4	46.8	0.45b	0.40–0.50
Kidney / Renal Pelvis	4	18.0	10	11.7	1.53b	1.37–1.72
Corpus / Uterus, not otherwise specified	5	16.7	7	19.6	0.86b	0.74–0.99
Non-Hodgkin Lymphoma	9	9.8	8	17.3	0.57b	0.48–0.66
Ovary	7	12.5	9	13.6	0.92	0.76–1.10
Stomach	8	11.5	18	4.9	2.37b	2.02–2.76
Pancreas	11	7.9	14	9.8	0.80b	0.66–0.95
Urinary Bladder	19	3.2	5	23.8	0.13b	0.10–0.18
Cervix Uteri	12	7.8	15	7.3	1.07	0.85–1.32
Leukemia	14	6.3	11	11.5	0.55b	0.46–0.66
Liver / Intrahepatic Bile Ducts	10	9.0	20	4.2	2.15b	1.80–2.54
Oral Cavity / Pharynx	18	3.3	12	10.4	0.32b	0.24–0.40
Myeloma	13	6.5	21	4.1	1.60b	1.30–1.95
Thyroid	15	5.8	13	9.9	0.59b	0.49–0.70
Melanoma–Skin	22	2.4	6	22.6	0.11b	0.08–0.14
Esophagus	23	2.4	19	4.7	0.51b	0.36–0.70
Testis	17	4.3	17	6.3	0.68b	0.52–0.89
Brain	21	2.5	16	6.6	0.37b	0.28–0.49
Gallbladder	16	5.5	32	0.8	6.98b	5.40–8.89
Larynx	26	1.0	22	3.5	0.27b	0.15–0.44
Other Biliary	20	2.9	29	1.4	2.15b	1.53–2.92
Soft Tissues including Heart	24	1.9	23	2.9	0.64b	0.45–0.88

Source: Cancer registries in the Centers for Disease Control and Prevention's National Program of Cancer Registries and/or the National Cancer Institute's Surveillance, Epidemiology, and End Results Program.

CHSDA indicates Contract Health Service Delivery Areas of the Indian Health Service; AI/AN indicates American Indians/Alaska Natives; NHW, non-Hispanic whites; CI, confidence interval.

^a Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130).
^b P-Value for rate ratio ≤ 0.05.

Years of data and registries used: 1999–2004 (41 states and the District of Columbia): Alaska,* Alabama,* Arkansas, Arizona,* California,* Colorado,* Connecticut,* the District of Columbia, Delaware, Florida,* Georgia, Hawaii, Iowa,* Idaho,* Illinois, Indiana,* Kentucky, Louisiana,* Massachusetts,* Maine,* Michigan,* Minnesota,* Missouri, Montana,* North Carolina,* Nebraska,* New Hampshire, New Jersey, New Mexico,* Nevada,* New York,* Ohio, Oklahoma,* Oregon,* Pennsylvania,* Rhode Island,* Texas,* Utah,* Washington,* Wisconsin,* West Virginia, and Wyoming*; 1999 and 2002–2004: North Dakota*; 2001–2004: South Dakota*; 2003–2004: Mississippi* and Virginia; 2004: Tennessee. (*Asterisks indicate states with at least one county designated as a Contract Health Service Delivery Area (CHSDA).)

Percentage regional coverage of AI/AN in CHSDA counties to AI/AN in all counties: Alaska, 100%; East, 13.1%; Northern Plains, 59.0%; Southern Plains, 64.1%; Pacific Coast, 55.6%; Southwest, 87.5%.

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