Cancer Incidence Among American Indian and Alaska Native Populations, 2012–2016 (Purchased/Referred Care Delivery Areas)

U.S. Cancer Statistics Data Briefs, No. 12
October 2019

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Purchased/Referred Care Delivery Areas (PRCDA) are counties that contain federally recognized tribal lands or are adjacent to tribal lands. Race classification for the American Indian/Alaska Native (AI/AN) population is more accurate in these counties.

New cancer diagnoses (cancer incidence) data from the central cancer registries have been linked with the Indian Health Service (IHS) patient registration database to improve the accuracy of the category of race for AI/AN persons diagnosed with cancer. Data from earlier years showed geographic variation in incidence rates (counts of new cases divided by the population count) for the most common cancers (the cancers with highest numbers) among AI/AN populations. Rate ratios (the ratio of AI/AN cancer incidence rates to cancer incidence rates among non-Hispanic white populations, adjusted for differences in population age distributions) provide a relative measure of cancer burden. Large rate ratios indicate a disproportionate burden for that cancer among AI/AN populations.1 This data brief highlights the most common types of cancer among the AI/AN population and the cancers with the largest rate ratios (compared to white populations) in 6 geographic regions: Northern Plains, Alaska, Southern Plains, Pacific Coast, East, and Southwest.

  • During 2012 to 2016, a total of 32,411 new cancer cases were reported for the AI/AN population in PRCDA counties in the United States: 15,197 among males and 17,214 among females.
  • The types of cancer that were diagnosed most often among AI/AN men were prostate, lung, and colorectal. Breast, lung, and colorectal were the most frequent cancer types diagnosed among AI/AN women.
  • Liver cancer had the largest rate ratio among AI/AN men and women compared to white populations overall.

Variation by Sex and Geographic Region

Northern Plains

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 1. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in the Northern Plains, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Liver and Intrahepatic Bile Ducta 3.32
Stomacha 2.25
Kidney and Renal Pelvisa 2.03
Female
Liver and Intrahepatic Bile Ducta 3.27
Kidney and Renal Pelvisa 2.12
Lung and Bronchusa 1.92
Most Common
Male
Lung and Bronchusa 1.63
Prostate 1.08
Colon and Rectuma 1.78
Female
Female Breast 0.99
Lung and Bronchusa 1.92
Colon and Rectuma 1.55

a Indicates rate ratio is statistically significant (P<0.05)

  • Lung and breast cancers were the most common cancers among AI/AN males and females, respectively, in the Northern Plains.
  • Liver cancer had the highest rate ratio among both males (RR = 3.32) and females (RR = 3.27).

Alaska

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 2. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in Alaska, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Stomacha 4.36
Colon and Rectuma 2.47
Esophagusa 2.06
Female
Stomacha 4.07
Colon and Rectuma 2.96
Oral Cavity and Parynxa 2.61
Most Common
Male
Lung and Bronchusa 1.78
Colon and Rectuma 2.47
Prostatea 0.73
Female
Female Breast 1.25
Colon and Rectuma 2.96
Lung and Bronchusa 1.51

a Indicates rate ratio is statistically significant (P<0.05)

  • Lung and breast cancers were the most common cancers among AI/AN males and females, respectively, in Alaska.
  • Colorectal cancer was the second most common cancer among AI/ANs for both sexes and had the second largest rate ratio among males (RR = 2.47) and females (RR = 2.96).
  • Stomach cancer had the highest rate ratio among males (RR = 4.02) and females (RR = 4.07).

Southern Plains

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 3. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in the Southern Plains, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Liver and Intrahepatic Bile Ducta 2.45
Kidney and Renal Pelvisa 1.96
Stomach 1.74
Female
Liver and Intrahepatic Bile Ducta 2.93
Stomacha 2.27
Kidney and Renal Pelvisa 2.10
Most Common
Male
Lung and Bronchusa 1.36
Prostatea 1.15
Colon and Rectuma 1.62
Female
Female Breasta 1.33
Lung and Bronchusa 1.49
Colon and Rectuma 1.58

a Indicates rate ratio is statistically significant (P<0.05)

  • Lung and breast cancers were the most common cancers among AI/AN males and females, respectively, in the Southern Plains.
  • Liver cancer had the highest rate ratio among both males (RR = 2.45) and females (RR = 2.93).
  • Kidney and stomach cancers had the second and third largest rate ratios among AI/AN males, and the third and second largest rate ratios among AI/AN females.

Pacific Coast

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 4. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in the Pacific Coast, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Liver and Intrahepatic Bile Ducta 2.59
Stomach 1.29
Testis 1.20
Female
Liver and Intrahepatic Bile Ducta 2.85
Stomacha 2.03
Cervixa 2.00
Most Common
Male
Prostatea 0.82
Lung and Bronchusa 1.18
Colon and Rectuma 1.16
Female
Female Breast 0.99
Lung and Bronchusa 1.92
Colon and Rectuma 1.55

a Indicates rate ratio is statistically significant (P<0.05)

  • Prostate and breast cancers were the most common cancers among AI/AN males and females, respectively, in the Pacific Coast.
  • Lung and colorectal cancers were the second and third most common cancers among both AI/AN males and females.
  • Liver cancer had the highest rate ratio among both males (RR = 2.59) and females (RR = 2.85).

East

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 5. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in the East, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Liver and Intrahepatic Bile Ducta 1.72
Stomach 1.01
Kidney and Renal Pelvisa 0.92
Female
Liver and Intrahepatic Bile Ducta 2.17
Stomacha 2.05
Cervix 1.38
Most Common
Male
Prostatea 0.64
Lung and Bronchusa 0.68
Colon and Rectuma 0.77
Female
Female Breasta 0.62
Lung and Bronchusa 0.75
Colon and Rectum 1.00

a Indicates rate ratio is statistically significant (P<0.05)

  • Prostate (males) or breast (females), lung, and colorectal cancers were the most common cancers among AI/AN males and females in the East.
  • Liver cancer (RR=1.72) was the only cancer with a rate ratio significantly higher than 1 among males.
  • Liver cancer had the highest rate ratio among females (RR = 2.17).

Southwest

(a) Indicates age-adjusted rates in the AI/AN population and the non-Hispanic white population living in PRCDA counties were significantly different.

Table 6. AI/AN Versus Non-Hispanic White Rate Ratios for Most Common Cancers and Cancers with the Largest Rate Ratios in the Southwest, US 2012-2016
Cancer Site Rate Ratio
Largest Rate Ratio
Male
Stomach a 2.66
Liver and Intrahepatic Bile Ducta 2.58
Kidney and Renal Pelvisa 1.93
Female
Liver and Intrahepatic Bile Ducta 3.63
Stomacha 3.16
Kidney and Renal Pelvisa 1.84
Most Common
Male
Prostatea 0.67
Colon and Rectuma 1.14
Kidney and Renal Pelvisa 1.93
Female
Female Breasta 0.56
Colon and Rectum 0.99
Corpus and Uterus, NOSa 1.25

a Indicates rate ratio is statistically significant (P<0.05)

  • Prostate and breast cancers were the most common cancers among AI/AN males and females, respectively, in the Southwest.
  • Stomach cancer had the highest rate ratio among males (RR = 2.66), and liver cancer had the highest rate ratio among females (RR = 3.63).

Data Source

Data are from the U.S. Cancer Statistics American Indian and Alaska Native Incidence Analytic Database (USCS AIAD). This database includes data from cancer registries participating in CDC’s National Program of Cancer Registries or the National Cancer Institute’s Surveillance, Epidemiology, and End Results program that have been linked with the Indian Health Service Patient Registration Database. The USCS AIAD and PRCDA counties have been described previously.2 These linkages address racial misclassification of the AI/AN population in the central cancer registries. These data met quality criteria for 2012 to 2016.

References

1AI/AN versus white rate ratios (RR) that are significantly higher than 1 indicate disproportionate burden among the AI/AN population. Cancers were selected from the 15 leading causes of cancer. Only cancers with counts greater than 6 are displayed.

2Espey DK, Wiggins CL, Jim MA, Miller BA, Johnson CJ, Becker TM. Methods for improving cancer surveillance data in American Indian and Alaska Native populations.external icon Cancer 2008;113:1120–1130.

Suggested Citation

Centers for Disease Control and Prevention. Cancer Incidence Among American Indian and Alaska Native Populations, 2012–2016 (Purchased/Referred Care Delivery Areas). USCS Data Brief, no. 12. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2019.

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Page last reviewed: October 1, 2019