U.S. Cancer Statistics American Indian and Alaska Native Incidence Data

Accurate determination of disease burden is a critical first step toward identifying health disparities. More American Indian and Alaska Native (AI/AN) patients are misclassified as another race in cancer registry records than patients in other racial groups. This misclassification can result in underestimates of cancer incidence among AI/ANs. Cancer incidence data from the central cancer registries have been linked with the Indian Health Service (IHS) patient registration database for improved accuracy of racial classification.

Another way to improve the precision of AI/AN cancer statistics is to restrict statistical analyses to areas with health care services provided by the IHS. IHS purchased/referred care delivery areas (PRCDAs) consist of counties that include all or part of an AI/AN reservation, as well as any county that has a common boundary with a reservation. Updates to the PRCDA list are published in the Federal Register.

The U.S. Cancer Statistics American Indian and Alaska Native Incidence Analytic Database is restricted to populations residing in PRCDA counties (defined in the April 7, 2016 Federal Register (81 FR 20388external icon)). The database includes incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

States and Purchased/Referred Care Delivery Area Counties by IHS Region:
United States, 2016
Map of the United States by Indian Health Service (IHS) region showing states and counties, designated by IHS as Purchased/Referred Care Delivery Areas (PRCDA). The IHS Regions are East, Northern Plains, Southern Plains, Southwest, Pacific Coast, Alaska, and Hawaii. States within the East IHS Region having PRCDA counties are Maine, Massachusetts, New York, Pennsylvania, Virginia, South Carolina, Florida, Alabama, Mississippi, and Louisiana. All states in the Northern Plains, except for Illinois, have PRCDA counties. All states on the Southern Plains, Southwest, and Pacific Coast IHS regions have PRCDA counties, as well as Alaska. Hawaii does not have PRCDA counties. Expand the table below for more details.

Map of the United States by Indian Health Service (IHS) region showing states and counties, designated by IHS as Purchased/Referred Care Delivery Areas (PRCDA).

States with PRCDA Counties
State PRCDA Counties
Alabama Baldwin, Elmore, Escambia, Mobile, and Monroe
Alaska All counties in the state
Arizona Apache, Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai, and Yuma
Arkansas No counties in the state
California Entire state of California, excluding the counties of Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura
Colorado Archuleta, La Plata, Montezuma, and Rio Blanco
Connecticut All counties in the state
Delaware No counties in the state
Florida Broward, Collier, Escambia, Glades, Hendry, and Miami-Dade
Georgia No counties in the state
Hawaii No counties in the state
Idaho Bannock, Benewah, Bingham, Boundary, Caribou, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce, Owyhee, Power, and Lemhi
Illinois No counties in the state
Indiana Elkhart, Kosciusko, La Porte, Marshall, St. Joseph, and Starke
Iowa Monona, Pottawattomie, Tama, and Woodbury
Kansas Brown, Doniphan, Douglas, and Jackson
Kentucky No counties in the state
Louisiana Allen Parish, Avoyelles, Elton, Grant Parish, LaSalle Parish, Rapides Parish, and St. Mary Parish
Maine Aroostook, Penobscot, and Washington
Maryland No counties in the state
Massachusetts Barnstable, Bristol, Dukes, Norfolk, Plymouth, and Suffolk
Michigan Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Chippewa, Clare, Crawford, Delta, Emmet, Gogebic, Grand Traverse, Houghton, Iosco, Isabella, Itasca, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Luce, Mackinac, Manistee, Marquette, Mason, Menominee, Midland, Missaukee, Montmorency, Muskegon, Newaygo, Oceana, Ogemaw, Ontonagon, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Schoolcraft, Van Buren, and Wexford
Minnesota Aitkin, Becker, Beltrami, Carlton, Cass, Chippewa, Clearwater, Cook, Goodhue, Houston, Hubbard, Itasca, Kanebec, Koochiching, Lake of the Woods, Mahnomen, Marshall, Mille Lacs, Norman, Pennington, Pine, Polk, Redwood, Renville, Roseau, Scott, St. Louis, Traverse, and Yellow Medicine
Mississippi Attala, Jasper, Jones, Kemper, Leake, Neshoba, Newton, Noxubee, Scott, and Winston
Missouri No counties in the state
Montana Big Horn, Blaine, Carbon, Carter, Chouteau, Daniels, Flathead, Glacier, Hill, Lake, Liberty, McCone, Missoula, Phillips, Pondera, Richland, Roosevelt, Rosebud, Sanders, Sheridan, Treasure, Valley, and Yellowstone
Nebraska Boyd, Burt, Cherry, Cuming, Dakota, Dawes, Dixon, Douglas, Hall, Holt, Knox, Lancaster, Madison, Platte, Richardson, Sarpy, Sheridan, Stanton, Thurston, and Wayne
Nevada All counties in the state
New Hampshire No counties in the state
New Jersey No counties in the state
New Mexico Bernalillo, Chaves, Cibola, Colfax, Lincoln, Los Alamos, McKinley, Otero, Rio Arriba, San Juan, Sandoval, Santa Fe, Socorro, Taos, Torrance, and Valencia
New York Allegany, Cattaraugus, Chautauqua, Chenango, Cortland, Erie, Franklin, Genesee, Herkimer, Madison, Nassau, Niagara, Oneida, Onondaga, St. Lawrence, and Suffolk
North Carolina Cabarrus, Cherokee, Cleveland, Gaston, Graham, Haywood, Jackson, Mecklenburg, Rutherford, Swain, and Union
North Dakota Adams, Benson, Divide, Dunn, Eddy, Emmons, Grant, McKenzie, McLean, Mercer, Morton, Mountrail, Nelson, Ramsey, Richland, Rolette, Sargent, Sioux, Ward, and Williams
Ohio No counties in the state
Oklahoma All counties in the state
Oregon Benton, Clackamas, Columbia, Coos, Curry, Deshutes, Douglas, Harney, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Union, Wasco, Washington, and Yamhill
Pennsylvania Warren
Rhode Island Washington
South Carolina All counties in the state
South Dakota Bennett, Bon Homme, Brule, Buffalo, Campbell, Charles Mix, Codington, Corson, Custer, Day, Dewey, Douglas, Fall River, Grant, Gregory, Haakon, Hand, Hughes, Hutchinson, Hyde, Jackson, Lyman, Marshall, Meade, Mellette, Moody, Pennington, Perkins, Potter, Roberts, Shannon, Stanley, Sully, Todd, Tripp, Walworth, and Ziebach
Tennessee No counties in the state
Texas El Paso, Maverick, and Polk
Utah Box Elder, Carbon, Daggett, Duchesne, Emery, Grand, Iron, Juab, Kane, Millard, San Juan, Sevier, Summit, Tooele, Uintah, Utah, Wasatch, Washington
Vermont No counties in the state
Virginia No counties in the state
Washington Chelan, Clallam, Clark, Cowlitz, Douglas, Ferry, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Whatcom, Whitman, and Yakima
West Virginia No counties in the state
Wisconsin Adams, Ashland, Barron, Bayfield, Brown, Burnett, Clark, Columbia, Crawford, Dane, Eau Claire, Forest, Iron, Jackson, Juneau, La Crosse, Langlade, Marathon, Marinette, Menominee, Monroe, Oconto, Oneida, Outagamie, Polk, Sauk, Sawyer, Shawano, Vernon, Vilas, Washburn, and Wood
Wyoming Big Horn, Fremont, Hot Springs, Sheridan, and Sublette

The U.S. Cancer Statistics AI/AN Incidence Analytic Database can be used to—

  • Describe the incidence of cancer.
  • Identify AI/AN populations most affected by cancer.
  • Evaluate cancer prevention and screening activities.
  • Assess cancer disparities.

You can use the AI/AN Incidence Analytic Database module in the U.S. Cancer Statistics Data Visualizations tool to explore the data. The module includes the latest and most complete AI/AN cancer data.

The AI/AN Incidence Analytic Database module provides interactive graphics and data interpretations—

  • For new cancer cases.
  • By IHS region.
  • By sex and age.
  • By type of cancer.