title: Invasive cervical cancer among American Indian women in the Northern Plains, 1994-1998: incidence, mortality, and missed opportunities.
abstract: OBJECTIVE
  Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region.
  
  
  METHODS
  We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population.
  
  
  RESULTS
  Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100,000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms.
  
  
  CONCLUSIONS
  While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. Richard.f.leman@state.or.us
authors.forename: Richard F
authors.initials: RF
authors.lastname: Leman
authors.forename: David
authors.initials: D
authors.lastname: Espey
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Cobb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009658:North Dakota / Q000453:epidemiology; D013023:South Dakota / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D016549:United States Indian Health Service; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D016387:Women's Health / Q000208:ethnology*