title: Regional differences in cervical cancer incidence among American Indians and Alaska Natives, 1999-2004.
abstract: BACKGROUND
  Reports from limited geographic regions indicate higher rates of cervical cancer incidence in American Indian and Alaska Native (AI/AN) women than in women of other races. However, accurate determinations of cervical cancer incidence in AI/AN women have been hampered by racial misclassification in central cancer registries.
  
  
  METHODS
  The authors linked data from cancer registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program with Indian Health Service (IHS) enrollment records to improve identification of AI/AN race. NPCR and SEER data were combined to estimate annualized age-adjusted rates (expressed per 100,000 persons) for the diagnosis years 1999 to 2004. Analyses focused on counties known to have less racial misclassification, and results were stratified by IHS Region. Approximately 56% of AI/ANs in the US reside in these counties. The authors examined overall and age-specific incidence rates and stage at diagnosis for AI/AN women compared with non-Hispanic white (NHW) women.
  
  
  RESULTS
  Invasive cervical cancer incidence rates among AI/AN women varied nearly 2-fold across IHS regions, with the highest rates reported in the Southern Plains (14.1) and Northern Plains (12.5); the lowest rates were in the Eastern region and the Pacific Coast. Overall, AI/AN women had higher rates of cervical cancer than NHW women and were more likely to be diagnosed with later stage disease.
  
  
  CONCLUSIONS
  The wide regional variation of invasive cervical cancer incidence indicates an important need for health services research regarding cervical cancer screening and prevention education as well as policy development regarding human papillomavirus vaccine use, particularly in the regions with high incidence rates. Cancer 2008;113(5 suppl):1234-43. Published 2008 by the American Cancer Society.
authors: Department of Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon 97202-3098, USA. beckert@ohsu.edu
authors: Thomas M
authors: TM
authors: Becker
authors: David K
authors: DK
authors: Espey
authors: Herschel W
authors: HW
authors: Lawson
authors: Mona
authors: M
authors: Saraiya
authors: Melissa A
authors: MA
authors: Jim
authors: Alan G
authors: AG
authors: Waxman
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D004930:Inuit / Q000706:statistics & numerical data*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011159:Population Surveillance; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000473:pathology; D014626:Vaginal Smears