Lung cancer incidence among American Indians and Alaska Natives in the United States, 1999-2004.
BACKGROUND
Lung cancer incidence rates among American Indians and Alaska Natives (AI/ANs) in the United States have not been described well, primarily because of race misclassification and, until the 1990s, incomplete coverage of their population by cancer registries. Smoking, the predominant cause of lung cancer, is particularly prevalent among this population.


METHODS
Data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted incidence rates of lung cancer during 1999 through 2004. Cases were linked to Indian Health Service (IHS) registration databases to identify AI/ANs whose race may have been misclassified. Age-adjusted rates were calculated for Contract Health Service Delivery Area (CHSDA) counties and for all counties by IHS region, and comparisons were made between AI/ANs and non-Hispanic whites (NHWs).


RESULTS
Among populations living in CHSDA counties, NHWs overall had higher rates of lung cancer than AI/ANs. However, the rates (per 100,000 population) among AI/ANs varied substantially between IHS regions from 14.9 (Southwest) to 87.1 (Southern Plains), 93.2 (Alaska), and 104.3 (Northern Plains). Approximately 41.6% of AI/AN lung cancer cases were diagnosed before age 65 years compared with approximately 29.8% of NHW lung cancer cases. The overall percentage stage distribution was not different between AI/ANs and NHWs. Squamous cell carcinomas were slightly more common and adenocarcinomas were less common among AI/ANs than among NHWs. Lung cancer rates were not decreasing for AI/ANs as they were for NHWs.


CONCLUSIONS
Data from this study clarified the need for culturally appropriate tobacco prevention and control policies and resources for AI/ANs in all regions, and especially in the Plains and Alaska.
Bliss
Anne
A
Chronic Disease Services, Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA.
Cobb
Nathaniel
N
Solomon
Teshia
T
Cravatt
Kym
K
Jim
Melissa A
MA
Marshall
LaTisha
L
Campbell
Janis
J
D000230:Adenocarcinoma / Q000208:ethnology; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D018287:Carcinoma, Large Cell / Q000208:ethnology; D018288:Carcinoma, Small Cell / Q000208:ethnology; D002294:Carcinoma, Squamous Cell / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States / Q000453:epidemiology