title: Breast cancer mortality among American Indian and Alaska Native women, 1990-2009.
abstract: OBJECTIVE
  We compared breast cancer death rates and mortality trends among American Indian/Alaska Native (AI/AN) and White women using data for which racial misclassification was minimized.
  
  
  METHODS
  We used breast cancer deaths and cases linked to Indian Health Service (IHS) data to calculate age-adjusted rates and 95% confidence intervals (CIs) by IHS-designated regions from 1990 to 2009 for AI/AN and White women; Hispanics were excluded. Mortality-to-incidence ratios (MIR) were calculated for 1999 to 2009 as a proxy for prognosis after diagnosis.
  
  
  RESULTS
  Overall, the breast cancer death rate was lower in AI/AN women (21.6 per 100,000) than in White women (26.5). However, rates in AI/ANs were higher than rates in Whites for ages 40 to 49 years in the Alaska region, and ages 65 years and older in the Southern Plains region. White death rates significantly decreased (annual percent change [APC] = -2.1; 95% CI = -2.3, -2.0), but regional and overall AI/AN rates were unchanged (APC = 0.9; 95% CI = 0.1, 1.7). AI/AN women had higher MIRs than White women.
  
  
  CONCLUSIONS
  There has been no improvement in death rates among AI/AN women. Targeted screening and timely, high-quality treatment are needed to reduce mortality from breast cancer in AI/AN women.
authors.affiliation: Arica White, Lisa C. Richardson, Chunyu Li, and Donatus U. Ekwueme are with the Division of Cancer Prevention and Control, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Judith S. Kaur is with the Mayo Clinic, Rochester, MN.
authors.forename: Arica
authors.initials: A
authors.lastname: White
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Chunyu
authors.initials: C
authors.lastname: Li
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.forename: Judith S
authors.initials: JS
authors.lastname: Kaur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance; D012042:Registries; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
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