Native American Women Reducing the Cancer Risks

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					Native American Women: Reducing the Cancer Risks
Linda Burhansstipanov, MSPH, DrPH (Cherokee Nation of OK) Executive Director Native American Cancer Research 3022 South Nova Road Pine, CO 80470-7830 Phone: 303-838-9359; Fax: 303-838-7629 Native Cancer Survivor’s Support Network: 1-800-537-8295 Web Page: http://NatAmCancer.org

Denver staff: Lisa Castro, Judy Hariton, Lisa Harjo, Rose Lee, Terri Rattler
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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OBJECTIVES By the end of this segment, the learner will be able to:
1. Identify at least 3 factors that increase your risks for developing cancer. 2. Identify at least 3 components of successful cancer prevention / early detection programs among Native Americans.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Updated data from IHS
Roberta Paisano, MHSA and David Espey, M.D., Indian Health Service National Epidemiology Program
“Best” source of data from any federal agency

Clearly illustrates regional variations
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Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

Five Geographic Regions
WA MT OR

ND
MN SD WI MI NE IA IN NY PA CO KS

ID

WY

ME

CA

NV

MA RI CT

UT

AZ

NM

OK MS TX LA

TN
AL

NC SC

AK

FL

ALASKA

NORTHERN PLAINS

EAST

PACIFIC COAST

SOUTHWEST

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Age-Adjusted Cancer Mortality Rates Breast, By Region, Females, 1994-98

Southwest

All IHS (14.2)
East Pacific Coast Alaska No. Plains

All US (24.0)

0

5

10

15

20

25

30

Rate per 100,000 per year, adjusted to 1970 U.S. population
Special thanks to Indian Health Service National Epidemiology Program: Roberta Paisano, MHSA and David Epsey, M.D

Age-Adjusted Cancer Mortality Rates Cervical, By Region, Females, 1994-98

Alaska

All US (2.6)
Pacific Coast

All IHS (3.7)
Southwest East No. Plains

0

1

2

3

4

5

6

7

8

9

10

Rate per 100,000 per year, adjusted to 1970 U.S. population
Special thanks to Indian Health Service National Epidemiology Program: Roberta Paisano, MHSA and David Epsey, M.D

Age-Adjusted Cancer Mortality Rates Ovary, By Region, Females, 1994-98

Pacific Coast

All IHS (5.2)
East

All US (7.4)
Southwest No. Plains Alaska

0

5

10

15

Rate per 100,000 per year, adjusted to 1970 U.S. population
Special thanks to Indian Health Service National Epidemiology Program: Roberta Paisano, MHSA and David Epsey, M.D

Age-Adjusted Cancer Mortality Rates Colon/Rectum, By Region, Females, 199498

Pacific Coast Southwest East No. Plains Alaska

All IHS (12.0)

All US (14.4)

0

5

10

15

20

25

30

35

40

45

50

Rate per 100,000 per year, adjusted to 1970 U.S. population
Special thanks to Indian Health Service National Epidemiology Program: Roberta Paisano, MHSA and David Epsey, M.D

Lung Cancer Mortality Rates Females, 1994-98

Southwest

All IHS (22.3) *
East

All US (33.9)
Pacific Coast Alaska No. Plains

0

25

50

75

100

Rate per 100,000 per year, adjusted to 1970 U.S. population

** Denotes a rate significantly higher (* lower) than the U.S. rate.

Who develops cancer?
Anyone can develop cancer. Cancer knows no prejudice It is found in all racial groups.
Both men and women develop cancer.

But, your chances of developing

cancer increase as you grow older.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Cancer develops over time...
It is a result of a complex mix of factors related to: lifestyle environment heredity/genetics These are called risk factors.
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Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

What “makes” a factor a bigger “risk” for cancer?
Frequency how often are you exposed to

the factor?

Duration Intensity

how long have you used or been exposed to the factor? how strong is the dosage of the factor?
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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What are examples of cancer risk factors?
Age: All people’s risk for developing cancer increases as they age. Previous diagnosis of cancer Anyone who has had cancer has a chance of having it again. Family history – parents, brothers or sisters diagnosed with colon cancer
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Examples of cancer risk factors
Gender: Some cancers are more common in women than in men (and vice versa) Obviously when one gender has organs the other does not (cervix, prostate)
Less obviously – hormonal? cultural life style patterns?

Alaska Native Women and colon cancer
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Examples of cancer risk factors
Habitual tobacco use Limited / no physical activity Being overweight or obese Elevated alcohol use (more than 7 “drinks” in a WEEK)
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Examples of cancer risk factors
Daily dietary behaviors Low amounts of vitamins A, C, E and the minerals calcium and folic acid.
Low amounts of fiber (beans, vegetables) may or may not be a risk

High in animal fat
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Increasing Mammography Rescreening Among Urban American Indian Women
 Funded by the NCI [R25 CA77665]  Preliminary research with CMAP showed that <16% of American Indian women participated in re-screening within 24 months of their last mammogram

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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The women in the study
 American Indian women age 40 and older  live in the Denver metropolitan area
 received at least one mammogram

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Research Design
GROUP No. BASELINE INTERVENTION POSTTEST

1 2 3

132 132 132

0 0 0

X1 X2 Observation Only

0 0 0

X1 = NAWWA breast education intervention X2 = Telephone breast education intervention

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Findings
Pretest Telephone Face-to-Face CMAP (comparison) Telephone Posttest 29.0 34.4 51.9 41.3

Face-to-Face 45.2 CMAP (comparison) 50.0 Pre vs Post for Navigator interventions, p=.013 Telephone vs. Face-to-Face, p=.83 Comparison Group had no change
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Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

Summary
• Intervention may have had a greater impact on women with lower educational levels • Improvement in screening from pretest (32%) to posttest (43%) • Greatest increase in adherence seen in women age 65+ • No difference between intervention modalities • Telephone intervention was not more cost effective than was the face-to-face
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Conclusions
The cultural education intervention had an increase in screening 50% within 24 months The number of women who lose access to a functioning private phone was higher than anticipated None of the existing data surveillance programs were appropriate

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Mission of NAWWA
Improve access to screening

Increase opportunities for health education
support circles for cancer survivors and their families.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Mission of NAWWA
Guided by community input and organizational leadership Works to engage program participants through culturally sensitive strategies.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Yvgvbvgets – Let’s Walk!® Guiding Principles
• Make good choices • Make a promise (to self as well as to others) • Set Goals (for self)
• Get Support (group)

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Yvgvbvgets – Let’s Walk!®
12 weeks
meets on Saturday at various city parks

walking, warm up exercises and nutrition
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Yvgvbvgets – Let’s Walk!
Family event

Special “gifts” for special days

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Yvgvbvgets – Let’s Walk!®
Journal Pedometer A water bottle Healthy snacks Perseverance! Takes time for the community to trust and accept
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Healthy Eating: Guiding Principles •Reduce fats •Control Serving Size •Vary Food Preparation: •Steam •Bake/Broil •Sauté
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Benefit of Healthy Eating Eat a variety of healthy foods. Includes at least five servings of fruits and vegetables each day. This will: •Increase energy •Increase weight loss •Strengthen the heart •Prevent cancer
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Local Healthy Recipes
Contributed by local women and staff

Rose adds nutritional breakdowns
Staff modifies recipe to be healthier and still tasty

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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What is an American Indian Cancer Survivor Support Circle?
A place where … American Indian cancer survivors can share their experiences with someone like them who has been there. You can learn more about your cancer, your treatment, your recovery, and life after.
Your culture is respected and valued.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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How does a support circle work?
A series of 8-12 meetings are set up with dates, locations, and topics Meeting dates are posted around the community, in newsletters, and flyers are shared with American Indian community members Circle Members invite others who have or have had cancer
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Native Survivors’ Support Circles
Doctors and clinics who provide care for American Indian cancer patients refer Circle members Organizations, both Indian and nonIndian, refer individuals to the Circle Family members of cancer survivors are also invited to join in the meeting.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Tips for Successful Support Circles
Begin each session with a prayer or silent time for members Provide dedicated time for members to share their experiences since the previous week’s meeting Survey members to see which topics they want to cover and in what order
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Tips for Successful Support Circles
Hold sessions at times that are convenient for members, for example evenings, weekends Be flexible with the topics and modify agenda as the needs of the members demand Have tissues handy for members. Help to lighten the mood when necessary.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Tips for Successful Support Circles
Have healthy and appropriate food available for meetings. Encourage circle members to establish rules for interaction and to follow them Utilize the Medicine Wheel to address the physical, mental, emotional and spiritual aspects of life and survival
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Tips for Successful Support Circles
Hold meetings in a private, safe place

Keep the size of Circles reasonable. 610 members is a great number for interaction and trust Be patient… may take 1-2 years to get going Be persistent. Set meeting dates, hold meetings, even if only one person comes. And do it again and again. People will come.
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Sample Topic List
Dietary Concerns
Radiation Therapy

Chemotherapy Surgery Outlook on Life

Pain Control Intimacy and Sexuality

Spirituality / Traditional Indian Medicine
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Annual Wellness Event: Purposes
Promote healthy living; prevention of diseases Collaboration among AI organizations Overall wellness rather than limiting a behavior to specific disease prevention Behaviors that help prevent/reduce diabetes also prevent/reduce cancer, heart disease, obesity
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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What else can I do about my health?

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Don’ts”
Smoke cigarettes (i.e., misuses the sacred gift of tobacco) Drink more than 1 drink of any alcoholic beverage in a day Use medicines (over-the-counter and prescriptions) inappropriately Use recreational drugs
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Don’ts”
Over-consume caffeine (less than 4 cups of
coffee, tea, cola soda -- chocolate)

Gossip / trash family, neighbors, friends – brings evil back onto yourself Beat yourself up for mistakes – but take action to NOT repeat those errors Feed” a grudge … whose path are you on?
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Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

Daily Healthy Behaviors: “Do’s”
Pray (greet the sun) Get vigorous weight-bearing physical activity (like walking, biking, dancing) Drink “lots” of water Eat foods that are low fat / low calorie / low sugar Eat foods that have folic acid and iron; vitamins A, B1, B2, B6, C, D, E
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Do’s”
Eat foods that are high in dietary fiber (e.g., vegetables, fruits) Take at least 15 minutes every day to do something you personally enjoy (e.g., dance? weave? bead? sing?) Take medications and vitamin supplements as recommended
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Do’s”
Practice healthy stress relief Compliment family, neighbors, friends for something they have done or do that you appreciate

Dedicate at least 15 minutes of uninterrupted time to be with your husband /wife /parent /child. Total concentration!!
Laugh
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Do’s”

Practice responsible sexual behavior Planned pregnancy (=use birth control) Avoid exposure to sexually transmitted diseases (e.g., HIV, herpes; minimize number of partners)
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Do’s”
Summarize your day by identifying something … good that happened that day you did that was good
someone else did that was good
Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Daily Healthy Behaviors: “Do’s”

Pray (sundown prayers and songs) Thank the Creator for our blessings

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Weekly / Monthly Healthy Behaviors: “Do’s”
Ceremonial / spiritual growth Maintenance of healthy weight Sufficient consumption of water / fluids Sufficient consumption of vitamins and minerals
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Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

Weekly / Monthly Healthy Behaviors: “Do’s”
Healthy balance of family, work, community
If not, develop a plan for how you can do a better job bringing balance into your life …

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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Annual Healthy Behaviors: “Do’s”

Immunizations Vaccinations
Maintenance of healthy weight

Ceremonial / spiritual growth

Reducing Cancer Risks - Burhansstipanov- NACR 303-838-9359

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