Fighting breast cancer; A Native woman's journal; IS CANCER THE NEW SMALLPOX?
Leaving aside for a minute the tobacco companies that ruthlessly market
their cancer sticks, I'm not saying the blankets are poisoned.
I am saying it's a disease, or 400-some related diseases, that will maim or
kill 1 in 2 American men and 1 in 3 American women. Unlike cancer among
other Americans, little has been known until recently about cancer among
American Indians ... except that we have the lowest five-year survival
rates in the nation.
The lack of knowledge reminds me of when a mysterious new illness called
smallpox was first sweeping through tribal communities.
I began taking cancer personally on Jan. 7 when I was diagnosed with an
aggressive form of breast cancer. I quickly turned my newspaper reporting
skills to researching cancer, both for myself and in the hope that my
writing could help Native America deal with this worldwide pandemic. So
I've been sitting at my kitchen table, drinking healthful green tea instead
of my old toxic coffee and running up my phone bill by calling the small
handful of experts in American Indian cancer.
"I think cancer control is about to enter one of those great successes like
vaccinations, and Native people aren't sharing in it," said David Espey, an
epidemiologist with the Centers for Disease Control and Prevention who is
on assignment with the Indian Health Service in Albuquerque, N.M.
Espey is the author of a new analysis of cancer mortality rates among
American Indians and Alaska Natives which was published last month in
"Cancer," a journal of the American Cancer Society. Espey states that what
might be obvious to us as Native people, is likely revolutionary in the
world of medical statistics.
Up to now researchers have looked for national estimates of cancer rates
among American Indians and Alaska Natives. But that notion of a single rate
for all Natives, or even of a generic Indian, is one of the great American
myths.
In everything from popular movies to cancer data, that notion causes us to
miss the truth. The truth in this case, Espey said, is that cancer varies
geographically among tribal communities, whose members have different gene
pools, different eating habits and different exposures to environmental
pollutants.
The data is further flawed because 41 percent of Native people were
racially misclassified when someone else, such as a hospital administrator
or a funeral home director, filled out the paperwork.
Natives in the Northern Plains and Alaska suffered the highest cancer
mortality rates: far higher than Native in the East, Southwest or Pacific
Coast.
Let's look at lung cancer mortality to understand the geographic
differences among Native people. Lung cancer mortality, Espey reported, is
four times higher in Northern Plains tribes than Southwestern tribes.
Smoking, as ABC anchorman Peter Jennings so bravely explained when he
recently announced his own lung cancer, is a key factor in this kind of
cancer. The rates for lighting up that Espey reported for Natives bear that
out: smoking is less common among Southwestern tribes. But in Northern
Plains states, as many as 50 percent of adults smoke. Smoking is growing
among Alaska Natives in the 49th state, as are deaths from lung cancer.
Alaska Native women have the highest rates of colon cancer of any racial,
ethnic or gender group in the country. Cancer of the gall bladder is four
times higher among Native people than among all other Americans. It strikes
particularly in the Southwest, where other cancer rates are lower.
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But gall bladder cancer, unlike colon cancer, is declining among Natives.
So is cervical cancer, which has decreased among Native women by 36 percent
in recent years compared with a decrease of only 15 percent among all races
combined.
Prostate cancer is another one to watch. Dr. Jeft Henderson, a Cheyenne
River Sioux and epidemiologist with the Black Hills Center for American
Indian Health, believes that prostate cancer among Lakota men occurs at a
rate comparable to African-American men, who are generally considered to
have the highest rate in the nation.
Generalized American Indian statistics from the Centers for Disease Control
and Prevention put prostate cancer rates at 20 per 100,000, or half the
rate for white men and one-quarter the rate for African-American men.
Henderson is seeking a grant from the National Institute of Health to
accurately document rates among Lakota men.
Original epidemiology studies comprise the center's primary business, which
Henderson founded six years ago in Rapid City, S.D. Epidemiology is the
study of the sources of disease.
In six years, the center has won $10 million in federal grants to study
different aspects of Native cancer. That puts the Black Hills center, with
its 10 employees, in direct competition for funding with Harvard, Stanford
and Johns Hopkins, a few of the universities that have dabbled in Native
epidemiology.
Henderson said the center is attempting studies that no one else has ever
considered among Native Americans. Henderson blames the statisticians who
say things like, "It will be exceedingly costly to do this right with
American Indians." He also blames the researchers who parachute into tribal
communities and never take the time to build relationships.
"We've been excluded from the larger studies for decades," Henderson said.
"Meanwhile, the most glaring health disparities are those that exist
between American Indians and Alaska Natives and the general population,
particularly in the area of cancer."
Now the center, along with its partners the University of Utah and the
Alaska Native Tribal Health Consortium, is in the pilot phase of what
promises to be the largest epidemiology study of American Indians. Called
the EARTH Study, or the Education and Research Toward Health Study, it aims
to follow 16,000 young Native adults for (hopefully) decades to chronicle
their diets, habits and lifestyles that might contribute to cancer.
"It is our hope that none of these individuals will develop cancer in their
lifetimes," Henderson told me. "But some will, despite our best efforts.
People will continue to smoke, eat junk food and work in dangerous jobs."
The information about those who develop cancer will give future generation
a baseline understanding about how this disease develops among us. Right
now we are working in the dark, and that hurts our chances to get the
dollars and the community support we need to stop cancer from ravaging our
communities.
Statistically, our lives are expected to get longer. Our children born in
the middle 1990s will probably live until their 70s, compared with Natives
born in 1940 who were only expected to live until 50. Those future
generations will need to understand cancer better because in living longer,
they will be more likely to face cancer.
Knowing how to prevent cancer, or even live with it, will make all the
difference for future generations.
Kara Briggs is a Yakama journalist from Portland, Ore., where she is
currently on medical leave from her job at The Oregonian. She chronicles
her battle with breast cancer in this bimonthly series. She is a former
president of the Native American Journalists Association and winner of the
2004 Richard LaCourse Award for Investigative Journalism.
She is interested in the experiences of readers who have had cancer and
also remedies, cultural practices or unusual treatments that have helped
them. Contact her by e-mail at briggskm@gmail.com or by mail through
Indian Country Today.
