50 years of data show cancer still leading cause of death for Alaska Natives

A sign that says Alaska Native Medical Center
The Alaska Native Medical Center in Anchorage. (Joey Mendolia/Alaska Public Media)

A new study from the Alaska Native Tribal Health Consortium shows cancer rates among Alaska Native people have increased over the last half-century.

Researchers say the data points to opportunities for prevention.

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The most common cancers among Alaska Native people are breast, colorectal and lung cancer. And with screenings like mammograms and colonoscopies, they can be detected and treated early.

But cancer remains the leading cause of death for Alaska Native people — as it has been for decades.

“This is outrageous. Why are we not at war with this thing? Why are we not doing more?” asked Eric Fox, who lost his mother to cancer in 2017.

Within months of her death, Fox was serving on the state’s advisory board to the American Cancer Society. He said you’d be hard-pressed to talk to anyone in the Alaska Native community who hasn’t lost someone close to cancer.

“It’s happening every day,” he said. “One-fifth of our deaths in the Alaskan Native community are attributed to cancer.”

Fox’s mother died after a long battle with colorectal cancer — which Alaska Native people have at the highest rates in the world, according to data collected by the Alaska Native Tribal Health Consortium.

And Alaska Native rates of colorectal cancer have been constant over the last half-century, while the incidence among white people has gone down. It’s a growing disparity.

“This disparity has persisted for the entire time that we’ve had a cancer registry,” said Sarah Nash, cancer surveillance director at Alaska Native Tribal Health Consortium. She and her team collect cancer information in a “tumor registry” for all Indigenous people living in Alaska.

“These data provide a baseline from which we can then go away and ask other questions. And we can use this for the base of public health programming and research,” Nash said.

Screening for cancer is one element of prevention. Lifestyle choices such as a healthy diet, exercise and quitting smoking can significantly reduce risk. But cancer is a tough problem to solve, she says. Each case has more than one contributing factor.

“Every cancer is a different jigsaw puzzle. So for one person, the jigsaw puzzle may look like smoking and historical trauma and lack of activity. And for another person, it might look like genetics and diet and some kind of chemical exposure,” Nash said.

It’s rare to have cancer data spanning 50 years, but the tumor registry at ANTHC does. This year the data team released a report compiling the data. Researchers say the findings are crucial to address higher rates of certain cancers and health disparities.

For example, physicians usually recommend anyone over 50 years old to be screened for colorectal cancer. But the registry showed Alaska Native patients tended to get the cancer at a younger age, so ANTHC changed the screening recommendation to include people 40 and older.

Ayyu Qassataq, a breast cancer survivor, says she’d like to see more Alaska Native-specific protocols like that one.

“At the time that I went through cancer as a young woman, younger than so-called normal, there were a number of other Alaska Native women who I was going through treatment with at the same time, who were having the exact same experience. Younger than, you know, the recommended age for annual mammograms and those kinds of things,” Qassataq said.

Qassataq found her cancer by chance in her late 30s and has been cancer-free for a few years, but she’s still managing long-term health effects from treatment. She said if cancer messaging had been targeted to her demographic, she would have been more likely to pay attention and perform monthly self-checks.

Indigenous knowledge should also be incorporated into cancer treatment, she said: Things like plant medicine and ceremony helped heal her whole person. She said it’s important to take a holistic approach when talking about health disparities, too.

“We need to be able to really look at those things and be able to talk about them, and not look at the statistics in isolation from the context that created them,” Qassatak said. “I want to have those conversations about how we talk about health equity and the root causes of the inequities that we experienced.”

The data highlights a hard reality, but Eric Fox — the advocate working with the American Cancer Society — says it’s one that can change with more awareness. Medical recommendations are just one part of the solution, he says. The other is changing what he calls a generational mindset of toughing things out.

“We’ve got to make it okay in our community to have these conversations, to bring awareness, and ask the people that we love and care about to go and get these screenings,” he said.

Colonoscopies and mammograms can be a delicate subject, but Fox wants to eliminate those taboos. That little bit of discomfort can save a life.