Ovarian and uterine cancer incidence and mortality in American Indian and Alaska Native women, United States, 1999-2009

Abstract

Objectives: We examined geographic differences and trends in incidence and mortality of ovarian and uterine cancer in American Indian/Alaska Native (AI/AN) women.

Methods: We linked mortality data (1990-2009) and incidence data (1999-2009) to Indian Health Service (IHS) records. Death (and incidence) rates for ovarian and uterine cancer were examined for AI/AN and White women; Hispanics were excluded. Analyses focused on Contract Health Service Delivery Area (CHSDA) counties.

Results: AI/AN and White women had similar ovarian and uterine cancer death rates. Ovarian and uterine cancer incidence and death rates were higher for AI/ANs residing in CHSDA counties than for all US counties. We also observed geographic differences, regardless of CHSDA residence, in ovarian and uterine cancer incidence and death rates in AI/AN women by IHS region; Pacific Coast and Southern Plains women had higher ovarian cancer death rates and Northern Plains women had higher uterine cancer death rates.

Conclusions: Regional differences in the incidence and mortality of ovarian and uterine cancers among AI/AN women in the United States were significant. More research among correctly classified AI/AN women is needed to understand these differences.

FIGURE 1—

Incidence rates by year for (a) ovarian cancer and (b) uterine cancer: CHSDA counties; United States; 1999–2009. Note. AI/AN = American Indians/Alaska Natives; CHSDA = Contract Health Service Delivery Areas; CI = confidence interval; IHS = Indian Health Service; NHW = non-Hispanic White; NPCR = National Program of Cancer Registries; SEER = Surveillance, Epidemiology, and End Results Program. Rates per 100 000 persons and were age adjusted to the 2000 US standard population (11 age groups; Census P25-1130). AI/AN race is reported by NPCR and SEER registries or through linkage with the IHS patient registration database. Includes only AI/AN of non-Hispanic origin. Source. Cancer registries in the Centers for Disease Control and Prevention’s NPCR or the National Cancer Institute’s SEER program. Years of data and registries used are as follows: 1999–2008: WI^a; 1999–2009 (43 states): AK,^a AL,^a AZ,^a CA,^a CO,^a CT,^a DE, FL,^a GA, HI, IA,^a ID,^a IL, IN,^a KS,^a KY, LA,^a MA,^a MD, ME,^a MI,^a MN,^a MO, MT,^a ND^a NE,^a NH, NJ, NM,^a NV,^a NY,^a OH, OK,^a OR,^a PA,^a RI,^a SC,^a TX,^a UT,^a VT, WA,^a WV, WY^a; 1999–2001 and 2003–2009: DC; 2001–2009: AR, NC,^a SD^a; 2002–2009: VA; and 2003–2009: MS,^a TN. ^aState with ≥ 1 county designated as CHSDA.

FIGURE 2—

Death rates by year for (a) ovarian cancer and (b) uterine cancer: CHSDA counties; United States; 1990–2009. Source: AI/AN–US Mortality Database (1990–2009). Note. AI/AN = American Indian/Alaska Native; CHSDA = contract health service delivery areas; IHS indicates Indian Health Service; NHW = non-Hispanic White;. Analyses are limited to persons of non-Hispanic origin. Cancer causes of death was created using the Surveillance, Epidemiology and End Results (SEER) Cause of Death recode. AI/AN race is created using death certificate race and IHS Link. Rates are per 100 000 persons and are age-adjusted to the 2000 US standard population (11 age groups - Census P25-1130). States and years of data excluded because Hispanic Origin was not collected on the death certificate: LA: 1990; NH: 1990–1992; OK: 1990–1996. Percentage of regional coverage of AI/AN in CHSDA counties to AI/AN in all counties: Northern Plains = 64.8%; Alaska = 100%; Southern Plains = 76.3%; Southwest = 91.3%; Pacific Coast = 71.3%; East = 18.2%; Total US = 64.2%.