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Am J Public Health. 2014 Jun;104 Suppl 3:S415-22. doi: 10.2105/AJPH.2013.301681. Epub 2014 Apr 22.

Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999-2009.

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Meg Watson, Vicki Benard, Cheryll Thomas, and Annie Brayboy are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Roberta Paisano is with the Indian Health Service (IHS), Albuquerque, NM. Thomas Becker is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland.



We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races.


We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009.


AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter.


Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions.

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