Tribal Cancer Control Education

Eric Vinson
Northwest Tribal Comprehensive Cancer Program
May 21, 2012
Risky Business Training

Northwest Portland Area

Indian Health Board
Indian Leadership for Indian Health
Supported by CDC Grant #1 U58 DP000786-4
 Organizational Chart

N o r th w e st P or tla n d A r e a In d ia n H e a lth B o a rd
E x e c utiv e C o m m itte e M em b e rs

N P A IH B
J o e F in kb o n n e r,
E x e cu tiv e D ire c tor

N o r th w e st T rib a l E p id e m o lo g y C e n ter
V ic to ria W arre n -M e a rs,
D ire c tor

NTCCP & W TDP

K e rri L o p e z,
D ire c tor

Northwest Diabetes Project NTC C P National Diabetes Project

& W H PP
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 Northwest Tribal Cancer
Control Project (NTCCP)

July 1998
Northwest Portland Area Indian
Health Board Delegates resolved to
form the Northwest Tribal Cancer
Coalition and the Northwest Tribal
Cancer Control Project

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 NTCCP Mission

To envision and work toward cancer-

free tribal communities by taking an
integrated and coordinated approach
to cancer control

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 NTCCP 20 Year Plan

An integrated and coordinated approach

towards preventing and controlling
cancer in tribal communities

To reduce cancer incidence, mortality,

and morbidity among American Indians
and Alaskan Natives (AI/AN) in Northwest
tribal communities

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 NTCCP Goals

• Facilitate a process for Northwest tribes to

promote cancer risk reduction strategies.
• Provide information on the most current early
detection, screening and treatment practices
through education and resource materials.
• Provide education regarding quality of life for
cancer patients, their families and caregivers.
• Coordinate and collaborate with local and national
cancer organizations and individuals.
• Improve Indian-specific cancer control data.
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 Cancer 101:
6 Lessons to help Us Understand Cancer

• Cancer among American Indians and

Alaskan Natives
• What is Cancer?
• Screening and Early Detection
• Risk Factors and Risk Reduction
• Diagnosis and Treatment
• Support for Patients and Caregivers
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 What Is Cancer?

• The term “cancer” refers to more than 100

different diseases that begin in the cells,
the body’s basic unit of life.
• Cancer develops when cells grow and form
more cells without order or control.
• Under normal circumstances, new cell
growth and old cell death are kept in
balance.
• In cancer, this balance is disrupted.
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 Normal vs Cancerous Cells

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 Ca 101 Learning Module 1

Cancer among American Indians

And Alaskan Natives

Goal: Understand the growing health

concern of cancer among AI/AN.
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 Cancer Background

Lifestyles : Traditional and Western

• Dietary changes

• Decrease in exercise

• Personal vs. traditional use of tobacco

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 Cancer Survival Rates

AI/AN have the lowest five-year survival

rate for all cancer sites combined of
any racial group in the U.S.

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 Cancer Survival Rates

Contributing factors:
• Late detection
• Treatment compliance
• Concurrent disease
• Access to care
• Barriers to care

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 Improving Survival Rates

• Reduce barriers to care

• Increase participation in screening

and early detection services

• Chance for survival is better if

cancer is found early.
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 Breast and Cervical Cancer 101
Adapted from Modules 3&4
Risk Factors and Risk Reduction
Screening and Early Detection
Goals:
Understand breast and cervical cancer risk factors
and how to reduce risks associated with cancer.
Understand breast and cervical cancer screening
and early detection and why it is important.

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 Am I at risk for breast cancer?

Research has shown that these factors increase your risk:

• Gender (Female) • HRT

• Age •Alcohol
• Family History •Personal history
• Genetic alternations •Diet
• Benign breast disease •Obesity
• Early Menstruation •Radiation
• Not Having Children •Aging
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 Can I do anything to reduce my
risk for breast cancer?
• Regular exercise
• Breastfeeding during pregnancy
• Maintain a healthy diet
• Maintain a healthy weight
• Limit alcohol consumption
• Consult with your clinician regarding
menopausal hormone use
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 What are the symptoms of
Breast Cancer?
• A lump or thickening in or near the breast or
underarm
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple
pulled back (inverted) into the breast
• Ridges or pitting of the breast (the skin looks
like the skin of an orange
• A change in the way the skin of the breast,
areola, or nipple looks or feels

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 Screening for Breast Cancer

• Breast Self Exam (BSE):

 DO NOT substitute BSE for regularly scheduled
mammograms and clinical breast exams.
• Clinical Breast Exam (CBE):
 Performed by a healthcare professional.
• Mammogram:
 A special kind of x-ray image of the breasts.
 Women in their 40’s and older should have a
mammogram regularly, every 1 to 2 years

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 Am I at risk for Cervical
Cancer?
You are at risk if you…
• Are a women
• Sexually active before age 16
• Many sexual partners
• No regular Pap tests
• Weakened immune system
• Over age 40
• Smoke cigarettes
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 What causes Cervical Cancer?

• Human papillomavirus (HPV)

 Very common virus – over 100 types!
 About 15 types cause cervical cancer
 Other types cause warts, but not cancer

• Other factors may work with HPV to increase your

risk of developing cervical cancer:
 Use of birth control pills more than 5 years
 Having 7 or more children
 Smoking cigarettes

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 Prevention and Early Detection

Pap Test (or Pap Smear)

• Performed in a doctor’s office or
clinic during a pelvic exam
• Looks at cervical cells
• Is used to detect cancer or changes
that may lead to cancer
• Can show non-cancerous conditions
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 How often should women have
Pap tests?
Doctors generally recommend that women:

• Should begin having Pap tests 3 years after they

begin having sexual intercourse or when they turn
21
• Should have a Pap test at least once every 3 years
• Who have had a total hysterectomy do not need
to have cervical cancer screening, except if they
had cervical cancer

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 Questions

What are the three recommended

screenings for Breast Cancer?

• Breast Self-Exam (BSE)

• Clinical Breast Exam (CBE)
• Mammography or Mammogram

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 Tribal Cancer Action Planning

Cancer Control in Northwest Tribal

Communities
 Prevention
 Screening & Early Detection
 Treatment
 Survivorship
• Rehabilitation
• Palliation
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 Cancer Prevention through
Education and Outreach
Women’s Health Example
Objective Strategy
Increase the awareness of Develop a community
women aged 40 and older awareness campaign
about the importance of Plan a “women’s health
annual mammograms. day” to distribute
information about breast
health
Plan an activity in
connection with Breast
Cancer Awareness Month
(October)
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Evaluation
Record activities of awareness
campaign·
Record number of persons served at
community health day
Measure awareness of importance
of screening
Survey community for change in
level of awareness of importance of
screening
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 Tribal Action Plans

Planning to achieve a specific objective.

Includes:
• Who will conduct each component of the activity
• When actions are to be carried out
• What resources need to be allocated
• What outcomes are anticipated
• What evaluation is needed to determine success

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 Sample Tribal Action Plan
Activity: Cancer Mural Walk
Feedback
Action Steps Accountability Schedule Resources
Mechanism
Time
Primary Others Start Complete Dollars
(hrs)
Register to Use Park Jensen Thayer, WA May 7, May 7, $25 0.3
BCCP 2007 2007
Get Tables for Park ONCS ACS

Wagon Rental Jensen Thayer, WA $195 0.3

BCCP

T-Shirts Pat Ike/ONCS WA BCCP $600 8

Cancer Pins/Tape Measures Jensen Thayer, WA $50 0.60

BCCP
Juice Ellen Yakama Juice $108 0.60
Doublerunner/ONCS
Mural Walk Posters Ellen Yakama Legends $200 8
Doublerunner/ONCS Casino
Mural Walk Maps Jensen Thayer, WA Mural Society .15
BCCP

Cancer Literature Yakama Navigator ACS .30

Total $1,188 18.25 Sign-In

Sheets
Yakama ONCS Mural Walk/Ride
2005
 Successful Strategies for
Developing Partnerships
• Use partnerships to extend resources and
delivery
• Partner with providers and other clinical
staff
• Consult with other tribal programs
• Partner with state programs for services and
training
• Use advisors to provide clinical guidance
and test new ideas
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 Partners
Foundations and Non-Profits

American Indian and Alaska Native Organizations

State and Federal Organizations

 Tribal Action Plans

Planning to achieve a specific objective.

Includes:
• Who will conduct each component of the activity
• When actions are to be carried out
• What resources need to be allocated
• What outcomes are anticipated
• What evaluation is needed to determine success

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 Upcoming Activity

June 5&6, 2013

• Northwest Tribal Cancer Coalition Tobacco
Cessation Facilitation Training
 Second Wind Curriculum
 Portland, Oregon

Online Registration:
https://www.surveymonkey.com/s/
June2013NWTribalTobaccoCessation
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 Contact Information
Northwest Tribal Comprehensive Cancer Program
Kerri Lopez (Tolowa), Project Director
Eric Vinson (Cherokee), Project Coordinator
Elizabeth Viles (Siletz), Project Assistant
Tom Becker, MD, PhD, Medical Epidemiologist
Improving Data & Enhancing Access - NW (IDEA-NW) Project
Sujata Joshi, MPH, Project Director
Phone: 503-416-3301
Email: klopez@npaihb.org
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