Tribal Cancer Control Education Eric Vinson Northwest Tribal Comprehensive Cancer Program March 12, 2009 Risky Business Training Supported by CDC Grant #1 U58 DP000786-2

Northwest Portland Area Indian Health Board Organizational Chart 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board NTCCP Mission To envision and work toward cancer-free tribal communities by taking an integrated and coordinated approach to cancer control 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board 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 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board 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. 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board 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. 11/28/2018 Northwest Portland Area Indian Health Board

Normal vs Cancerous Cells 11/28/2018 Northwest Portland Area Indian Health Board

Ca 101 Learning Module 1 Cancer among American Indians And Alaskan Natives Goal: Understand the growing health concern of cancer among AI/AN. 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Cancer Background Lifestyles : Traditional and Western Dietary changes Decrease in exercise Personal vs. traditional use of tobacco 11/28/2018 Northwest Portland Area Indian Health Board

What We Know About Cancer Among AI/AN Cancer rates on the increase Second leading cause of death for AI Leading cause of death for AN Patterns for cancer types vary 11/28/2018 Northwest Portland Area Indian Health Board

What We Don’t Know About Cancer Among AI/AN Limitations of data: Racial misclassification Undercounting Coding errors Insufficient numbers Cannot be generalized 11/28/2018 Northwest Portland Area Indian Health Board

Northwest AI/AN Cancer Data Leading Cancer Sites 1996-2002 Breast Lung Colorectal Prostate Leukemia/Lymphoma 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board 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. 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Cancer Survival Rates Contributing factors: Late detection Treatment compliance Concurrent disease Access to care Barriers to care 11/28/2018 Northwest Portland Area Indian Health Board

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. 11/28/2018 Northwest Portland Area Indian Health Board

What are some Limitations of data? Question What are some Limitations of data? Racial misclassification Undercounting Coding errors Insufficient numbers Cannot be generalized 11/28/2018 Northwest Portland Area Indian Health Board

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. 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

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 11/28/2018 Northwest Portland Area Indian Health Board

What are the three recommended screenings for Breast Cancer? Questions What are the three recommended screenings for Breast Cancer? Breast Self-Exam (BSE) Clinical Breast Exam (CBE) Mammography or Mammogram 11/28/2018 Northwest Portland Area Indian Health Board

Cancer 101 Learning Module 6 Support for Patients and Caregivers Goal: Understand the psychological and social issues that affect cancer patients and their caregivers. 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Coping with feelings Common emotions after diagnosis: Denial Anger Stress Anxiety Depression 11/28/2018 Northwest Portland Area Indian Health Board

Support for the Patient Do: Treat me like you always have Be there for me Share emotions with me Help my family Ask if I’d like to talk Listen 11/28/2018 Northwest Portland Area Indian Health Board

Support for the Patient Remember now more than ever before, people are surviving after a Cancer diagnosis. 11/28/2018 Northwest Portland Area Indian Health Board

Support for the Caregiver Caregiving can be made less stressful by: Setting realistic limits Offer periodic breaks Support groups Use community and volunteer resources 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board The Path to Recovery Facing a cancer diagnosis and surviving cancer treatment may be the greatest challenge a person will face in their lifetime. 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Path to Recovery How we become well again: Attain and maintain balance Find a sense of purpose Keep physical & emotional defenses strong Share stories of survival 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Question What are some ways to support caregivers? Set realistic limits Offer periodic breaks Support groups Use community and volunteer resources 11/28/2018 Northwest Portland Area Indian Health Board

Tribal Cancer Action Planning Cancer Control in Northwest Tribal Communities Prevention Screening & Early Detection Treatment Survivorship Rehabilitation Palliation 11/28/2018 Northwest Portland Area Indian Health Board

Cancer Prevention through Education and Outreach Women’s Health Example Objective Strategy Evaluation Increase the awareness of women aged 40 and older about the importance of annual mammograms. Develop a community awareness campaign Plan a “women’s health day” to distribute information about breast health Plan an activity in connection with Breast Cancer Awareness Month (October) 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 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board 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 11/28/2018 Northwest Portland Area Indian Health Board

Sample Tribal Action Plan Activity: Cancer Mural Walk Action Steps Accountability Schedule Resources Feedback Mechanism Primary Others Start Complete Dollars Time (hrs) Register to Use Park Jensen Thayer, WA BCCP May 7, 2007 $25 0.3 Get Tables for Park ONCS ACS Wagon Rental $195 T-Shirts Pat Ike/ONCS WA BCCP $600 8 Cancer Pins/Tape Measures $50 0.60 Juice Ellen Doublerunner/ONCS Yakama Juice $108 Mural Walk Posters Yakama Legends Casino $200 Mural Walk Maps Mural Society .15 Cancer Literature Yakama Navigator .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 11/28/2018 Northwest Portland Area Indian Health Board

Partners Foundations and Non-Profits American Indian and Alaska Native Organizations State and Federal Organizations

Northwest Portland Area Indian Health Board Upcoming Activities April 20, 2009 Northwest Tribal Cancer Coalition March 8-13, 2009 (This week!) Community based Cancer-Control: A Seminar for American Indian and Alaska Native Community Health Advocates June 15 - July 2, 2009 Summer Research Training Institute For American Indian and Alaska Native Heath Professionals 11/28/2018 Northwest Portland Area Indian Health Board

Northwest Portland Area Indian Health Board Contact Information Northwest Tribal Comprehensive Cancer Program Kerri Lopez (Tolowa), Project Director Eric Vinson (Cherokee), Project Coordinator Tom Becker, MD, PhD, Medical Epidemiologist Northwest Tribal Registry Project Megan Hoopes, MPH, Project Director Phone: 503-416-3301 Email: klopez@npaihb.org 11/28/2018 Northwest Portland Area Indian Health Board