1. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Title slide
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

2. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Breast cancer knows no prejudice and affects Native women just as it does other women.
Most Non-Native women are diagnosed with breast cancer after the age of 50.
However, based on women in the “National Native American Cancer Survivors’ Support Network” about half of Native women diagnosed with breast cancer were younger than age 50.
Although most American Indian and Alaska Native women who are diagnosed with breast cancer are 40 years old and older, some younger Native women have also been diagnosed.
These three photos are of women enrolled in the National Native American Breast Cancer Survivors’ Support Network ( ). These and others have helped Native American Cancer Research (NACR) develop cancer education support resource materials. We hope this product is of use to you and your community.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

3. All four are employees of NACR.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Lisa Harjo, MA (Choctaw) took the leadership role in modifying this education product.
Terri Rattler (Oglala) helped to refine the product and assisted Ms. Harjo in the focus group evaluation and pretesting.
Linda Burhansstipanov (Linda Bee) (Cherokee) helped refine and added the scientific and cultural-specific information and layout of the product.
Rick Clark helped modify graphics to respond to focus group members’ suggestions and expert reviewers’ comments.
All four are employees of NACR.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

4. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
NACR staff have wanted to develop culturally relevant resources such as this material for many years. However, to do so in a conscientious, scientific, and culturally respectful manner requires funding.
We are very thankful to the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation for supporting our local NACR program, “Native American Women’s Wellness through Awareness” (NAWWA). Through their support in 2002, NACR staff were able to develop, pretest, and disseminate this product.
NACR is a partner with Mayo Clinic’s Native American Programs (“Spirit of EAGLES”, the Native CIRCLE, and the Native WEB). “Spirit of EAGLES” funding partially supported the refinement and dissemination of this product.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

5. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Linda Krebs, RN, AOCN, PhD, provided a very detailed review of scientific accuracy.
Catherine A. Offutt, was the Project Coordinator of the Pathways to a Healthy Life project, which was supported by the national Susan G. Komen Breast Cancer Foundation in 1999 (grant #9820). This was a partnership among the women’s Health Coordinators from the Navajo Nation, Hopi Tribe, Indian Health Service, the New Mexico Breast and Cervical Cancer Program, Zuni and Apache Nations. The graphics from their lovely and effective booklet were used or modified for use within this product.
The Rocky Mountain Cancer Information Service Partnership Program developed the original flip chart which served as the model for this product, Spread the Word about Mammograms and the Pap Test: An Educational Resource for Health Care Professions. Pub. No This product is limited to breast because NACR is awaiting approval to use graphics from another American Indian program within the Cervix Health product.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

6. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
This is an introductory slide with a focus of the message we want to leave with them. It is presented here in case the women are unable to take part in the entire health education session.
NAWWA is the name of our local Denver program. It stands for Native American Women’s Wellness through Awareness.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

7. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Cancer was not a common disease among our ancestors, even among those who reported lived to very old ages (90+).
Cancer has been gradually increasing among American Indians and Alaska Natives since World War II.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

8. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Even though many of our ancestors lived to be very old, cancer was not a common disease among Native peoples living in North America.
Many of the daily practices which were necessary for survival, were also helpful in preventing the development of cancer (e.g., physical activity was needed to obtain food for the family and community).
Unfortunately, we have changed or stopped many of these practices. Since we are not behaving in a healthy way, almost all Native communities are having an increase in cancer, diabetes, heart disease, and obesity. All four of these diseases can be reduced or eliminated by living a healthy lifestyle.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

9. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Since the introduction of European cultures to the North American continent, many Natives choose or were forced to quit traditional practices.
In place of healthier behaviors, they adopted unhealthy practices, like alcohol drinking, habitual tobacco smoking (rather than reserving tobacco for ceremonies), eating unhealthy high fat, high sugar foods, and getting little daily physical activity.
These lifestyle changes are NOT limited to Natives, but have occurred in most cultures living in North America.
These lifestyle changes may lead to increases in diseases such as cancer.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

10. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Sample script:
Today I want to talk with you about your breasts and breast cancer. In particular, I’d like to talk to you about how important it is to practice breast health behaviors regularly (like monthly BSE, annual CBE, and annual mammograms).
It is really important for you to know that breast cancer has a high cure rate when detected or found early.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

11. We need to be healthy again.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
It is important to note that breast cancer rates vary across the country and for different racial/ethnic groups
Many health care providers tell Native patients that they are unlikely to develop breast cancer. This is because most of the national statistics that are published from federal agencies only use information from the southwest.
Cancer data cannot accurately be generalized from one region of Indian Country to another. This means statistics from the east cannot be used to summarize what is happening in Indian country in the central part of the U.S.
Contrary to many scientific reports, breast cancer continues to increase among Native women. Although white women are finally showing a decrease in new diagnoses, this is not true in our community.
The increase in breast cancer is not simply due to more access to screening. Even when this is “controlled for” in statistical analyses, we are seeing more breast cancer in our communities.
We need to be healthy again.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

12. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Among non-Natives, only 25% are diagnosed younger than age 50, but within our community, half are diagnosed before age 50.
Breast cancer appears to act differently in our community. We do not know why.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

13. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
BSE, CBE, and Mammography are not “preventive” but are “early detection” (i.e., may identify breast cancer while it is in the early stages of development)
The earlier breast cancer is diagnosed, the greater the likelihood for quality life.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

14. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Lisa Harjo and Terri Rattler answer both the local Denver number and the toll free number.
The CIS number goes to whichever CIS is closest to your location. For example, in Denver, we reach the Rocky Mountain CIS offices.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

15. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Brochures
Breast Cancer
Cervical Cancer
Endometrial Cancer
Prostate Cancer
Lung Cancer
Dietary Needs of Cancer Patients
Cancer Control Materials
Smoking and Smoking Cessation
Dietary Habits and Healthy Eating
Healthy Living Styles
Videos
Wellness
Native Nutrition
PAP Smear/Cervical Cancer
Tobacco and Health
Stories of AI/AN Cancer Survivors
Smoking Cessation
Online Resources
American Indian Resource Center
Association of American Indian Physicians
Center for American Indian Research and Education (CAIRE)
Native American Resources on the Internet
Native American Cancer Initiatives, Inc
Indian Health Services
Minnesota Indian Affairs Council
Susan G. Komen Breast Cancer Foundation
American Cancer Society
Center for Disease Control and Prevention (CDC)
Native American Women's Health Education Resource Center
Northwest Portland Area Indian Health Board
Other Resources
Extensive Bibliography
Access to Medical Journals and Reference Materials
Grant Information
Speakers Bureau
Introduction.10
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

16. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
These are the local public health educators and Native Sisters and are available to help local women take part in screening, receive personalized breast health education, and similar related functions.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

17. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
This is the national headquarters for any queries from women within or outside of Colorado.
Thank you for taking time to visit with us and talk about breast health.
Be well.
Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives