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

2. Northwest Portland Area Indian Health Board
Organizational Chart
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Northwest Portland Area Indian Health Board

3. 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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Northwest Portland Area Indian Health Board

4. 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
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Northwest Portland Area Indian Health Board

5. 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

6. 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

7. 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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Northwest Portland Area Indian Health Board

8. 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.
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Northwest Portland Area Indian Health Board

9. Normal vs Cancerous Cells
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Northwest Portland Area Indian Health Board

10. 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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Northwest Portland Area Indian Health Board

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

12. 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
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Northwest Portland Area Indian Health Board

13. 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

14. Northwest AI/AN Cancer Data
Leading Cancer Sites
Breast
Lung
Colorectal
Prostate
Leukemia/Lymphoma
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Northwest Portland Area Indian Health Board

15. 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.
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Northwest Portland Area Indian Health Board

16. Northwest Portland Area Indian Health Board
Cancer Survival Rates
Contributing factors:
Late detection
Treatment compliance
Concurrent disease
Access to care
Barriers to care
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Northwest Portland Area Indian Health Board

17. 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

18. 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

19. 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

20. 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

21. 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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Northwest Portland Area Indian Health Board

22. 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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Northwest Portland Area Indian Health Board

23. 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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Northwest Portland Area Indian Health Board

24. 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

25. 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

26. 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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Northwest Portland Area Indian Health Board

27. 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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Northwest Portland Area Indian Health Board

28. 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
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Northwest Portland Area Indian Health Board

29. 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

30. Northwest Portland Area Indian Health Board
Coping with feelings
Common emotions after diagnosis:
Denial Anger
Stress Anxiety
Depression
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Northwest Portland Area Indian Health Board

31. 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
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Northwest Portland Area Indian Health Board

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

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

34. 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.
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Northwest Portland Area Indian Health Board

35. 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
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Northwest Portland Area Indian Health Board

36. 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
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Northwest Portland Area Indian Health Board

37. Tribal Cancer Action Planning
Cancer Control in Northwest Tribal Communities
Prevention
Screening & Early Detection
Treatment
Survivorship
Rehabilitation
Palliation
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Northwest Portland Area Indian Health Board

38. 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
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Northwest Portland Area Indian Health Board

39. 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
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Northwest Portland Area Indian Health Board

40. 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

41. Yakama ONCS Mural Walk/Ride 2005

42. 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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Northwest Portland Area Indian Health Board

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

44. 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

45. 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:
11/28/2018
Northwest Portland Area Indian Health Board