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
This segment addresses breast cancer, including some statistical data specific to American Indians and Alaska Natives.
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. For every 100 females diagnosed with breast cancer, there is one male.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Breast cancer is one of the most common cancers found in women in the United States.
Lung cancer is the most common type of cancer within American Indian and Alaska Native women. Other common cancers include colorectal cancer and “female cancers” such as ovarian and cervix cancers.
The greatest risks for getting breast cancer are being female and getting older.
For every 100 females diagnosed with breast cancer, there is one male.
Breast cancer occurs in Native men too, but they rarely discuss their disease. They mistakenly think that it means they are less manly. But this is not true. Since men have breasts, the breasts are susceptible to cancer just like they are in women. It is less common in men, primarily because males usually only have small levels of female hormones. The female hormones stimulate the breast which may in turn stimulate cancer growth (remember that not all cancers are “hormone sensitive”).
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. Tribal perspectives on two-spirited women vary greatly.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
All ethnicities and racial groups have women who are gay, lesbian, or sometimes referred to as “two-spirited” among some Tribal Nations.
Being gay/lesbian/two-spirited frequently interferes with getting high quality health care.
The women have frequently been treated insultingly or inferiorly by health care providers and thus may be hesitant to share information about one’s sexual preference with the provider.
Breast cancer has nothing to do with sexual preferences. Gay/lesbian/two-spirited women have the same hormonal levels as do heterosexual women. They need regular screening as do all women.
Tribal perspectives on two-spirited women vary greatly.
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
There are Natives alive today who were diagnosed with breast cancer more than 20 years ago.
For a growing number of breast cancer patients, this is a “chronic” disease and they are likely to pass on from something other than breast cancer.
Breast cancer does not have to be a death sentence. But some people will die of this disease. Another module is being developed by NACR to help cancer patients and their families prepare for death with dignity and respect.
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. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Cancer is the second leading cause of death among American Indians and Alaska Natives who are 45 years old and older.
Although most people in our communities know about diabetes, cancer is much more common.
But most of our tribal communities have only recently begun to even use the word, “cancer”. So people didn’t talk about it and people didn’t know others in their community who had been diagnosed with 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

12. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
This map is based on Indian Health Service data published in 1997 … the rates are similar today. Consistently the breast cancer death rates are higher among American Indian women who live in the Northern Plains.
A quick glance at the map shows how differently breast cancer affects Tribal Nations in each IHS Area.
This difference in breast cancer deaths is probably due to less healthy daily behaviors.
There have only been a very few Native women diagnosed with breast cancer who have had a genetic test to see if they inherited a “pre-disposition” for breast cancer and as of April 2003, none have been positive. We are not likely to have the genetic type of breast 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

13. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Alaska is a larger geographic region than are the lower 48. There are great differences in cancer rates throughout Alaska. Southeastern Alaska has different rates than do Alaska Natives who live in the bush or those who live in villages near the Artic Slope.
But we do not have accurate, current regional information for Alaska to include those numbers here. We (NACR) apologizes.
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. These data are not yet published but were provided by Roberta Paisano, MHSA (Laguna Pueblo) and David Epsey, M.D. from Indian Health Service National Epidemiology Program in Albuquerque, NM.
Since non-Natives have such a difficult time understand IHS Service Areas, Dr. Epsey reanalyzed the IHS data by geographic region so that comparisons could be made with more ease.
The IHS data only reflects patients who have used IHS health care facilities within the previous two years.
Typically, IHS data is more accurate for reservation-dwelling American Indians than it is for those who live in urban areas (i.e., in undercounts urban Indians).
NOTE: Age-adjusted data masks the burden of disease … Native women are more likely to be diagnosed at a younger age than are women from other racial groups … and the entire family / community is likely to experience the burden of disease and years of life lost.

15. Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
Rather than use “bar graphs”, Roberta Paisano and David Epsey, MD, made this graph more understandable and friendly to community members by using Indian women graphics. It clearly shows Alaska and Northern Plains dwelling Natives to be comparable to other ethnicities in the U.S.
However, remember that most federal statistical summaries are based on southwestern data only. Death certificate data for geographic regions outside of Arizona, New Mexico, Alaska, and South Dakota usually identify the deceased person as a race other than American Indian or Alaska Native. This is one of the more common reasons why death statistics continue to undercount American Indians and Alaska Natives living in those communities.
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
This information is limited to American Indian and Alaska Native males who have used the IHS health care facilities within the previous two years.
This shows that Native men have also been diagnosed with breast 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

17. 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

18. 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

19. 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

20. 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