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
Reminder that most people diagnosed with breast cancer had no risk factors other than being female and growing older
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
The most important risk factors for breast cancer are being a woman and growing older ... Two factors we are unlikely to want to change ...
But we can take part in behaviors that help prevent cancer or help to identify it before it grows very large or spreads.
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. This is primarily due to our female hormones.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
All women, regardless of race or ethnicity are at risk for developing breast cancer.
This is primarily due to our female hormones.
As we age, our bodies have been exposed to estrogen for a long time … the longer the exposure, the greater the risk.
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. There is abundant data for these risks.
Get on the Path to Breast Wellness -- Denver NAWWA Program ( ) of NACR ( ); Survivors’ Network
There is abundant data for these risks.
Increased “risk” does not mean you will develop cancer. It only means in comparison to someone who is similar to you, but does not have that risk, you are more likely to develop cancer than is she / he.
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
Unusual findings may or may not be indicative of a concern. If the woman has fibrocystic growths, the provider will “watch” them, but most have no relationship to cancer.
Exposure to hormones is a risk ... Any long term (over 9 months) break from the monthly bombardment of estrogen may be protective against breast cancer. Estrogen levels increase every month to help make the uterus thicker for the possibility of impregnation. If there is no pregnancy, the estrogen levels go back down and your period/moon occurs A “break” would include:
Having a baby
Breast feeding a child continuously for over 2 years may decrease risk
Not taking hormone replacement therapy for menopause symptoms – this is controversial; study showed a very slight increase – only in those taking the combination pill with both estrogens and progesterones (as opposed to t”he normal which is a cyclical pattern) – so short term, low dose HRT, not with the combination pill, may be at very low, if any, risk
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
Studies contradict one another on the impact of a high calorie or high fat diet.
Studies also report obesity as a risk factor. But it is not known if that is another marker for high calorie / high fat diet since most obese people do consume a high fat / high calorie diet.
Some environmental factors are known to be related to breast cancer. The one most often cited are Japanese girls who were about 12 or 13 and exposed to the atom bomb explosions in World War II. These little girls who survived the bombing were 20 times more likely to develop breast cancer. In our community, women have asked about environmental exposure to nuclear wastes stored on the reservation and in areas which may have been playgrounds for the children. This is not known and not confirmed through any studies yet.
Alcoholism and alcohol abuse are common behaviors among many Native youth and young adults and this may be a trigger for pre-breast cancer genetic changes.
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
Most painful lumps are due to cysts and other non-cancerous changes. But none of us are qualified to make diagnoses and there are occasionally lumps which do hurt and are cancerous. It is important to have it checked out.
Breast cancer occurs in all ethnicities. This myth is a result of historical records that did not document breast cancer within our population. It is also due to racial misclassification within state and federal databases.
Over 8 out of 10 people diagnosed with breast cancer in stage I (small tumor size, no lymph nodes with cancer cells present, no spreading to other organs, selected types of cells/histologic grade) are alive 5 and more years after treatment. If diagnosed late stage (stage 4), less than 1 out of 10 are alive 5 years after treatment.
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
The erroneous factor is that because of all of the focus on risk factors, women think that if they have few of these risk factors that they do not need to be concerned with breast health.
But most women (>80%) diagnosed with breast cancer only had two factors .... They were women and they were growing older.
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
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

16. 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

17. 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

18. 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