1. N orthwest P ortland A rea I ndian H ealth B oard Indian Leadership for Indian Health Tribal Cancer Control Education Eric Vinson Northwest Tribal Comprehensive Cancer Program May 4, 2010 Risky Business Training Supported by CDC Grant #1 U58 DP000786-3

2. Organizational Chart Northwest Portland Area Indian Health Board11/27/2015 2

3. July 1998 Northwest Portland Area Indian Health Board Delegates resolved to form the Northwest Tribal Cancer Coalition and the Northwest Tribal Cancer Control Project Northwest Tribal Cancer Control Project (NTCCP) Northwest Portland Area Indian Health Board11/27/2015 3

4. To envision and work toward cancer- free tribal communities by taking an integrated and coordinated approach to cancer control NTCCP Mission Northwest Portland Area Indian Health Board11/27/2015 4

5. 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 NTCCP 20 Year Plan Northwest Portland Area Indian Health Board11/27/2015 5

6. 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. NTCCP Goals Northwest Portland Area Indian Health Board11/27/2015 6

7. 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 Cancer 101: 6 Lessons to help Us Understand Cancer Northwest Portland Area Indian Health Board11/27/2015 7

8. 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. What Is Cancer? Northwest Portland Area Indian Health Board11/27/2015 8

9. Normal vs Cancerous Cells Northwest Portland Area Indian Health Board11/27/2015 9

10. Cancer among American Indians And Alaskan Natives Goal: Understand the growing health concern of cancer among AI/AN. Ca 101 Learning Module 1 Northwest Portland Area Indian Health Board11/27/2015 10

11. Lifestyles : Traditional and Western Dietary changes Decrease in exercise Personal vs. traditional use of tobacco Cancer Background Northwest Portland Area Indian Health Board11/27/2015 11

12. AI/AN have the lowest five-year survival rate for all cancer sites combined of any racial group in the U.S. Cancer Survival Rates Northwest Portland Area Indian Health Board11/27/2015 12

13. Contributing factors: Late detection Treatment compliance Concurrent disease Access to care Barriers to care Cancer Survival Rates Northwest Portland Area Indian Health Board11/27/2015 13

14. Reduce barriers to care Increase participation in screening and early detection services Chance for survival is better if cancer is found early. Improving Survival Rates Northwest Portland Area Indian Health Board11/27/2015 14

15. 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. Breast and Cervical Cancer 101 Adapted from Modules 3&4 Northwest Portland Area Indian Health Board11/27/2015 15

16. Am I at risk for breast cancer? Northwest Portland Area Indian Health Board11/27/2015 16 Research has shown that these factors increase your risk: Gender (Female) HRT AgeAlcohol Family HistoryPersonal history Genetic alternations Diet Benign breast disease Obesity Early MenstruationRadiation Not Having ChildrenAging

17. Regular exercise Breastfeeding during pregnancy Maintain a healthy diet Maintain a healthy weight Limit alcohol consumption Consult with your clinician regarding menopausal hormone use Can I do anything to reduce my risk for breast cancer? Northwest Portland Area Indian Health Board11/27/2015 17

18. 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 What are the symptoms of Breast Cancer? Northwest Portland Area Indian Health Board11/27/2015 18

19. 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 Screening for Breast Cancer Northwest Portland Area Indian Health Board11/27/2015 19

20. 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 Am I at risk for Cervical Cancer? Northwest Portland Area Indian Health Board11/27/2015 20

21. 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 What causes Cervical Cancer? Northwest Portland Area Indian Health Board11/27/2015 21

22. 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 Prevention and Early Detection Northwest Portland Area Indian Health Board11/27/2015 22

23. 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 How often should women have Pap tests? Northwest Portland Area Indian Health Board11/27/2015 23

24. What are the three recommended screenings for Breast Cancer? Breast Self-Exam (BSE) Clinical Breast Exam (CBE) Mammography or Mammogram Questions Northwest Portland Area Indian Health Board11/27/2015 24

25. Support for Patients and Caregivers Goal: Understand the psychological and social issues that affect cancer patients and their caregivers. Cancer 101 Learning Module 6 Northwest Portland Area Indian Health Board11/27/2015 25

26. Common emotions after diagnosis: DenialAnger StressAnxiety Depression Coping with feelings Northwest Portland Area Indian Health Board11/27/2015 26

27. 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 Support for the Patient Northwest Portland Area Indian Health Board11/27/2015 27

28. Remember now more than ever before, people are surviving after a Cancer diagnosis. Support for the Patient Northwest Portland Area Indian Health Board11/27/2015 28

29. Caregiving can be made less stressful by: Setting realistic limits Offer periodic breaks Support groups Use community and volunteer resources Support for the Caregiver Northwest Portland Area Indian Health Board11/27/2015 29

30. Facing a cancer diagnosis and surviving cancer treatment may be the greatest challenge a person will face in their lifetime. The Path to Recovery Northwest Portland Area Indian Health Board11/27/2015 30

31. How we become well again: Attain and maintain balance Find a sense of purpose Keep physical & emotional defenses strong Share stories of survival Path to Recovery Northwest Portland Area Indian Health Board11/27/2015 31

32. What are some ways to support caregivers? Set realistic limits Offer periodic breaks Support groups Use community and volunteer resources Question Northwest Portland Area Indian Health Board11/27/2015 32

33. Cancer Control in Northwest Tribal Communities  Prevention  Screening & Early Detection  Treatment  Survivorship Rehabilitation Palliation Tribal Cancer Action Planning Northwest Portland Area Indian Health Board11/27/2015 33

34. Women’s Health Example Cancer Prevention through Education and Outreach Northwest Portland Area Indian Health Board11/27/2015 34 ObjectiveStrategyEvaluation  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

35. 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 Tribal Action Plans Northwest Portland Area Indian Health Board11/27/2015 35

36. Sample Tribal Action Plan Activity: Cancer Mural Walk Action StepsAccountabilityScheduleResources Feedback Mechanism PrimaryOthersStartCompleteDollars Time (hrs) Register to Use ParkJensen Thayer, WA BCCP May 7, 2007 $250.3 Get Tables for ParkONCSACS Wagon RentalJensen Thayer, WA BCCP $1950.3 T-ShirtsPat Ike/ONCSWA BCCP$6008 Cancer Pins/Tape MeasuresJensen Thayer, WA BCCP $500.60 JuiceEllen Doublerunner/ONCS Yakama Juice$1080.60 Mural Walk PostersEllen Doublerunner/ONCS Yakama Legends Casino $2008 Mural Walk MapsJensen Thayer, WA BCCP Mural Society.15 Cancer LiteratureYakama NavigatorACS.30 Total$1,18818.25Sign-In Sheets

37. Yakama ONCS Mural Walk/Ride 2005

38. 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 Successful Strategies for Developing Partnerships Northwest Portland Area Indian Health Board11/27/2015 38

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

40. June 14 – July 1, 2010 Summer Research Training Institute For American Indian and Alaska Native Heath Professionals Upcoming Activities Northwest Portland Area Indian Health Board11/27/2015 40

41. 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 Contact Information Northwest Portland Area Indian Health Board11/27/2015 41