ANCHORAGE - Fifty years ago, almost half the death certificates for Alaska Natives listed tuberculosis as the killer and cancer was rare.
The tables have turned. Alaska Natives now have a 30 percent higher risk of dying from all cancers than do white Americans, according to two recent reports published in the journal Alaska Medicine and a 30-year report tracking cancer among Alaska Natives from 1969 to 1998.
Among other findings: Doctors diagnose four times more invasive cases of cancer in Alaska Natives than they did 30 years ago, and Alaska Natives are 40 percent more likely to die of lung cancer than U.S. whites.
The studies said Alaska Natives have a higher incidence of colorectal cancer than U.S. whites. Also, though Alaska Natives once had half the rate of breast cancer, the rates now are almost identical.
"Cancer is now the leading cause of death in Alaska Natives," said Dr. Anne Lanier, who has worked in the state for 35 years and directs research for the Alaska Native Tribal Health Consortium. "That's just an astounding fact, because even when I came to work in Alaska, cancer was considered not a big deal."
Lanier and colleague Gretchen Ehrsam shared Alaska Native cancer research Monday at the Association of American Indian Physicians' annual conference at the Hotel Captain Cook.
Health officials did not have to tell 100,000 Alaska Natives that cancer is a problem.
"They were telling us before the data came out," Lanier said.
Tlingit Sylvia Montero saw little cancer when she began working as a community health aide 18 years ago. But about a decade ago, working in a Prince of Wales village, she started seeing cervical, breast and lung cancer cases. Oral cancer also surfaced in a village where men chewed tobacco.
"They were doing it for 15, 20 years, and it was catching up with them," said Montero, who has survived two bouts of breast cancer and one of bone cancer.
The biggest killer is lung cancer. The Alaska Medicine studies, published by Lanier, Ehrsam and their colleagues, revealed that Alaska Natives are 40 percent more likely to die of lung cancer than U.S. whites. Lung cancer, followed by colorectal and breast cancer, were the three most common types of cancer detected among Natives between 1984 and 1998.
The primary factor driving the increase in lung cancer is tobacco, researchers said.
"We do know that 90 percent of lung cancer is tobacco-related," Lanier said.
It's also likely that tobacco use is associated with other cancers, including cancer of the oral cavity, esophagus, pancreas, cervix, and colon and rectum, said Lanier and Ehrsam, an epidemiologist.
Data show that at least 43 percent of Alaska Native men smoked in 1997 but only 26 percent of American males overall did.
"We have no evidence that the proportion of Alaska Natives smoking has gone down in the last 10 years," Lanier said.
It's not just Alaska Native adults smoking either.
"I've even been asked by 3- and 4-year-olds if I had chew and 'Could I have some?' " Montero said.
Lanier focused some of her remarks on colorectal and breast cancer. Today, Alaska Natives have a higher incidence of colorectal cancer than U.S. whites.
"This was probably our biggest surprise," Lanier said. "There's a big push going on to get people screened."
Decades ago, Alaska Natives had half the rate of breast cancer as U.S. whites. Now the two rates are almost identical. Lanier said she does not know much about the causes for the increase.
"We have more data than we have answers," she said.
She also struggled to explain the high incidence of nasopharyngeal cancer. The nasopharynx is behind the nose, just above the palate.
While Alaska Natives still have a high incidence of cervical cancer, there are fewer cases of invasive cervical cancer. Alaska Native men have almost half the risk of dying from prostate cancer as U.S. white men. Natives also have lower death rates for leukemia, lymphoma and uterine cancer, the journal articles said.
Lanier and Ehrsam said more comprehensive programs are needed to prevent cancer, detect it earlier and eliminate tobacco use.
The Alaska Medicine studies said the best types of prevention include stopping tobacco use, limiting consumption of alcohol, eating a proper diet, exercising regularly and controlling weight.