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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2004.053769v1 95/5/838    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Puukka, E. Articles by Becker, T. M. Search for Related Content PubMed PubMed Citation Articles by Puukka, E. Articles by Becker, T. M. Related Collections Epidemiology Native Americans Cancer

Emily Puukka, MS, Paul Stehr-Green, DrPH, MPH and Thomas M. Becker, MD, PhD

Emily Puukka, Paul Stehr-Green, and Thomas M. Becker are with the Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, Ore.

Correspondence: Requests for reprints should be sent to Emily Puukka, MS, Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, 527 SW Hall, Suite 300, Portland, OR 97201 (e-mail: epuukka{at}npaihb.org).

Objectives. We compared the historical method of calculating cancer incidence rates with 2 new methods to determine which approach optimally estimates the burden of cancer among the Northwest American Indian/Alaska Native (AIAN) population.

Methods. The first method replicates the traditional way of calculating race-specific rates, and the 2 new methods use probabilistic record linkages to ascertain cancer cases. We indirectly adjusted all rates to the standard 2000 US population.

Results. Whereas the historical cancer incidence rates for all races are more than double those for the AIAN population, this apparent gap is considerably narrower when the all-race rates are compared with AIAN-specific rates calculated with probabilistic linkage methods. Similarly, there is no meaningful difference in incidence rates for selected site- and gender-specific cancers between the AIAN population and all races combined, and, in fact, some of these rates may be higher among the AIAN population.

Conclusions. Our results suggest that the burden of cancer among the AIAN population is considerably higher than was previously understood. We recommend that a standardized approach based on probabilistic linkage methods be adopted and that adequate financial and technical support be made available for conducting routine linkage studies throughout Indian communities.

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