Transcript breast cancer - Native American Cancer Research

Native Cancer 101 Module 10
“Prevention and Early
Cancer Diagnosis
(Screening)”
Sponsored by Mayo Clinic’s Spirit of Eagles
Communities Network Program 2 [NCI1U54CA153605]
Curricula based on excerpts from
“Get on the Path to Health”
Breast, Cervix, Colon, Lung, and Prostate
Native American Cancer Research Corporation
3022 South Nova Road
Pine, CO 80470-7830
Phone: 303-838-9359; 1-800-537-8295
http://www.NatAmCancer.org
Presented by:
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
2
Please turn off your cell
phones or switch them
to “vibrate” mode
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
3
Audience Response
System (ARS)
The Keypads
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
4
Turning Point Keypads
Lanyard
that goes
around
your
neck
These are
NOT
calculators
and need to
be returned to
the faculty at
the end of the
session
please
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
5
Audience Response System (ARS) –
keypads
We want to ask a few questions that will
let us know a bit about you
We will be using keypads to gather the
information
You press the number on the keypad that
best describes your answer (use “0” for
“10” on the keypad)
No identifying information will be collected
(this is why there is no consent form)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Audience Response System (ARS) –
keypads
This is how we vote on different items and
issues
Although the keypads are “anonymous” (we
don’t know who uses which keypad); but we
would like you to use the same one throughout
the workshop
You do not need to “point” the keypad (like a TV
remote control)
You will see a counter on the screen that shows
how many people have “voted” on any item
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Audience Response System (ARS) –
keypads
A top bar appears and the upper right-hand box
needs to be “green” before you vote.
You can change your vote up until the final vote
has been collected and the slide advances
A summary of bar graphs appears on the screen
after the votes are completed for most items so
that everyone can see the total tallies
The summary bar graph will not appear for preworkshop knowledge items or workshop
satisfaction
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Demographic
5 items
(TP)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
9
Please Choose the Answer that Best
Describes Your Gender.
1. Male
2. Female
3. Don’t want to
answer
0%
0%
1.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
2.
0%
3.
gender2
About How Old are You?
1.
2.
3.
4.
5.
6.
7.
8.
9.
81 and older
65-80
50-64
41-49
31-40
21-30
13-20
Under 12
Don’t want to answer
0%
1.
0%
0%
0%
0%
0%
0%
0%
2.
3.
4.
5.
6.
7.
8.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
brthyr5
9.
What is Your Primary Race?
1. American Indian / Alaska Native
(AIAN)
2. Pacific Islander
3. Asian
4. African-American
5. Non-Hispanic white (Caucasian)
6. Other
7. Don’t know / Don’t want to answer
Are you Hispanic, Latino or Chicano?
1.
2.
3.
4.
Yes
No
Don’t Know / Not sure
Don’t want to answer
How Much Schooling have You Completed?
1. Elementary (kindergarten through
grade 6 / grade school)
2. 7th , 8th , or 9th grade (middle school)
3. 10, 11, or 12th grade (no degree)
4. High school graduate / GED
5. Technical school /apprentice training
6. Some college (no degree)
7. College AA degree
8. College BA, BS degree
9. Masters’ degree
10.Excerpts
Doctorate
more
from Get on the Pathor
for Health
curricula from Native American Cancer Research 1-800-5370%
0%
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0%
0%
0%
1.
2.
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8295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
Educ3
10.
Pre-workshop Health
Knowledge
9 items
15
WIRB approved –
What is the primary risk factor for
breast cancer?
1. Being younger than 50 years of age
2. Being a woman
3. Having only one child
4. Having a family member with breast
cancer
5. Don’t know / not sure
16
WIRB approved –
Which statement is true about
inherited forms of breast cancer?
1. They cause 5-10% of all breast cancers
2. They only occur in older women
3. The only factors involved are diet and
lifestyle habits
4. The cancer risk is not passed from a
parent to a child
5. Don’t know/not sure
17
WIRB-Approved
When should a woman start having Pap
tests?
1. Beginning at age 21
2. Once she starts
having intercourse
3. After she has her first
child
4. Before she receives
her first HPV vaccine
5. Don’t know / Not sure
18
WIRB-Approved
Which is TRUE about HPV?
1. The HPV vaccine only works in females
2. Most women (90%) have no symptoms
when they are infected with HPV
3. Women who only have sex with one
partner are not at risk for HPV infection
4. Women who have given birth and want no
more children are not at risk for
developing HPV infections
5. Don’t know / Not sure
19
WIRB approved:
Which colon screening test is probably the
most accurate?
1. Fecal Occult Blood Test (FOBT)
2. Flexible sigmoidoscopy
3. Colonoscopy
4. They are equally accurate
5. Don’t know / not sure
20
WIRB approved:
Which is TRUE about early warning signs of
colon cancer?
1. Orange rind texture of skin on the stomach
means the cancer is advanced
2. A protruding belly button is one of the
earliest common symptoms
3. A hot feeling in the lower stomach area is
the most common symptom
4. Most people have no symptoms
5. Don’t know/Not sure
21
WIRB Approved
What percentage of lung cancer is caused
by habitual cigarette smoking?
1.
2.
3.
4.
5.
30%
50%
70%
90%
Don’t know / Don’t
want to answer
WIRB Approved
Habitual cigarette smoking causes
what percentage of all types of cancer?
1.
2.
3.
4.
5.
30%
50%
70%
90%
Don’t know / Don’t want
to answer
Which is TRUE about prostate cancer?
1. Prostate cancer is more common among
AIs living in the Southwest than among
those who live elsewhere.
2. Prostate cancer usually has spread to other
parts of the body by the time of diagnosis.
3. People who are 50 and older need to be
screened even if they have no symptoms.
4. Prostate cancer is significantly more
common among women than among men.
5. Don’t know / Not sure
24
“Get on the Path to Health”
Early Detection and Cancer Screenings for:
Breast
Cervix
Colon
Lung
Prostate
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Objectives:
1. Identify at least 2 factors that increase your risk
for developing cancers
2. Identify benefits of taking part in early detection
screening services
3. Identify at least 2 ways to sign up for screening.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Rate per 100,000
AI/AN and NHW death rates,
all malignant cancers combined, by region, males,
1999-2009
Region
Espey et al 2014
Rate per 100,000
AI/AN and NHW death rates,
all malignant cancers combined, by region, females,
1999-2009
Region
Espey et al 2014
Who Develops Cancer?
Anyone can develop colon cancer
Cancer knows no prejudice
It is found in all racial groups
Both men and women develop colon cancer
But, your chances of developing cancer increase as
you grow older
Cancer develops over time:
It is a result of a complex mix of factors related to:
Lifestyle (daily behaviors)
Called “risk
Environment
factors”
Heredity/genetics
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
29
Breast Health
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
30
Rate per 100,000
AI/AN and NHW death rates,
breast cancer, by region, females,
1999-2009
Region
Espey et al 2014
%
6.0
0.2
68.0
10.0
3.0
3.0
3.0
2.0
2.0
1.0
1.8
Type of pre-cancer or cancer
Non-invasive (not cancer yet)
Ductal carcinoma, in situ
Lobular carcinoma, in situ
Invasive (cancer)
Ductal carcinoma
Lobular
Tubular
Cribriform
Medullary
Mucinous
Microinvasive
Papillary
Other rare types (apocrine, metaplastic, adenodcystic cancers)
32
The shield in these slides
represents your protection
against things that may make
you more susceptible to
cancer (i.e., cancer risks)
The larger the holes and the
more number of holes in the
shield, the less likely it is to
protect you from cancer or
other health problems
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Breast Cancer risks that “damage”
the shield of protection include:
1.
2.
3.
4.
5.
6.
7.
8.
Being a woman
Being female is the “biggest” risk!
Growing older
Personal history of breast cancer
Personal history Only
of another
type of cancer
5-10%
of all breast
Hereditary risk (e.g., BRCA1, BRCA2)
cancers are inherited
Family history
Sedentary life style
Over recommended body weight by 15-20
pounds (high fat / calorie diet)
9. Drinking equivalent to more than 7
alcoholic drinks in a week
10.No birth children
11.No breast feeding longer than 1 year
12.Tobacco use (store-bought)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
34
How Can I Help Myself?
1. By age 18, do monthly Breast
Self-Exams, so you can become
familiar with your own breasts.
2. Have your health provider perform
a Clinical Breast Exam during your
annual checkup.
3. Have your mammogram as
recommended by your provider
4. if you have breast symptoms
contact your provider for follow-up
Clinical Breast Exam
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
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“Know your lumps”
Have any lumps checked by
a healthcare provider
Cannot diagnose yourself
Not all lumps are cancer,
your lump may be a cyst,
fibrous tissue or a fatty
tumor instead of cancer
You cannot let fear paralyze
you … take action!
Breast Self-Exam
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
36
“Know your body”
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
37
How Can I Get A Mammogram?
Your doctor may
recommend that you
have one
You can take part in a
program through your
local health department
You can take part in a
local program that offers
mammograms
Mammogram
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Cervix Health
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
39
Cervix Cancer risks that “damage” the shield of
protection include:
1. Early age at first intercourse (16 years old or
younger)
2. More than 5 different sexual partners in your
whole life
3. Having sex with partners who have had many
sexual partners
4. Having a sexually transmitted infection
5. HPV
6. Herpes virus
7. HIV infection
8. Exposure to cigarette smoke (smoking and
second hand smoke)
9. Giving birth to more than 4 children
10.Long term use of oral contraceptives
11.Diets Low In Carotene, Vitamins C And E
How Can I Help Myself?
Avoid HPV Infection!
100 types of human papillomavirus (HPV)
Only about 12 types cause cancer of the cervix
HPV16 and HPV18 found in most cervix tumors
Both current HPV vaccines include coverage for
HPV types 16 and 18
Most women have no noticeable symptoms
Some women get genital warts
Most may not even know they have it
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
41
How Can I Help Myself?
Avoid HPV Infection!
Limit number of sexual partners
Most people will get HPV if they have more than 5
sexual partners in their lifetime
Sexual partners are likely to share the same HPV
type - both partners need to be treated.
(Men also at risk for other cancers; can get vaccine)
Use condoms
HPV may be present on skin not covered by a
condom = transmission is possible.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
42
How Can I Help Myself?
HPV (Human Papillomavirus)
The HPV vaccine is likely to eliminate
most Cancer of the Cervix, but it is not a
cure-all
Talk with you provider about whether or
not the HPV vaccine is appropriate for you
Females still need to practice good
behaviors that help prevent Cancer of the
Cervix
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
43
How Can I Help Myself?
Get a Pap test every year or
as often as your provider
suggests
If you have a sexually
transmitted disease (STD),
get treatment
Do not use manufactured
tobacco habitually and reduce
your exposure to second hand
smoke
Excerpt from Get on the Path for Health, Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
44
What are Pap Tests?
The Pap Test can tell if
you have abnormal cells
that might be cancer.
If identified early, cancer
of the cervix can be
prevented or cured
The test is done during a
pelvic examination by a
trained provider
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
45
Who Needs To Get A Pap Test?
All women once they are
21 years old
All women even after they
have quit having children
Young girls who were
molested / raped
Your provider will let you
know when you can stop
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
46
Who Needs To Get A Pap Test?
Every 3 years in women between
the ages of 21 and 65
In women 30 to 65, the time can
be lengthened to 5 years with a
combination of a Pap Test and
HPV screening
After 65, the Pap test is needed
only in women at high risk
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
47
Who Needs To Get A Pap Test?
Many American Indian women quit
having Pap Tests after their
childbearing years
But women beyond their
childbearing years need
Pap Tests too, including women
Dominga Rosetta
who have gone through the change
Santo Domingo
of life (menopause).
Pueblo
http://www.acog.org/~/media/Districts/District%20II/PDFs/USPSTF_Cervical_Ca_Screening_Guidelines.
pdf; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
48
Colon Health
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
49
Rate per 100,000
AI/AN and NHW death rates,
colorectal cancer, by region, males,
1999-2009
Region
Espey et al 2014
Rate per 100,000
AI/AN and NHW death rates,
colorectal cancer, by region, females,
1999-2009
Region
Espey et al 2014
Colon Cancer risks that “damage” the
shield of protection include:
1. Personal history of polyps in colon
2. Growing older
3. Personal history of colon cancer
4. Personal history of another type of cancer
5. Alaska Native / No. or So. Plains
6. Hereditary risk (e.g., HNPCC, FAP)
7. Family history
8. Personal history of colon problems
9. Sedentary life style
10.Habitual tobacco use
11.Diabetes
12.Diet (low fiber/ folic acid)
13.Over recommended body weight by 15-20 pounds (high fat / calorie diet)
14.Drinking equivalent to more than 7 (F) / 14 (M) alcoholic drinks in a week
15.For post-menopausal women, not taking hormonal replacement therapy
Colon Polyps (paul-lips)
Groups of cells in the lining of the colon
Most are “benign”
Some are pre-cancerous and may develop
into cancer; others never become cancer
May be very small (tiny dot) to fairly large
(size of a walnut)
Can be surgically removed to help prevent
problems
May be the most common risk factor for
CRC
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
53
QUESTION: How is colorectal
cancer diagnosed?
Fecal occult blood testing (FOBT) annually
Flexible sigmoidoscopy (flex sig) every 5
years
Double contrast barium enema with flex sig
every 5 years
Colonoscopy every 10 years
Stool DNA Test (Cologuard)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
54
At What Age Should CRC
Screening Begin?
If you are at normal risk, by age 50
If you have a family history of CRC or
symptoms, you should discuss earlier
screening with your doctor.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
55
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
Symptoms
Colorectal cancer is a silent disease
Generally there are no symptoms
Some people may notice :
Changes in bowel habits
Pelvic gas pains
Persistent constipation or diarrhea
Rectal bleeding
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
58
Lung Health
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
59
Traditional Use
Cigarette smoking is not our
tradition.
Paul Ortega, Mescalero Apache, “it is not
respectful use of the sacrament, ‘tobacco’
when you hold the cigarette away from the
body, drop it to the ground, and ground it
out with your foot … that is not how we
treat our sacraments.”
personal communication w. Linda B, Bethesda, MD, 1993
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
What is the history of Tobacco for
American Indians?
Each Tribe has its own beliefs
about Tobacco and its origins.
Tribal stories carry the story of the
origin of tobacco or how the gift of
tobacco came to the people.
Tribal stories also tell how to use
tobacco and take care of it for
future generations.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
Examples of Traditional Uses of Tobacco
Medicinal uses
Spiritual uses
Asthma
Symbolism of
Rheumatism
agreement between
Chills
people or groups.
Fevers
Prayers
Headaches
Smoking pipes to
Earaches
come to mutual
Toothaches
agreement
Intestinal
disorders
Tobacco ties
Childbirth pains
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
62
Rate per 100,000
AI/AN and NHW death rates,
lung and bronchus cancer by region, males,
1999-2009
Region
Espey et al 2014
AI/AN and NHW estimated prevalence of current smokers,
Behavioral Risk Factor Surveillance System,
Contract Health Service Delivery Areas, males,
Prevalence (%)
2000-2010
US male NHW
prevalence (21.6)
Region
Espey et al 2014
Rate per 100,000
AI/AN and NHW death rates,
lung and bronchus cancer by region, females,
1999-2009
Region
Espey et al 2014
AI/AN and NHW estimated prevalence of current smokers,
Behavioral Risk Factor Surveillance System,
Contract Health Service Delivery Areas, females,
Prevalence (%)
2000-2010
Region
Espey et al 2014
Risk Factors
Smoking and second-hand smoke
85-90+% of lung cancer is related to
smoke or chew
Tobacco use and/or exposure is the #1 risk
factor
Total exposure includes:
Number of cigarettes smoked
Age when smoking began
Duration of smoking
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
67
Synergistic Risk Factors
Secondhand / environmental smoke
Air pollution
Tuberculosis
Asbestos
Radon
Metals: nickel, silver, chromium
Being overweight and sedentary
Not eating enough fresh vegetables and
fruits
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
68
Lung Cancer Risks
Tobacco (inhaled carcinogens): 85% - 87%
Second-Hand Passive Smoke
5% - 7%
Scar/Fibrosis
1% - 2%
Others
5% - 7%
Habitual use of store-bought tobacco
contributes to 30%+ of ALL types of cancer
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
69
Smokeless Tobacco (ST) Nicotine
Content
4.8 mg nicotine / gm of MOIST snuff X 30
gm/can = 144 mg nicotine (=80 cigarettes
or 4 packs)
1 can snuff = 4 packs of cigarettes
ST users are exposed to as much, and
possibly more, daily nicotine than cigarette
smokers
Excerpts from Get on the Path for Health curricula from Native American Cancer
Research 1-800-537-8295; http://www.NatAmCancer.org; sponsored by Mayo
Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
70
How is Lung Screening Done?
At present CT scan is the only approved
screening test for lung cancer
Other tests may be performed prior to
CT scan (to check for breathing and
lung volume because the test is
(~$2,000)
If lungexpensive
cancer is found
when it is very small and has not
spread, it may be curable
But, only a small proportion of lung cancer is found in
this early stage of growth
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
71
Lung Cancer Screening
Low dose computed tomography (LDCT)
is used in:
adults 55 to 80 who have a 30 packyear smoking history
Currently smoke or quit within the past
15 years
Screening can be stopped when the
person has not smoked for more than
15 years
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/lung-cancerscreening; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities
Network Program 2 [NCI1U54CA153605]
72
Prostate Health
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
73
Rate per 100,000
AI/AN and NHW death rates,
prostate cancer, by region, males,
1999-2009
Region
Espey et al 2014
QUESTION: What is the Prostate Gland?
The prostate is a gland inside a man’s
body behind and below the bladder
Think about hunting and
cleaning a carcass
The “guts” between the legs
include the prostate gland
All male four-legged and two-legged
have a prostate gland - We are all
related
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
75
What is the Prostate Gland?
Sex gland in men
It produces part of the fluid that allows sperm
to swim / move
It is about the size of a walnut before the
walnut has its shell removed
It can change in size with cancer or with
benign disease
An enlarged prostate may make it difficult to
start the stream when you pee
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
76
Male Side View of Reproductive System
Prostate
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
Prostate Cancer risks that “damage”
the shield of protection include:
1. Male
2. Age: Men over 50 (risk increases
as you get older)
3. Family history (“1st degree
relative”)
4. Race
a. African Americans have 2 X
the incidence as white men
b. Northern or Southern Plains
higher incidence than other
tribal Nations
5. Diet (high-fat, especially animal
fats) increase risks
6. Alcohol (>14 drinks a week)
What is the Digital Rectal Exam (DRE)?
Physical exam by the provider
Provider feels the prostate with a finger
through the wall of the rectum
Provider feels for
Lumps
Uneven surfaces
Recommended as part of annual
checkups for men over 50 years old
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
79
What is the “PSA” Test?
“Prostate Specific Antigen” = PSA
A blood test recommended by some
providers as part of the annual checkup
for:
men over 50 years old
younger men who are at high risk for the
disease
Talk with your provider about whether
PSA testing is right for you
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
80
PSA Tests (nanograms per milliliter
circulating in the blood (ng/mL))
PSA Level
Probability of Cancer
0-2 ng/mL
1%
2-4 ng/mL
15%
4-10 ng/mL
25%
>10 ng/mL
>50%
A 35 year old man with 8 ng/mL is more of a concern
than an older man with same PSA level
As cited on 05-07-2010 from MD Anderson website: http://www.mdanderson.org
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
81
What is the “PSA” Test?
Healthy men have small amounts of
“prostate-specific antigen” in their blood
Less than 4.0 ng/mL (varies by age)
Levels higher than 4.0 ng/mL can mean
prostate cancer or other conditions
Some medications can falsely lower the
PSA by about half (Proscar, Propecia,
Avodart)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
82
Examples of What can Cause Higher PSA
Levels Other Than Cancer?
Enlarged prostate (benign prostatic
hyperlasia [BPH])
Infected or inflamed prostate
Biopsy or operation on prostate
Pre-cancerous cells in the prostate
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
83
Symptoms
Trouble urinating (Frequent desire to
urinate/pee with little success)
Decreased force in the urine stream
Blood in your urine or semen (Native men
rarely refer to blood for any health concerns)
Swelling in your legs
Discomfort in the pelvic area
Bone pain (very painful and most Native
men refused to discuss such pain)
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
84
Basic Prevention and
Where to Find
Screening Services
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
85
Behaviors that help “protect” the shield of health
against cancer include:
Daily physical activity
Healthy, low fat diet
high fruits and vegetables
Maintain recommended body weight
Limited to no alcohol
No store-bought tobacco use
limit tobacco to ceremonial use only
Follow cancer screening guidelines
Knowing your personal risk factors
ex. history of polyps, exposure to
cigarette smoke, or your family’s history
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
How Can I Get Cancer Screenings?
Doctor recommendation or referral.
You can also ask your doctor to send you for a screening if you
have symptoms (ex. breast lump).
IHS / Tribal and Urban Indian clinics with direct services.
Veterans Administration (VA) hospitals and clinics (for vets only).
Private insurance or Medicare can pay.
Check with local health department or clinics.
State, community programs may also pay for specific tests.
Contact local Community Health Educator/Worker.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Medicare
Based on age eligibility, Medicare will pay for enrollees to have:
Mammogram once a year
Pap Test once a year
CRC screening:
FOBT once a year
Sigmoidoscopy once every 4 years
Colonoscopy every 10 years (more frequent for “high risk”)
DNA Stool Test every 3 years
PSA blood test and DRE every year
Lung screening (LDCT) per provider recommendations
Tobacco cessation
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
The CDC National Breast and Cervical Cancer
Early Detection Program (BCCEDP)
Pays for women who meet eligibility criteria
Below 250% of Federal Poverty Level
Ages 21-64 for cervical cancer screening
Ages 40-64 for breast cancer screening
~14 Tribal programs, 50 States, 5 Territories
CBEs, mammograms, pap tests, pelvic exams
HPV tests, diagnostic testing, treatment referrals
If younger and high risk (abnormal CBE), Medicaid MAY pay.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Local Screening Resources
Caring Hands Free Clinic
Health Department / health district numbers
BCCEDP: 1-800-CDC-INFO
Susan G. Komen for the Cure –
mammograms
VA hospital/clinics
Suggestions?
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
90
Thank you for allowing
me to share this excerpt
from “Get on the Path to
Health” with you
Bingo Activity
Bear and Coyote
Activity
Post-Workshop Knowledge
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
Post-workshop Health
Knowledge
9 items
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
92
WIRB approved –
What is the primary risk factor for
breast cancer?
1. Being younger than 50 years of age
2. Being a woman
3. Having only one child
4. Having a family member with breast cancer
5. Don’t know / not sure
0%
0%
1.
2.
0%
0%
3.
4.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
5.
93
WIRB approved –
Which statement is true about
inherited forms of breast cancer?
1. They cause 5-10% of all breast cancers
2. They only occur in older women
3. The only factors involved are diet and lifestyle
habits
4. The cancer risk is not passed from a parent to a
child
5. Don’t know/not sure
0%
1.
0%
0%
0%
3.
4.
2.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
5
94
WIRB-Approved
When should women start having Pap
tests?
1. Beginning at age 21
2. When she begins to
have intercourse
3. After she has her first
child
4. Before she receives
her first HPV vaccine
5. Don’t know / Not sure
0%
1.
0%
2.
0%
0%
3.
4.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
5.
95
WIRB-Approved
Which is TRUE about HPV?
1. The HPV vaccine only works in females
2. Most women (90%) have no symptoms when
they are infected with HPV
3. Women who only have sex with one partner are
not at risk for HPV infection
4. Women who have given birth and want no more
children are not at risk for developing HPV
infections
0%
0%
0%
0%
5. Don’t know / Not sure
1.
2.
3.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
4.
0%
5.
96
WIRB approved:
Which colon screening test is probably the
most accurate?
1. Fecal Occult Blood Test (FOBT)
2. Flexible sigmoidoscopy
3. Colonoscopy
4. They are equally accurate
5. Don’t know / not sure
0%
1.
0%
2.
0%
0%
3.
4.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
5.
97
WIRB approved:
Which is TRUE about early warning signs of
colon cancer?
1. Orange rind texture of skin on the stomach
means the cancer is advanced
2. A protruding belly button is one of the earliest
common symptoms
3. A hot feeling in the lower stomach area is the
most common symptom
4. Most people have no symptoms
5. Don’t know/Not sure
0%
1.
0%
2.
0%
0%
3.
4.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
0%
5.
98
WIRB Approved
What percentage of lung cancer is caused
by habitual cigarette smoking?
1.
2.
3.
4.
5.
30%
50%
70%
90%
Don’t know / Don’t want
to answer
0%
1.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
0%
0%
2.
3.
0%
0%
4.
5.
99
WIRB Approved
Habitual cigarette smoking causes
what percentage of all types of cancer?
1.
2.
3.
4.
5.
30%
50%
70%
90%
Don’t know / Don’t want
to answer
0%
1.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
0%
0%
2.
3.
0%
0%
4.
5.
100
Which is TRUE about prostate cancer?
1. Prostate cancer is more common among AIs
living in the Southwest than among those
who live elsewhere.
2. Prostate cancer has usually spread to other
parts of the body by the time of diagnosis.
3. People who are 50 and older need to be
screened even if they have no symptoms.
4. Prostate cancer is significantly more common
among women than among men.
0%
0%
0%
0%
5. Don’t know / Not sure
1.
2.
3.
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-5378295; http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network
Program 2 [NCI1U54CA153605]
4.
0%
5.
101
Session Evaluation
4 Items
(you won’t see the results on the
screen)
Overall, this session was
understandable to me.
1.
2.
3.
4.
5.
I strongly agree
I agree
I don’t agree
I strongly disagree
I don’t want to
answer
E_undrst1a
Overall, this session provided useful
information to me.
1.
2.
3.
4.
5.
I strongly agree
I agree
I don’t agree
I strongly disagree
I don’t want to
answer
E-useful
Overall, the quality of the content
information was appropriate for me
1.
2.
3.
4.
5.
I strongly agree
I agree
I don’t agree
I strongly disagree
I don’t want to
answer
E_quality
Would you recommend this workshop
to your friends or colleagues?
1.
2.
3.
4.
Yes
Maybe
No
Not Sure
E_rec
Thank you for inviting
and allowing me to
share American
Indian cancer
screening information
with you.
Wado
Burhansstipanov, Native American Cancer Research Corp (NACR)
303-838-9359; http://www.NatAmCancer.org/
107
“Get on the Path to Health”
Bear (True) vs. Coyote Trickster (False)
17 items
Excerpts from Get on the Path for Health curricula from Native American Cancer
Research 1-800-537-8295; http://www.NatAmCancer.org; sponsored by Mayo
Clinic’s Spirit of Eagles Communities Network Program 2 [NCI1U54CA153605]
108
Women should have annual clinical breast
exams starting at age 40.
Coyote / False
Most breast cancers are inherited.
Coyote / False
Being a woman and getting older are the
biggest risk factors for breast cancer.
Bear / True
Most women with cancer of the cervix
have no signs or symptoms
Bear / True
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
109
Habitual tobacco use decreases your risks of
developing cancer of the cervix. Coyote / False
Having intercourse as a young girl (under 16)
increases your risks for developing cancer of
the cervix.
Bear / True
Colorectal cancer is significantly more common
among men than among women.
Coyote / False
All polyps develop into cancer.
Coyote / False
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
110
The most accurate colon cancer screening
test is the colonoscopy.
Bear / True
Ceremonial tobacco use is just as dangerous
as habitual cigarette smoking.
Coyote / False
About 90% of all lung cancer deaths are
directly related to habitual smoking.
Bear / True
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
111
Prostate cancer is increasing among Native
women.
Coyote / False
By the time men are 80 years old, most of them
will have prostate cancer.
Bear / True
Men should start getting annual Prostate health
screening tests at age 50.
Bear / True
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
112
About 30% of all cancer deaths are directly
related to habitual smoking.
Bear / True
The lifestyle our ancestors lived put them more
at risk for getting cancer. Coyote / False
Cigarette smoking is the single most
preventable cause of cancer in the US.
Bear / True
Excerpts from Get on the Path for Health curricula from Native American Cancer Research 1-800-537-8295;
http://www.NatAmCancer.org; sponsored by Mayo Clinic’s Spirit of Eagles Communities Network Program 2
[NCI1U54CA153605]
113