# Gynecological Cancers Among American Indian and Alaska Native Women Living in the Upper Midwest, 1995–2019

## TL;DR

American Indian and Alaska Native women in the Upper Midwest have higher cervical cancer rates and mortality compared to non-Hispanic White women, showing ongoing health disparities.

## Contribution

This study provides recent, region-specific data on gynecological cancer disparities among AI/AN women in the Upper Midwest.

## Key findings

- AI/AN women had 1.87 times higher cervical cancer incidence and 2.92 times higher mortality compared to non-Hispanic White women.
- Most AI/AN women with gynecological cancers started treatment within a month, similar to non-Hispanic White women.
- Ovarian and uterine cancer rates were similar between AI/AN and non-Hispanic White women.

## Abstract

American Indian and Alaska Native (AI/AN) women experience higher rates of mortality from many cancers than their non-Native counterparts.

To examine recent data on gynecological cancers (cervical, ovarian, and uterine) among AI/AN women living in the Upper Midwest (Iowa, Montana, Nebraska, North Dakota, South Dakota, and Wyoming) for any improvement in equity.

We used data from the North American Association for Central Cancer Registries Cancer in North America database (1995–2019). We used descriptive statistics, including incidence mortality rates, trends, and time to treatment. Analyses were restricted to non-Hispanic individuals living in a purchased/referred care delivery area (PRCDA) at the time of diagnosis; sensitivity analyses included all AI/AN people, regardless of PRCDA residence or ethnicity.

From 1995 to 2019, there were 647 gynecological cancers diagnosed among AI/AN women living in PRCDA counties in the Upper Midwest (cervical n = 194, ovarian n = 142, uterine n = 311). Incidence and mortality rates for ovarian and uterine cancers were similar between AI/AN and non-Hispanic White (NHW) women; however, the incidence of cervical cancer was 1.87 (95% confidence interval [CI]: 1.60, 2.17) times higher, and mortality was 2.92 (95% CI: 2.29, 3.68) times higher among AI/AN compared to NHW women. The majority of AI/AN women diagnosed with gynecological cancer initiated treatment within 1 month (cervical = 67.2%, ovarian = 80.6%, uterine = 63.1%), which was similar to NHW women.

Differences exist in incidence and mortality for cervical cancer between AI/AN and NHW women in the Upper Midwest, with AI/AN facing continued inequity.