Cancer is the second leading cause of death for Indian women in the Aberdeen Area. Mortality rates for most cancers are higher than rates among other Indian women. The 1984-1988 age-adjusted mortality rates for Aberdeen Area American Indian women exceed U.S. rates as follows: all cancers for women, 1.5 times; lung cancer, 1.7 times; cervical cancer, 3.5 times; and uterine cancer, 3.4 times. While breast cancer mortality is less than U.S. rates, it is 1.5 times higher than for other Indian women. This proposal will expand the Sioux Cancer Study, an innovative three year developmental research program that defined the magnitude of the problem, established risk factor prevalence, and provided cancer screening to 1,522 Indians aged 45-75. The proposed study will evaluate whether a special program to provide cancer screening for breast and cervical cancers and tobacco cessation counseling can increase the rates of these services for the women residing in the Aberdeen Area communities. In this experiment, specialized cancer prevention and control programs implemented sequentially and randomly for communities that have a fixed mammography unit or do not have easy access to a fixed mammography unit and will be served by a mobile unit, will be compared to regular health care services through IHS or tribal health care facilities. Cancer screening rates and tobacco cessation counseling rates will be monitored to assess whether the specialized intervention increases these rates significantly more than usual care. Effectiveness of the intervention will be assessed by reviewing the charts of 40 randomly selected women per community per year. Statistical analysis will use a multiple time series model with screening and counseling rates as the dependent variables and whether the community was pre-or post intervention at the time of the data collection as independent variables. This study will provide important information on the best ways to achieve the Year 2000 objectives related to cancer prevention and control in American Indian women.
