National Colorectal Cancer Awareness Month
Colorectal Cancer in American Indian and Alaska Native (AI/AN) Communities
Colorectal cancer (CRC) disproportionately affects American Indian and Alaska Native (AI/AN) populations, with higher incidence and mortality rates compared to non-Native populations. In 2018, AI/AN individuals in Alaska had the highest CRC incidence rate globally—61.9 per 100,000 people. Similar trends have been observed in recent years in North Dakota, where AI/AN individuals experience higher rates of advanced-stage colorectal cancer at diagnosis due to lower baseline screening rates compared to non-Native populations.
What is Colorectal Cancer?
The colon plays a crucial role in digestion, nutrient absorption, and waste processing. It is divided into four sections:
Ascending colon – moves upward on the right side of the abdomen.
Transverse colon – extends across the upper abdomen from right to left.
Descending colon – travels downward on the left side.
Sigmoid colon – an S-shaped section connecting to the rectum.
Colorectal cancer develops when abnormal growths called polyps form in the inner lining of the colon or rectum. While many polyps are benign (non-cancerous), some can become cancerous over time. CRC typically begins in the mucosa (innermost layer) and grows outward, progressing through various stages.
Stages of Colorectal Cancer:
Stage 1: Cancer is confined to the inner layers of the colon.
Stage 2: Cancer has spread through the muscle layer but not to lymph nodes.
Stage 3: Cancer has spread to nearby lymph nodes or glands.
Stage 4: Cancer has spread to distant organs, such as the liver or lungs.
Signs and Symptoms
Colorectal cancer often presents no symptoms in early stages, making regular screening critical. However, when symptoms do appear, they may include:
Changes in bowel habits (constipation, diarrhea, or narrow stools lasting more than two weeks)
Blood in the stool or rectal bleeding
Persistent abdominal pain or cramping (unrelated to menstrual cramps)
Unexplained weight loss
Fatigue
Loss of appetite
Vomiting
Who is at Risk?
Several factors contribute to an increased risk of colorectal cancer, including:
Age (higher risk for those over 45)
Genetic mutations and family history
Environmental exposures
Diet low in fiber and calcium
Low physical activity levels
Addressing Barriers in AI/AN Communities
AI/AN communities face unique barriers to CRC prevention and treatment, including:
Limited access to screening facilities
Focus on other pressing health issues
Lack of culturally tailored health promotion
Socioeconomic factors impacting healthcare access
Studies in AI/AN communities highlight three key facilitators to increase CRC screening and prevention:
Awareness of CRC risks and screening importance
Respect for cultural perspectives on healthcare
Effective communication of information within AI/AN communities
Prevention and Early Intervention
Early detection through regular screening significantly reduces CRC mortality rates. Organizations working to promote screening include:
American Indian Cancer Foundation (AICAF)
AICAF offers culturally tailored education, awareness campaigns, and patient support to increase CRC screening rates in AI/AN communities.
Blue Beads Campaign
An initiative under AICAF, the Blue Beads Campaign encourages AI/AN individuals to wear blue beads or clothing to show solidarity and raise awareness of CRC screening using the #BlueBeads hashtag.
Spirit of EAGLES Program – Mayo Clinic
This program provides scholarships for AI/AN students to attend medical conferences, supporting cancer education, research, and outreach efforts in Native communities.
Screening Guidelines
Regular screenings can detect early polyps before they develop into cancer. Recommended screening options include:
Stool-based test: Annually
Colonoscopy: Every 10 years for those at average risk; every 3-5 years if polyps or other risk factors are present
Screening age: 45-75 years (consult a medical provider for individual recommendations)
What to Ask Your Healthcare Provider
If your screening results indicate abnormalities, ask your provider about:
Polyp size: Risk increases with polyps larger than 1 cm
Number of polyps: Finding more than three polyps may require more frequent screening
Histology: If dysplasia (abnormal but non-cancerous cells) is present, additional monitoring may be needed
By increasing awareness and access to screening, we can reduce the impact of colorectal cancer in AI/AN communities.
