Cancer Causes & Control

, Volume 30, Issue 10, pp 1067–1074 | Cite as

Cancer incidence and associations with known risk and protective factors: the Alaska EARTH study

  • Sarah H. NashEmail author
  • Gretchen Day
  • Garrett Zimpelman
  • Vanessa Y. Hiratsuka
  • Kathryn R. Koller
Original Paper



Cancer is the leading cause of mortality among Alaska Native (AN) people. The Alaska Education and Research Towards Health (EARTH) cohort was established to examine risk and protective factors for chronic diseases, including cancer, among AN people. Here, we describe the cancer experience of the Alaska EARTH cohort in relation to statewide- and region-specific tumor registry data, and assess associations with key cancer risk factors.


AN participants were recruited into the Alaska EARTH cohort during 2004–2006. Data collected included patient demographic, anthropometric, medical and family history, and lifestyle information. This study linked the Alaska EARTH data with cancer diagnoses recorded by the Alaska Native Tumor Registry (ANTR) through 12/31/15. We compared EARTH incidence to ANTR statewide incidence. We examined independent associations of smoking status, diet, BMI, and physical activity with incident all-site cancers using multivariable-adjusted Cox proportional hazards models.


Between study enrollment and 2015, 171 of 3,712 (4.7%) Alaska EARTH study participants were diagnosed with cancer. The leading cancers among Alaska EARTH participants were female breast, lung, and colorectal cancer, which reflected those observed among AN people statewide. Incidence (95% CI) of cancer (all sites) among Alaska EARTH participants was 629.7 (510.9–748.6) per 100,000 person-years; this was comparable to statewide rates [680.5 (660.0–701.5) per 100,000 population]. We observed lower risk of all-sites cancer incidence among never smokers.


Cancer incidence in the Alaska EARTH cohort was similar to incidence observed statewide. Risk and protective factors for leading cancers among AN people mirror those observed among other populations.


Indians North American/statistics & numerical data Cohort studies Tumor registry Prospective studies Incidence Neoplasms/epidemiology Neoplasms/mortality 



American Indian/Alaska native


Alaska native


Alaska native tumor registry


Body mass index


Education and research towards health


Surveillance, epidemiology, and end results



Dr. Nash, Mr. Zimpelman and the Alaska Native Tumor Registry are supported by the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results Program, NCI contract number HHSN26120130010I, Task Order HHSN26100005. Ms. Day, Dr. Hiratsuka, and Dr. Koller are supported by a Native American Research Centers for Health Grant from National Institute of General Medical Sciences, Grant Number U261IHS0084. Dr. Hiratsuka is additionally supported by the NIGMS Grant No. 1S06GM123545. The Alaska EARTH study was funded by NCI Grants CA88958 and CA96095.

Supplementary material

10552_2019_1216_MOESM1_ESM.docx (19 kb)
Supplementary file1 (DOCX 19 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Alaska Native Epidemiology CenterAlaska Native Tumor Registry, Community Health Services, Alaska Native Tribal Health ConsortiumAnchorageUSA
  2. 2.Clinical and Research ServicesCommunity Health Services, Alaska Native Tribal Health ConsortiumAnchorageUSA
  3. 3.Research DepartmentSouthcentral FoundationAnchorageUSA

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