Cancer incidence and associations with known risk and protective factors: the Alaska EARTH study
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.
KeywordsIndians North American/statistics & numerical data Cohort studies Tumor registry Prospective studies Incidence Neoplasms/epidemiology Neoplasms/mortality
American Indian/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.
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