mortality rates due to cancer of lung and colon and rectum, Southwestern American Indian men experienced their highest mortality due to prostate cancer for that same period.

In general, the cancer incidence and mortality rates are not necessarily lower for all Native American populations and the data from the Southwest cannot be extrapolated to all American Indian and Alaska Native populations. Mortality statistics in state tumor registries are subject to underreporting of Indian ethnicity and hence all of this data must be interpreted with caution. Data on the larger cross-section of the American Indian population are needed to more accurately evaluate the cancer status of American Indians. SEER has established a tumor registry among the Cherokee Nation of Oklahoma to provide accurate statistics on this tribe.

Although the Indian Health Service (IHS) is generally viewed as the overseer of medical care for American Indian/Alaska Native populations, involvement is limited to the 33 ''reservation states" (Mahoney and Michalek, 1998). Contrary to popular impression, about two-thirds of American Indians reside in urban areas while fewer than 40 percent reside on federal reservations. Urban Indian health care programs account for just 2 percent of the IHS budget. IHS does not assume sole responsibility for American Indian and Alaska Native health care and attempts to incorporate support from federal and states agencies to assist in these programs.

IHS data for cancer incidence and mortality among American Indian and Alaska Native women demonstrated marked regional differences (Valway, 1990). These data document a high incidence of lung cancer among Alaska Native men (85 per 100,000 compared to 79 per 100,000, the overall average rate for U.S. men), and a high incidence of colorectal cancer among Alaska Native women (90.2 per 100,000 compared to 39.2 per 100,000 for U.S. women). In addition, IHS data reveal a higher incidence of lung cancer in American Indian men of the Northern Plains area, as well as a high incidence of breast cancer in American Indian women of that region.

Valway (1990), reporting on regional differences in cancer mortality among Native Americans, indicates that reporting statistics on one region of American Indians did not adequately describe cancer mortality for all Native Americans. Mortality statistics for Native Americans in the Southwest were lower than those living in the Northern Plains (North and South Dakota, Wisconsin, Michigan, Minnesota and Montana). This study confirmed the increasing American Indian mortality rates from cancer from 1968 to 1987, which was subsequently observed by Mahoney et al., (1998) from 1973 to 1993.



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