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Navajo balk at cancer screening

22nd September 2008

Many older Navajo people - Native Americans centred around an area of 27,000 square miles extending through Utah, Arizona and New Mexico - are not taking up available cancer screening programmes.

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Social advocates say around half the older people in the nation have never had a cancer screening, even when it is available on the government's Medicare programme.

Cancer rates among the Navajo Native American people in the desert state of Utah doubled during the 1970s. Many blame toxic waste from nearby uranium mines.

Cancer was the second-biggest cause of death among Native Americans in 2004, regardless of gender, and research has shown cancer care for ethnic minorities in the US lags behind that for the white mainstream.

While Native Americans are considered slightly less likely to get cancer than non-Hispanic whites, if they do get it, they are more likely than any other ethnic group to be dead within five years of diagnosis.

However, even the lower incidence rate was called into question in research published in August, suggesting that the ethnicity of Native Americans was often misclassified in clinical documentation.

Eleanor Yazzie, a Navajo Mountain patient navigator who has interviewed about 40 elders in recent months to try to promote screening programmes, said the response was that they were healthy and had no need to visit a clinic.

Huntsman Cancer Institute has been working to develop patient navigators like Yazzie in Utah and Montana tribes as part of a pilot study with the Centers for Medicare and Medicaid Services.

The navigators are there to guide elders through the maze of doctor's offices, clinics, hospitals, payment systems and other features of the government's Indian Health Service.

The aim was to reduce disparities in care, but the navigators face indifference, suspicion and other hurdles. The first problem is that people targeted for screening do not wish to discuss the matter.

The Navajo Nation is a sparsely populated region with unreliable phone coverage. Medical records are often inaccurate or years out of date. Travel within the nation is a long and unpredictable process.

The Navajo language has no word for cancer, using instead a word that means "wound that does not heal". Even saying the word can call the disease, according to traditional belief, which also says it can enter the body if a snake crosses the person's path, or from a nearby lightning bolt.

Janice Jumbo, site coordinator for the pilot program on the Navajo Nation and a doctoral candidate in epidemiology and public health, said most people refused to discuss the issue at all, and many would keep a cancer diagnosis secret even from their loved ones out of shame or embarassment that their own misstep or indiscretion caused the problem in the first place.

Instead, Navajo have turned to the Evil Way, the Lightning Way and other healing ceremonies for generations, often postponing Western forms of treatment in favour of traditional healing modalities.

While tribal members receive free primary healthcare from the Indian Health Service, which has 12 hospitals and clinics on Navajo land, people must routinely travel hundreds of miles for an appointment, and often spend all their money on traditional help which involves the entire community in healing ceremonies.

 

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