Addressing health disparities in Alaska Natives
Mayo physicians and researchers work with local providers to prevent and control cancer
Mayo Clinic began collaborating with local health care providers in Alaska even before the region achieved statehood in 1958. Today, innovative partnerships between Mayo Clinic, the Alaska Native Medical Center and the Alaska Native Tribal Health Consortium target cancer on multiple fronts.
Addressing unique health problems head-on
In the early 1990s, the Yupik people in Alaska's Yukon-Kuskowim Delta region were inexplicably suffering from anemia, despite their iron-rich diet of walrus, seal and whale meat. A research team from Mayo Clinic in Rochester, Minn., along with an investigator from the Centers for Disease Control and Prevention, traveled to the Yukon-Kuskowim Delta to find out why Alaska Native people were losing blood.
The Mayo Clinic team, led by gastroenterologist David Ahlquist, M.D., examined stool samples and discovered that the population was infected with H. pylori bacteria — a condition that produces chronic blood loss from stomach ulcers and can lead to stomach cancer, which is common among Yupik people.
The Mayo team also learned that the Yupik people have among the highest incidence and mortality rates from colorectal cancer in the world. Conventional screening approaches are problematic to offer in the remote villages of the Yukon-Kuskowim Delta. Dr. Ahlquist and his colleagues have developed an accurate, noninvasive screening test with potential to improve screening effectiveness in Alaska Native people — and in populations around the world. The test, which is easy to use and can be returned by mail, detects DNA from 90 percent of colorectal cancers and 70 percent of precancerous polyps throughout the colon. A collaborative study is currently underway to evaluate the accuracy of the new test in Alaska Native people.
"No one has gone as far as Mayo Clinic to improve the health of Alaska Natives. They do not abandon a project and are willing to partner with others, such as the CDC, to address a problem," says Christine DeCourtney, Cancer Program planning manager, Alaska Native Tribal Health Consortium.
Curbing tobacco use to prevent lung and oral cancers
Although the population believes their homemade chewing tobacco to be safer than commercially developed tobacco products, it is actually more toxic and has resulted in high rates of cancer. To combat the widespread use of tobacco among Alaska Native children, teens and pregnant women, Mayo clinical psychologist Christi A. Patten, Ph.D., and her team have developed innovative educational programs, fun camps for children and a culturally relevant video featuring regional Native women.
"This is very meaningful work," Patten says. "The Native community has made reducing tobacco use their No. 1 priority."
Providing education to health care providers and Alaska Natives
The state of Alaska has just a limited number of oncologists, with only three providing care for cancer patients at the Alaska Native Medical Center in Anchorage. Alaska health care providers also have limited access to updates in cancer care and prevention, so Mayo oncologists Steven Alberts , M.D. and Judith S. Kaur, M.D., began an annual cancer-related education seminar for health care providers in 1998 that continues today.
Dr. Kaur also received funding in 1999 for Native CIRCLE, a culturally specific educational resource center for American Indians and Alaska Native people, and she leads the Spirit of EAGLES, a Community Networks Program specific to American Indians and Alaska Native people initiated in 2000.
Preventing breast cancer through telemedicine
Using telemedicine to prevent breast cancer was among the pilot programs started by Dr. Kaur and the Spirit of EAGLES program. Sandhya Pruthi, M.D., now leads this effort and gives Alaska Native women at risk of breast cancer an individualized prevention plan via videoconferencing through the Mayo Center for Innovation. "It's a whole new world to be able to talk to patients this way. It's very much like seeing them in my Rochester clinic," explains Dr. Pruthi.
Looking ahead, expanding cancer prevention efforts
In 2011, the Mayo Clinic Cancer Center received a $6 million grant from the National Cancer Institute to help continue the work of the Spirit of EAGLES and expand its efforts in cancer prevention and control within American Indian and Alaska Native communities over the next five years.
Dr. Alberts is hoping to break another barrier by seeking access to clinical trials for Alaska Natives. He hopes to grant admission to Mayo Clinic studies and studies conducted by the North Central Cancer Treatment Group. "I am quite excited about this," says Dr. Alberts. "Alaska Native people and those who care for them are wonderful to work with."
50 years of cancer prevention and education for Alaska Natives
1950s — Mayo Clinic cardiologists travel to Alaska to conduct pediatric and adult cardiac clinics until local medical facilities were established to provide these services.
1958 — Congress approves statehood for Alaska.
1982 — Mayo Clinic oncologist Steven Alberts, M.D., begins working in Alaska with the Centers for Disease Control on projects related to hepatitis and evaluation of cancer trends in the Alaska Native population.
1990s — Mayo Clinic and Centers for Disease Control researchers travel to Yukon-Kuskokwim Delta on the west coast of Alaska to study blood loss in Native population.
1998 — Mayo Clinic doctors Steven Alberts, M.D., and Judith Kaur, M.D., begin annual cancer education seminars for Alaska health care providers.
1999 — Judith Kaur, M.D., receives funding for Native CIRCLE, a culturally specific educational resource center for American Indians and Alaska Native people.
2000 — Judith Kaur, M.D., initiates Spirit of EAGLES, the first national Community Networks Program funded by the National Cancer Institute specific to American Indians and Alaska Native people.
2001 — Mayo Clinic clinical psychologist Christi Patten, Ph.D., and team begin developing partnership to reduce tobacco-related health disparities among Alaska Native population.
2006 — Mayo Clinic and Indian Health Service formalize a partnership to work on Alaska Native health issues.
2010 — Mayo Clinic breast cancer researcher Sandhya Pruthi, M.D., establishes telemedicine program to give Alaska Native women at risk of breast cancer an individualized prevention plan.
2010 — Mayo Clinic receives $6 million grant from National Cancer Institute to expand cancer prevention and control efforts in American Indian and Alaska Native community, continuing the work of Spirit of EAGLES.