Screening & Early Detection

The primary goal of cancer screening is to detect cancer at an early stage. Medical treatments are often more successful when the diagnosis is received earlier in the development of the cancer. Effective cancer screening tests find cancer early, before there are symptoms, and generally screen for cancers that are easier to treat when detected early, and reduce the likelihood of death due to the cancer.

Some of the cancers that can be detected early by screening include breast, cervical, and colorectal cancers. However, access to screening is often limited by healthcare services available locally, healthcare coverage, transportation, time constraints, and cultural barriers.

In areas across the United States, American Indian/Alaska Natives are often found to have low rates of screening compared to the general population.

American Indian/Alaska Native women have the lowest rate of mammography of all ethnic groups. One study found that only 36.6% of AI/AN women over the age of 40 had received a mammography within the past year1. These rates vary by region and it is important to look into the rates within your specific service community.

For example, research has shown that Alaskan Natives have better screening rates than American Indians from the Southwest US2. This difference in screening rate is especially stark regarding colorectal cancer where 83.4% of respondents from the Southwest reported never having a colonoscopy compared to only 48.7% of Alaskan Natives. Forty-one percent of Alaskan Natives reported having had a colonoscopy within the past five years compared to only 11.7% of Southwest American Indians.

If cancer was detected during an initial screening, follow-up screenings become an important part of cancer care. Cancer patients need to understand the importance of participating in these follow-ups in order to monitor the cancer, even if it is in remission or if the patient has been declared “cancer-free,” as well as to track and short-term or long-term side effects to treatment. Someone who has had a cancer diagnosis will need to be more diligent with their cancer screenings to ensure that their treatment is working, or to determine early if the cancer has spread or come back.


  1. Ward, E., Jemel, A., Cokkinides. V., Singh, G.K., Cardinez, C.Ghafoor, A., & Thun, M. (2004). Cancer disparities by Race/Ethnicity and socioeconomic status. CA: A cancer journal for clinicians. 54(2). 78-93. Doi:10.3322/canjclin.54.2.78
  2. Schumacher, M.C., Slattery, M., Lanier, A.P., Ma, K., Edwards, S., Ferucci, E.D., & Tom-Orme, L. (2008). Prevalence and predictors of cancer screening among American Indian and Alaska native people: the EARTH study. Cancer causes control, 19(7), 725-737 doi:10.1007/s10552-008-9135-8
  3. National Institutes of Health National Institute on Drug Abuse. Tobacco/Nicotine. 2014

additional Resources

The following public health and medical resources address screening and follow-up regarding different types of cancer, and health insurance coverage issues for the AI/AN demographic.

Breast Cancer

  1. Journal of Health Disparities and Practice (PDF)
    Breast Cancer Screening Practices among American Indians and Alaska Natives in the Midwest
  2. American Cancer Society
    Breast Cancer: What Happens after Treatment

Cervical Cancer

  1. GW Cancer Center
    When compared to non-Hispanic White persons, AI/AN individuals experienced higher incidences of cervical cancer, as well as higher mortality rates.  Encourage routine screenings for cervical cancer and follow up of abnormal test results alongside imagery specific to a particular Tribal community.
    Gynecological Cancer Awareness Campaign
  2. National Native Network and Inter-Tribal Council of Michigan
    Pap-A-Thon Toolkit:  Hosting a Women's Community Health Event - Increasing Cervical Cancer Screening in Rural Tribal Communities
  3. American Society for Colposcopy and Cervical Pathology
    Management Guidelines
  4. American Society for Clinical Pathology, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (PDF)
    Screening Guidelines for the Prevention and Early Detection of Cervical Cancer
  5. American Cancer Society
    American Indian Women's Talking Circle: A Cervical Cancer Screening and Prevention Project
  6. Journal of Health Disparities Research and Practice (PDF)
    Pap Test Follow-up Pattern Among American Indian Women in Arizona
  7. Centers for Disease Control and Prevention
    Cervical Cancer Module

Colorectal Cancer

  1. American Indian Cancer Foundation (PDF)
    Improving Northern Plains American Indian Colorectal Cancer Screening
  2. Mona Sarfaty, MD (PDF)
    How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Clinician's Evidence-Based Toolbox and Guide, 2008
  3. Clinician's Reference (PDF)
    Fecal Occult Blood Testing (FOBT) For Colorectal Cancer Screening
  4. Indian Health Services (PDF)
    Strategic Plan to Increase Colorectal Cancer Screening Among American Indians and Alaska Natives
    Follow-up Care of Colorectal Cancer
  6. American Gastrointestinal Institute (PDF)
    Guidelines for Colonoscopy Surveillance after Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer
  7. American Cancer Society (PDF)
    Colorectal Cancer Facts & Figures, 2014–2016
  8. CDC Infographic
    Screening for Colorectal Cancer
  9. Journal of Community Engagement and Scholarship
    Partnering to Reduce Colon Cancer Health Disparities Among the American Indian Population in Michigan

Lung Cancer

  1. Prevent Cancer Foundation
  2. Dr. Donald Warne (PDF)
    Challenges in American Indian Lung Cancer Screening

Sample Policies

  1.  Wah-Zha-Zhi Health Center
    Provider Reminders Protocol for Cancer Screenings
  2. Wah-Zha-Zhi Health Center
    Patient Reminders Protocol for Cancer Screenings
  3. St. Croix Tribal Health Department
    Adult Preventative Care Timeline 2018