Cherokee Nation Public Health promotes prevention, treatment of cancer
In this 2010 photo, mammographer Kim Fielder performs a mammogram on a patient at Cherokee Nation Hastings Hospital in Tahlequah. Mammograms help detect breast cancer. ARCHIVE
This graph shows which cancers increased and decreased in incidence in Oklahoma during the years 2012-16. NATIONAL CANCER INSTITUTE
TAHLEQUAH – One of the scariest words for any health patient to hear is “cancer.”
Though medical science has made cancer far more treatable than it was 50 years ago, it is still the second-leading cause of death among the general population, including the Cherokee Nation. From 2005-14, cancer killed 2,253 CN citizens.
For CN Public Health, the primary goals in the fight against cancer are prevention and access.
“Things that affect mortality – besides incidence – are access to care, screening tests, treatment, timely and accurate diagnoses, appropriate treatment and follow-up,” Dr. David Gahn, Public Health medical director, said. “We might actually have a lower incidence of cancer somewhere, but the mortality rate is high. Maybe they aren’t getting screening tests or a diagnosis. The treatment may be available in Oklahoma City, but they can’t get there.”
Cancer encompasses more than 200 human diseases generally characterized by cell growth and multiplication that is unregulated and not in coordination with adjacent tissues. The “out of control” cell activity forms tumors that can spread to other parts of the body, usually through the lymphatic system or blood circulation.
Public Health works with the Oklahoma State Department of Health to gather and analyze data. Both organizations have a cancer registry. Public Health works to educate CN citizens and other residents about the hazards of smoking through smoking cessation efforts with adults and education of children. It can also assist organizations with formulating and writing tobacco and vaping policy.
“We have screening programs,” Gahn said. “We encourage screening for the most detectable cancers: breast, cervical, colon. We try to help remove barriers to health care. We have a program where we call women who are delinquent on their screenings. If they don’t make an appointment, we call to find out why. That can help us remove barriers. We also have patient navigators to help people who have been diagnosed with cancer because things can get complicated pretty quickly.”
Recently, there have been concerns about a “cancer corridor” along the Oklahoma-Arkansas border, and a spate of childhood cancers in Cherokee County.
Gahn said data on “cancer clusters” takes a long time to gather, and data for 2016-20 is still being collected. Looking at cancer incidence over longer spans among smaller populations provides a more accurate picture.
For 2011-15, the incidence of cancer fell within parameters along the state border, and incidence of childhood cancer in Delaware, Adair and Sequoyah counties was low enough to be regarded as insufficient data. However, there was a higher incidence of mortality, which some health experts attributed to poor access to medical care.
“It is difficult for health professionals and Public Health to communicate to people about cancer because there is so much we don’t know about it,” Gahn said. “We don’t know what causes many cancers, and they occur in every age group. Cancer is not rare, and it is not one disease.”
When gathering health data, statistical adjustments are used to avoid being misled by raw numbers. Figures are age-adjusted, and upper and lower “95 percent confidence intervals” are applied.
But the raw numbers can give the public an idea of incidence. In Cherokee County, the incidence of cancers in people under age 20 in the past three five-year spans has totaled 12, 15 and 17 respectively. The figure of 17 is enough to put Cherokee County among the six counties with the highest rates of childhood cancer. But an occurrence of 17 cases in five years among a population of nearly 50,000 remains within what could statistically be expected, and one or two additional cases in a year can dramatically change the rate.
That does not mean there might not be a carcinogenic factor endangering Cherokee County citizens or that the OSDH and Public Health won’t continue to monitor cancer incidence, but links are difficult to establish, partly because cancer does seem to strike randomly.
“We know that lung cancer rates are associated with smoking,” Gahn said. “Skin cancer rates are associated with sun exposure. Diet and exercise seem to affect colon cancer rates. Then there is something like breast cancer that we’re still trying to figure out. There are not any really strong associations.”
Completely avoiding carcinogens is impossible as they are all around us and they aren’t all manmade. Sunlight is one of the most dangerous carcinogens known, but few people want to avoid it entirely. With every breath taken, people risk inhaling particles of known carcinogens, regardless of where they live.
It is also difficult to determine what caused a patient’s cancer. If a three-pack-a-day smoker gets lung cancer, an educated estimation can be made; but conversely, many smokers never get lung cancer. Some sun worshippers develop melanomas, and others do not. Studies suggest it is difficult for children to develop environmentally induced cancer because such processes require many years of exposure.
“I always say smoking is ‘associated’ with lung cancer because I can find a bunch of people who smoke and don’t have cancer,” Gahn said.
Doctors generally agree that nothing is guaranteed to cause cancer at any level of exposure – with the possible exception of radiation, where decades of research have given medical science a picture of how much of what type of radiation over a given time is dangerous to humans.
Gahn said most carcinogens don’t work that way, and risk can be minimized with the “Big Four” that seem not only to mitigate cancer, but also heart disease and many other health problems.
“That’s physical activity, nutrition, not smoking and the behavioral health cloud (health care access, screenings, doctor visits),” he said.