Hidden in the Data: Breast Cancer Patterns, Gaps, and Challenges for Native American Women

This paper aims to provide a comprehensive overview of breast cancer screening, clinical characteristics, treatment, and survivorship in American Indian/Alaska Native (AI/AN) women.

Breast cancer in AI/AN women is a complex public health issue marked by disparities in incidence, stage, treatment, and survival that vary regionally. Limited screening mammography, workforce shortages, and underfunded healthcare systems contribute to late diagnoses and poorer outcomes. Social and cultural factors, including historical trauma and medical mistrust, further hinder care. Data on breast cancer topics for AI/AN is limited and often compromised by misclassification and underrepresentation. The Indian Health Service (IHS) plays a crucial but underfunded role in providing care, often insufficient to meet the complex needs of AI/AN women, especially those living in urban areas.

As Indigenous surgeons working with AI/AN communities, we applied our perspectives to a comprehensive review of the literature. To reduce disparities, research must prioritize Indigenous leadership, respect tribal sovereignty, improve data accuracy, and foster equitable collaborations that center AI/AN priorities.

The United States (US) Census Bureau defines American Indian and Alaska Natives (AI/ANs) as persons with origins from the Indigenous peoples of the Americas who maintain tribal affiliation and/or community attachment. Common terms for AI/ANs today include Native, Native American, Indigenous, First Nations, Native Hawaiian, Pacific Islander, among others. The most appropriate phrasing would be to use the specific tribe's self-designated name in that tribe's native language when possible. However, for simplicity and the purposes of this manuscript, we will use the term AI/AN.