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To the Editor: The incidence of breast cancer among Native Americans in the Southwest has nearly doubled in the last 30 years,¹ and in the 1990s breast cancer represented the most common cancer overall among all members of the Navajo Nation.² Native Americans with breast cancer have significantly lower 5-year survival rates when compared with the general population and other minority groups,^3-4 even when adjusting for stage of cancer presentation. It is unclear whether these worse outcomes for Native American women are related to the process of care delivery or to underlying tumor biology. We studied patterns of breast cancer care at Indian Health Service (IHS) hospitals on the Navajo Nation and evaluated their association with adverse outcome.

Methods

We conducted a retrospective, chart review study of all patients whose written records were retrievable from IHS facilities. Administrative records at each facility identified all patients with IHS medical record numbers from . . . [Full Text of this Article]

David R. Flum, MD, MPH
Department of Surgery
University of Washington
Seattle

Susan Stuart, MD
Gallup Indian Medical Center
Indian Health Service-Navajo Nation
Gallup, NM

Michael Wilcox, MD
Tuba City Medical Center
Indian Health Service-Navajo Nation
Tuba City, Ariz

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ABSTRACT | FULL TEXT