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. 2025 Dec 15;131(24):e70202.
doi: 10.1002/cncr.70202.

Cancer incidence, stage at diagnosis, and trends across the Navajo Nation, 2014-2018

Del Yazzie  1 , Dornell Pete  2 , Curtis Briscoe  3 , Melissa A Jim  4 , Angela Meisner  5 , Charles Wiggins  5 , Dana Doyle  6 , Georgia Yee  6 , Carol Goldtooth  7 , Priscilla R Sanderson  7 , Chesleigh Nicole Keene  8 , Melinda Smith  7 , Hannah Sehn  9 , Shawnell Damon  10 , Chelsea L Kettering  11 , Marc Emerson  12 , Caleigh Curley  13 , Jennifer Bea  13 , Sheldwin Yazzie  14 , Natalie Joe  15 , Jennifer Doherty  16 , Hendrik Dirk de Heer  7 ; Navajo Cancer Workgroup
Affiliations

Cancer incidence, stage at diagnosis, and trends across the Navajo Nation, 2014-2018

Del Yazzie et al. Cancer. .

Abstract

Background: American Indian/Alaska Native (AI/AN) people in the United States experience cancer disparities, but little is known about cancer patterns specific to each Tribal Nation. This study describes cancer incidence (2014-2018), trends (1998-2018), and stage of diagnosis across the Navajo Nation, one of the largest sovereign tribal nations worldwide.

Methods: Cases from six Arizona, New Mexico, and Utah counties covering most of the Navajo Nation were identified by population-based cancer registries and linked with Indian Health Services patient registrations. Cancer incidence and stage at diagnosis were compared between Navajo and non-Hispanic White persons in the same counties. Trends from 1998 through 2018 were analyzed using Joinpoint regression.

Results: Navajo people had significantly higher incidence than non-Hispanic White people of gallbladder (incidence rate ratio [RR] = 6.25), stomach (RR = 3.19), kidney (RR = 1.89), myeloma (RR = 1.80), and liver cancers (RR = 1.79) and a lower incidence of cancers of the lung (RR = 0.16), female breast (RR = 0.49), leukemia (RR = 0.49), prostate (RR = 0.62), pancreas (RR = 0.79), and non-Hodgkin lymphoma (RR = 0.79). Diagnostic stage was not different for breast, cervical, and colorectal cancers, but two thirds of patients with cervical and colorectal cancer were diagnosed in later/unknown stages. Although all-site cancer rates did not change significantly from 1998 through 2018 among Navajo people, a significant decrease was found from 2010 through 2018 (-2.1% annual percentage change, p < .01).

Conclusions: Navajo people experience a higher incidence of kidney, stomach, liver, myeloma, and gallbladder cancers and a lower incidence of cancers of the breast, prostate, lung, non-Hodgkin lymphoma, and leukemia. Tailored and targeted prevention efforts may help reduce cancer disparities in the Navajo Nation.

Keywords: American Indian; Native American; Navajo; cancer; disparities; registry.

Plain language summary

This study summarized cancer rates during 2014 through 2018 among Navajo people in six counties covering the Navajo Nation, one of the largest sovereign Tribal Nations worldwide. Compared to White people in the same area, Navajo people had higher rates of liver, kidney, myeloma, gallbladder, and stomach cancers, and lower rates of lung, breast, prostate, leukemia, non‐Hodgkin lymphoma, and pancreatic cancers. Breast, cervical, and colorectal cancers were diagnosed at comparable stages among Navajo and White people, although late‐stage diagnosis was common for cervical and colorectal cancers. Although some cancers increased, overall cancer rates among the Navajo decreased from 2010 to 2018.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Map of the Navajo Nation, embedded into the outline of the six counties that cover almost all of the Navajo Nation.
FIGURE 2
FIGURE 2
A bar chart of the most commonly diagnosed cancers among Navajo compared to non‐Hispanic White (NHW) people: incidence rates 2014–2018 (red bars), males and females combined, compared to non‐Hispanic White people in the same Arizona and New Mexico counties (yellow bars).
FIGURE 3
FIGURE 3
Estimated annual percentage change in colorectal cancer incidence from 1998 to 2018 for Navajo and non‐Hispanic White people, including overall trend lines.
FIGURE 4
FIGURE 4
Female breast cancer (ages 50–74) stage at diagnosis for Navajo compared to non‐Hispanic White (NHW) women, 2014–2018 and summarizes the proportion of Navajo and non‐Hispanic White women diagnosed in local, regional, distant, and unknown stages of breast cancer between 2014 and 2018.
See this image and copyright information in PMC

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