American Indian women at increased risk: The hidden breast cancer crisis in the United States
A new report sounds urgent alarm about American Indian women being “underscreened and overlooked” when it comes to breast cancer risk, a problem rooted in cultural norms, data gaps and evolving disease patterns that threatens a growing, unrecognized health crisis in the United States.Breast cancer has long been one of the most common cancers affecting women in the United States, accounting for about 16% of all new cancer diagnoses and is the leading cause of cancer death among women, according to the KFF Foundation, a leading U.S. health policy organization. While overall advances in screening and treatment have dramatically reduced mortality over the past several decades, these improvements have not been shared equally among all ethnic groups.For Asian Americans and Pacific Islanders, the broad category that includes Indian Americans, recent data from the Breast Cancer Research Foundation suggest that breast cancer rates have been rising more rapidly than other groups, especially among women under 50. However, American Indian women are particularly under-watched in health surveillance because census and health data often group them with other Asian subgroups, masking true risk patterns.
Why is the risk of breast cancer higher among American Indian women?
Historically, breast cancer was considered primarily a disease of older women. However, National Cancer Registry data show that new breast cancer rates have increased among younger Asian American women, especially those under 50, rising by more than 50% between 2000 and 2021 among some AAPI subgroups.
Breast cancer risk in American Indian women: an unexamined and neglected health crisis
For American Indian women specifically, this trend is complicated by a combination of biological, lifestyle, and cultural factors.Research suggests that Western diets, sedentary lifestyles, delayed birth, shorter breastfeeding periods, and increased exposure to estrogen in general can increase the risk of breast cancer. These reproductive and lifestyle changes become more common among American Indian women as they settle in the United States, which may increase their long-term risks.AAPI women, including women of Indian descent, are more likely to have dense breast tissue, which not only increases their risk of cancer but also makes small tumors harder to detect on mammograms.
Cultural norms about health care, language barriers, lack of awareness about preventive medicine, and limited trust in the health system in the United States can all reduce participation in regular screening. For many first-generation American Indian women, seeing a doctor only when symptoms appear, and not for preventative care, remains common.Regular screening for breast cancer, primarily through mammograms, greatly improves early detection, allowing for less invasive treatment and much higher survival rates.
However, data show significant disparities in examining participation across racial and ethnic groups. Nationally, about 78.5% of American women ages 50 to 74 reported having recently had a mammogram, according to data from the U.S. Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the Centers for Disease Control and Prevention.
The silent epidemic: American Indian women ignored in the fight against breast cancer
Among specific minority groups such as American Indian/Alaska Native women, screening rates can be much lower.
For AAPI women, including American Indians, CDC data indicate some of the lowest mammography rates, with only about 54% reporting a mammogram in the past two years, which is below the national average and lags behind other major groups.These gaps mean that cancer is more likely to be diagnosed at later stages among women who do not undergo screening, reducing treatment options and odds of survival. Early detection is especially vital because the incidence of breast cancer is rising faster among younger women, who may not yet be targeted by routine screening recommendations.
Why are American Indian women “ignored”?
One key issue is that American Indians do not appear separately in cancer statistics. In health reports, they are typically counted under the broader Asian American umbrella, obscuring differences between subgroups. This lack of disaggregated data makes it difficult for public health agencies to identify risk patterns that particularly affect South Asian communities and design screening and outreach efforts accordingly.Without clear data, American Indian women may be excluded from targeted prevention campaigns, even if their risks are higher. Cultural factors can affect how women perceive and respond to health information. In some American Indian communities, discussions about breast health remain rare, and preventive screenings may not be prioritized until symptoms appear.Other obstacles include:
- Language challenges that make understanding health recommendations more difficult.
- Humility and stigma around discussing breast health, which may lead to delays in clinical examinations.
- Mistrust or unfamiliarity with preventive medical practices common in the American health system.
Addressing these cultural and cognitive barriers through community education, physician outreach, and culturally sensitive messaging is critical to closing the screening gap.
What can be done to prevent the risk of breast cancer among American Indian women
Early-stage breast cancer is more treatable than advanced disease. When mammograms lead to earlier diagnosis, women often require less aggressive treatment and have much higher survival rates. Furthermore, the incidence of breast cancer among younger women is increasing, a trend seen among ethnic groups and especially among Asian Americans, reinforcing the need for awareness and regular screening before symptoms appear.Public health agencies such as the Centers for Disease Control and advocacy groups emphasize that mammography and regular clinical breast examinations remain the cornerstone of early detection and reduction of deaths from breast cancer. Experts recommend several strategies to address this neglected risk:
- Collect better data – Separating health data on American Indian women, rather than grouping them into broader Asian categories, would help determine true infection rates, screening rates, and outcomes.
- Community Awareness and Education – Culturally tailored educational campaigns can raise awareness h The risk of breast cancer, the importance of regular screening, and how to deal with the health system in the United States to obtain preventive care.
- Accessible screening services – Mobile mammography units, insurance coverage of screening, and local health partnerships can improve access for women who may delay or skip screening.
- Normalization of talks – Public figures, community leaders, and health influencers in American Indian communities can help destigmatize breast health discussions and encourage proactive care.
Breast cancer rates are rising fastest among Asian American women in the United States, especially under age 50, yet American Indian women remain poorly represented in data and underserved in screening outreach. Mammography screening rates are lower among some minority groups, including AAPI women, contributing to later diagnoses and poorer outcomes. Cultural barriers, lifestyle changes, and lack of disaggregated data contribute to the “negligence” of American Indian women despite increased risks.
Early detection saves lives and improved targeted screening and awareness can dramatically change outcomes for American Indian women.
