INTRODUCTION The American Indian population faces many important health issues including cancer, injuries, diabetes, alcohol and substance abuse, violence, suicide, cardiovascular disease, and obesity. Cancer has become the second leading cause of death for Alaska Native women and is the third cause of death among American Indian women. Due to a large Indian population residing in California, and the fact that American Indian women have a high mortality and low survival rate in certain cancers, California’s American Indian population is an ideal target for cancer control efforts, particularly in the early detection and treatment of breast cancer. Developing a breast cancer early detection and treatment education project for American Indians requires an understanding of American Indian illness beliefs, barriers to breast cancer screening, and the cultural constructs that inhibit or facilitate the utilization of screening protocols and treatment recommendations. This paper describes the steps taken in the development, implementation, and evaluation of the Pathways to Health project, a breast cancer education program targeting American Indian women in California.