On behalf of myself and the Arizona Cancer Center, I want to extend a warm welcome to all of you and to thank you for participating in this First National Conference on Cancer in Native Americans. Those of us working in the field of cancer research and treatment have been issued two challenges: The first challenge, by the National Cancer Programs, is to address the cancer needs of all United States citizens, regardless of ethnicity or socioeconomic status; the second challenge, set by the National Cancer Institute, is to achieve a 50 percent reduction in cancer mortality by the year 2000. In order to meet these challenges, we need to focus not only on cancer treatment in the Anglo population, but-perhaps more importantly-we also need to address the specific and unique issues related to cancer treatment, prevention, and control in the minority groups in this country. There currently exist over 1.5 million Native Americans on 278 reservations and over 200 Alaska Native villages. Over half of all Native Americans reside in the states of Arizona, California, New Mexico, and Oklahoma. There are 65,000 Alaskan Eskimos and over 200,000 Native Hawaiians and peoples of Hawaiian ancestry. Compared with the general United States population, American Indians have a much higher incidence for cancers of the stomach, cervix uteri, liver, gallbladder, and kidney. They have a higher mortality for cancer of the cervix and gallbladder. The survival rates are poor for all sites combined. American Indians have a high prevalence of smoking. Their use of smokeless tobacco among students in grades 7 to 12 is much higher than among white students in the same grades. Alaska Natives have a high risk for nasopharyngeal, gallbladder, cervix, and kidney cancer. Native Hawaiians have a higher incidence of cancer of the breast, cervix uteri, corpus uteri, and lungs. They have a higher mortality rate for all sites combined. Their smoking prevalence is also higher than in the general population, as is their dietary fat intake.

We conducted a community-based pilot study to train Hispanic cancer survivors as promotoras (lay health educators) to encourage their social contacts to obtain breast and cervical cancer screening. Promotoras were recruited from a private oncologist's practice at a Minority-Based Community Clinical Oncology Program (MBCCOP). Five Hispanic women were trained to serve as promotoras by attending a 12-week course. They shared cancer screening information with family and social contacts and encouraged them to obtain Papanicolaou smears and/or mammograms. Study endpoints included the number of women recruited and trained to serve as promotoras, the number of contacts made per promotora, and the number of contacts who were screened; data were based on contact logs maintained for 1 year. Screening examinations were documented by a postcard returned by the contact or by review of community health clinic records. Five promotoras contacted 141 (range = 24-49 per promotora) women to share cancer screening information. Fifty Hispanic women obtained screening after contact with a promotora. Twenty-nine underwent mammography (ages 25-58) and 43 received a Papanicolaou smear (ages 23-62). Hispanic female cancer survivors can be trained as promotoras. Screening information conveyed by a promotora can successfully prompt Hispanic women to obtain mammography and Papanicolaou smears.