His and hers cancer awareness: Alaska is rich in resources for screening and testing.

• Author: Maloney, Lisa
• Position: HEALTHCARE

There is no such thing as a "good" cancer, an "easy" cancer, or a "safe" cancer. But reproductive cancers can be especially devastating, perhaps because they strike at such an integral part of one's personal identity. They also pose a particular challenge to people who, for cultural, logistical, financial, or personal reasons, don't participate in the screenings that could save their lives.

The numbers are hard to face: "Cancer has been the leading cause of death since 1993," explains Julia Thorsness, program coordinator for the Comprehensive Cancer Control Program, which is working toward the vision of a cancer-free Alaska. One in four deaths in the state is from cancer, with breast cancer being the most commonly diagnosed and a non-reproductive cancer--lung cancer--as the most frequently fatal, followed by colorectal, pancreas, breast, and prostate cancers.

In most cases, Alaska's rates for cancer diagnoses are about the same as the national average. But upon a closer look at the state statistics, Alaska Native populations have significantly higher rates of occurrence than the state's average for several cancers: lung, colorectal, and cervical. The one outlier to that trend is prostate cancer; the Alaska Native rate of diagnosis is about half of the state's average rate.

"There's lots of conversation about [what causes those high rates]," Thorsness says. "But unfortunately we don't know why." Although she praised the Alaska Native Tribal Health Consortium's work to provide medical care in rural communities, there's no doubt that living in a remote community makes access to screening and treatment more difficult.

"Because of our geography and many folks living far from medical care in a lot of pockets of Alaska, people are less likely to get screened. Because of the lack of screening we tend to see more advanced cancers sometimes, particularly in the Native populations," explains Dr. Larry Daugherty, radiation oncologist at Alaska Cancer Treatment Center.

Cultural factors can come into play too. Sierra Winegarner, program director of Let Every Woman Know, an Anchorage nonprofit that educates women about gynecologic cancers and supports those with a diagnosis, points out that research has shown similarly elevated rates of cervical cancer diagnosis in other areas where there may be a cultural hesitancy toward participating in screening tests. "Cervical cancer is actually a preventable disease, thanks to pap smears and the HPV vaccine," she says. (Several types of HPV or human papilloma virus can cause cervical cancer.)

Body Knowledge Equals Health

Getting people to participate in screening is one of the biggest hurdles to catching any cancer early--which exponentially increases the odds of beating it. Undergoing appropriate screenings, understanding possible symptoms, and responding proactively make up the three-pronged path to early detection and relatively easy treatment for reproductive cancers.

If it seems like the recommendations for "best" screening practices are constantly changing, that's because they are. Nobody's going to dispute the usefulness of monthly breast self-exams, and many doctors even recommend monthly testicular self-exams for men. But when it comes to when to get a mammogram and whether to get a PSA test at all, patients often feel trapped in the middle of a constant tug of war between constantly updated research, doctor's advice, and recommendations from various advocacy groups.

The recommendations for screening tests provide a place to start. And for those wondering if preventative exams are covered under the Affordable Healthcare Act, the answer is generally yes for people with health insurance that falls under Affordable Care Act rules; and for those policies the full set of eighteen preventive benefits available to everybody, plus some that are specific to women and children, are available at healthcare.gov/preventive-care-benefits.

Silent Killers: Gynecologic Cancer

Some cancers, especially gynecologic cancers, are missing from the list of screening tests. That's because other than pap smears to detect cervical cancer, there are no true screening tests for gynecologic cancers.

"If you're having symptoms [of another cancer] we can do a CAT scan, an ultrasound, a lab draw," Winegarner explains. "But usually we won't know until we go in for surgery and remove the mass if it's even cancerous."...