In an extensive epidemiological evaluation of 197,078 malignant tumors diagnosed between 2005 and 2019, researchers quantified differences in patient and tumor characteristics as well as long-term survival between American Indian and Alaska Native cancer patients residing in Purchased/Referred Care Delivery Areas (PRCDA) counties and those living in non-PRCDA counties. The study calculated age-standardized 60-month net relative survival using geography-matched life tables for American Indian and Alaska Native residents aged 15 years and older. Patients were classified as American Indian and Alaska Native if they were identified as such by a reporting healthcare facility or through record linkage with Indian Health Service records. Across multiple primary cancer sites, the investigation determined that cancer survival was substantially lower among patients living in PRCDA counties than among those residing in non-PRCDA counties.
The differences in age-standardized 60-month net relative survival between PRCDA and non-PRCDA county residents were marked across a broad range of primary cancer sites. In leukemia, 60-month net relative survival was 0.492 for patients in PRCDA counties compared to 0.575 for those in non-PRCDA counties. In liver cancer, net relative survival was 0.133 in PRCDA counties compared to 0.205 in non-PRCDA counties. For patients diagnosed with non-Hodgkin lymphoma, net relative survival reached 0.611 in PRCDA counties compared to 0.710 in non-PRCDA counties. In pancreatic cancer, net relative survival stood at 0.086 among PRCDA residents versus 0.133 among non-PRCDA residents. For stomach cancer, relative survival was 0.231 in PRCDA counties compared to 0.293 in non-PRCDA counties. Similarly, for urinary bladder cancer, 60-month net relative survival was 0.669 for PRCDA county residents compared to 0.730 for non-PRCDA county residents.
In addition to these primary sites, substantial survival differences between PRCDA and non-PRCDA residents were documented for major screenable malignancies, including female breast cancer, colorectal cancer, lung and bronchus cancer, and prostate cancer. Notably, these geographic survival disparities between PRCDA and non-PRCDA counties generally persisted when the researchers performed stage-stratified analyses across tumor stages. The authors noted that American Indian and Alaska Native cancer patients living in non-PRCDA counties are less likely to be identified as American Indian and Alaska Native in reporting data. Because of this underidentification, official cancer statistics for American Indian and Alaska Native populations have commonly been restricted to PRCDA counties, a practice that potentially results in biased cancer statistics.
The researchers concluded that excluding non-PRCDA-resident American Indian and Alaska Native cancer patients from official cancer statistics results in direct data erasure for 3 in 10 American Indian and Alaska Native cancer cases. By omitting approximately thirty percent of cases, existing surveillance frameworks may mask important differences in survival disparities among American Indian and Alaska Native people across geographic regions. Consequently, these findings highlight an urgent need to improve racial classification systems for American Indian and Alaska Native individuals across reporting facilities and to monitor cancer statistics comprehensively for all American Indian and Alaska Native cancer patients regardless of county classification.
Subject of Research: Cancer survival disparities among American Indian and Alaska Native patients by geographic healthcare delivery areas
Article Title: Evaluating cancer survival among American Indian and Alaska Native patients living in Purchased/Referred Care Delivery Areas (PRCDA) and non-PRCDA counties
Article References: Morawski, B. M., Johnson, C. J., Joe, N. S., Pete, D., Tirumala, K., Sherman, R., Liu, L., & Nash, S. H. (2026). Evaluating cancer survival among American Indian and Alaska Native patients living in Purchased/Referred Care Delivery Areas (PRCDA) and non-PRCDA counties. BMC Cancer. https://doi.org/10.1186/s12885-026-17040-9
Image Credits: AI Generated
DOI: 10.1186/s12885-026-17040-9
Keywords: Cancer Survival, American Indian and Alaska Native Health, Healthcare Disparities, PRCDA, Oncology, Cancer Surveillance, Relative Survival, Epidemiology, Evaluating, cancer, survival, American
News Source: Nathaniel Bowman. (November 6, 2026). Cancer Survival Disparities Evaluated Across Healthcare Delivery Areas for Native Patients. Scienmag.
