美洲原住民和阿拉斯加土著人个体具有文化和地理上的多样性，但由于高质量医疗保健方面的障碍，他们普遍患有慢性疾病。作者综合分析了非拉美裔美洲原住民个体的癌症发病率和死亡率，与非拉美裔白人个体进行比较，使用国家癌症研究所、疾病预防与控制中心以及北美癌症中心协会的基于人口的数据作为背景。总体而言，非拉美裔美洲原住民个体的癌症发病率高于白人个体2%（2014至2018年，限于购买/转诊保健交付地区县以减少种族误分类），但死亡率高18%（2015至2019年）。然而，不同种类癌症和地理区域的差距巨大。例如，AIAN个体的乳腺癌和前列腺癌死亡率分别比白人个体高8%和31%，尽管发病率较低并且这些癌症有早期检测测试的可用性。AIAN个体的负担在感染相关的癌症（肝、胃和宫颈）、肾癌和阿拉斯加土著人的结直肠癌（91.3比35.5件/10万白人阿拉斯加人）方面最高，他们是世界上患病率最高的人群之一。早发性结直肠癌的激增，从1998年至2002年Native Alaskans 20-49岁的患病率为18.8/10万，增至2014-2018年的34.8/10万，加剧了这种差距。与白人个体相比，AIAN个体感染相关癌症（肝、胃和宫颈）和肾癌的死亡率大约是两倍。这些发现强调了需要采取更有效的策略来降低慢性致癌感染的患病率，并为AIAN个体改善获得高质量癌症筛查和治疗的途径。减轻不平等的负担需要扩大对部落医疗保健的财政支持，同时加强与这个边缘化人群的合作和参与。

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.© 2022 The Authors. CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society.