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NACP: Partnership for Native American 
Cancer Prevention 
Francine C. Gachupin, Jani C. Ingram, Kelly A. Laurila, Maria C. Lluria-Prevatt, Nicolette I. Teufel-Shone, 
Margaret M. Briehl* 

Department of Family & Community Medicine, University of Arizona, Department of Chemistry & 
Biochemistry, Northern Arizona University, Department of Anthropology, Northern Arizona University 
University of Arizona Cancer Center, Department of Health Sciences, Northern Arizona University 
Department of Pathology, University of Arizona 

 

ABSTRACT 
Cancer trends over a two-decade period show a greater reduction in cancer mortality rates for non-
Hispanic Whites than for Native Americans. The Partnership for Native American Cancer Prevention 
(NACP) was established to address cancer health disparities that impact Native Americans. The partners 
are Northern Arizona University, the University of Arizona Cancer Center, Arizona’s tribal communities 
and the National Cancer Institute. The activities include outreach, research and cancer education. 
Overall, NACP seeks to expand capacity for culturally-sensitive and community-relevant research on 
cancer, and to continue developing respectful collaborations that will empower sovereign Native 
American communities to define, implement, and achieve their goals for cancer health equity. 

KEYWORDS: Cancer, health disparities, American Indian, Native American, collaboration, research, 
education, outreach 

Citation: Gachupin FC et al (2021) NACP: Partnership for Native American Cancer Prevention. Cancer 
Health Disparities 5:e1-e6. doi:10.9777/chd.2020.1002 
 
 
  



 
 
 
 
 

 
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Cancer trends over a two-decade period show a 
greater reduction in cancer mortality rates for 
non-Hispanic Whites compared with Native 
Americans (Melkonian et al., 2019; White et al., 
2014). High rates of mortality and morbidity are 
attributed to delays and obstacles in seeking and 
receiving cancer care. Limited funds allocated to 
Native American health care; lower socioeconomic 
status; and cultural, social, and geographic barriers 
to cancer care impede patients’ ability to 
participate in screening, diagnosis, and treatment 
(Bastani et al., 2004; Warren-Mears et al., 2013). 
Low levels of health care literacy, mistrust in the 
health care delivery system, and dissatisfaction and 
cultural discordance with providers are further 
challenges specific to Native Americans (Coughlin 
et al., 1999; Guadagnolo et al., 2011; Kanekar and 
Petereit, 2009). Despite improvements in cancer 
screening techniques and developments in cancer 
treatment, tribal communities do not benefit 
equally from these advances. Furthermore, 
relatively few of the advancements in cancer 
research address the vulnerabilities and strengths 
in these communities. 

The state of Arizona is well-positioned to address 
cancer health challenges faced by Native 
Americans. The state is home to 22 federally 
recognized sovereign tribal nations, including the 
largest land-based one in the United States (US) – 
the Navajo Nation. Arizona Cancer Registry data 
shows that breast cancer is the most frequently 
diagnosed type of cancer among Native American 
women and is responsible for the highest number 
of deaths compared to other cancers (Timothy 
Flood, personal communication). This is notable in 
that non-Hispanic White women’s death rates 
from breast cancer have decreased with effective 
screening, detection, and treatment options. For 
Native American men in Arizona, prostate cancer 

has the highest incidence and mortality rates. 
When comparing Native Americans in Arizona to 
other non-Hispanic Whites, the Native Americans 
suffer disproportionately from prostate, kidney, 
stomach, ovarian, and cervical cancers. 

The low representation of Native Americans in the 
biomedical workforce exasperates progress 
towards addressing cancer disparities in this 
population. While there has been some progress 
in the numbers of Native Americans receiving 
baccalaureate and graduate degrees (Babco, 
2015), their representation is much lower than for 
other minorities. The problem is particularly acute 
for science and engineering fields. A national 
survey of doctorate degrees awarded by US 
universities reports that of the almost 9,000 
degrees conferred in the biological and 
biomedical sciences in 2016, only 11 (0.12%) were 
awarded to Native Americans (National Science 
Foundation 2016). The low number of doctorate 
degrees awarded to Native Americans results in a 
small number pursuing careers as independent 
scientists. Data from more than 9,400 National 
Institutes of Health K-award applications showed 
that only three Native Americans per year applied 
for this career development funding (Haak, 2011). 
This is more than ten times lower than expected 
based on the size of the Native American 
population in the US. The representation of Native 
Americans among Principal Investigators on 
National Institutes of Health awards drops even 
further compared to career development awards 
(Ginther et al., 2011). 

Collaborative research with Native American 
communities to address cancer disparities poses 
unique challenges as compared to work with other 
underserved populations. A major challenge is to 
overcome the history of distrust that developed as 



 
 
 
 
 

 
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the result of broken treaties, establishment of 
reservations, forced boarding of schoolchildren, 
and other patterns of mistreatment (Brave Heart 
and DeBruyn, 1998). In contemporary times, 
academic researchers have contributed to this 
distrust through misguided research approaches 
that were disrespectful to Native American tribes 
(Burhansstipanov et al., 2001; Dalton, 2004; 
Garrison, 2013). Some tribal nations have imposed 
a moratorium on genetic research. 

The Partnership for Native American Cancer 
Prevention (NACP) began in 2002 as a 
collaboration between two state universities and 
tribal communities. It developed from one Navajo 
leader’s concern about the significant cancer 
burden among his people. This leader’s 
discussions with a University of Arizona 
biochemistry faculty member blossomed into the 
initial vision for a partnership to tackle the 
challenge of cancer health disparities for Native 
Americans. The partnership brought together 
Arizona’s only National Cancer Institute-
designated comprehensive cancer center, the 
University of Arizona Cancer Center (UACC), with 
the Native American-serving university in the 
northern part of the state, North Arizona 
University (NAU). 

NACP is part of the National Cancer Institute’s 
Comprehensive Partnerships to Advance Cancer 
Health Equity (CPACHE) program. The CPACHE 
goals are: 1) to increase the participation of 
underrepresented minority-serving institutions in 
cancer research and research training, and 2) to 
increase the involvement and effectiveness of 
comprehensive cancer centers in developing 
effective outreach, research, and education 
programs that encourage diversity among 
competitive researchers and reduce cancer health 

disparities. The CPACHE program’s goals shape 
the vision of NACP’s collaborative outreach, 
research, and education activities. Additionally, the 
concerns of Native American communities play a 
critical role in informing the direction of NACP. 
The rate of change in the cancer burden among 
Arizona’s Native American populations will 
depend, in part, on NACP’s success in engaging 
these communities and navigating centuries of 
mistrust, and on these communities determining if 
research outcomes are beneficial, non-
threatening, and useful. 

NACP’s progress towards building successful, 
trusting academic/community relationships has 
resulted in significant outcomes. In the face of 
historical divides, Partnership leaders have worked 
to develop relationships with the sovereign nations 
and gain trust that NACP research would provide 
greater benefits than harm. Since its launch in 
2002, NACP has expanded NAU’s research 
capabilities and capacities, contributing to more 
than a three-fold increase in its annual National 
Institutes of Health-funded research. NACP has 
initiated or fostered the career development of 
eleven Native American early stage and mid-level 
investigators. The Partnership has recruited and 
attracted more than thirty-eight investigators at 
UACC to address Native American cancer health 
disparities. The Outreach Core has worked to 
increase community engagement skills and the 
competency of NACP students and investigators 
by providing training on culturally respectful 
research approaches with tribes and culturally 
relevant, evidence-based cancer education to 
tribal communities. Across both institutions, >275 
Native American undergraduate and graduate 
students have participated in NACP’s cancer 
research education activities, with a focused on 
mentored research experiences. Overall, the 



 
 
 
 
 

 
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Partnership has engaged fourteen of Arizona’s 
twenty-two sovereign nations through cancer 
outreach, research, or education. 

NACP’s current research projects focus on cancers 
of the stomach, breast and cervix. Data from the 
Navajo Department of Health (2014) show age-
adjusted incidence rates for stomach (gastric) 
cancer that are three to four times as high as the 
non-Hispanic White population in Arizona, making 
this cancer second only to colorectal cancer 
incidence. One NACP research project is 
investigating risk factors that contribute to this 
cancer disparity, including infection of the stomach 
with Helicobacter pylori. Relative to other 
ethnicities, Native American women have a 30-
70% higher risk of dying from breast cancer 
(Maskarinec et al., 2011; Wampler et al., 2005); they 
are more likely to be diagnosed with late-stage 
disease. The incidence of triple-negative breast 
cancer is higher for Native American than for 
NHW women at 14.6% of all breast cancers versus 
11.6%, respectively (Plasilova et al., 2016). A second 
NACP research project is investigating signaling 
pathways that may allow triple-negative breast 
cancers to avoid detection by the immune system 
and support aggressive metastatic expansion. The 
mortality rate from cervical cancer for Native 
American women is higher than for non-Hispanic 
White women (2.4 versus 1.8 per 100,000). 
Infection with specific types of human papilloma 
virus is the primary cause of cervical cancer (Bosch 
et al., 2002). An NACP team of researchers is 
investigating the role of differences in the vaginal 
microbiome, the microbes that naturally live in the 
vagina and are important to both health and 
disease, in persistence of HPV during chronic 
infection in Native American women. 

In addition to the research project teams, NACP 
has Administrative, Planning and Evaluation, 
Research Education and Outreach Core teams. A 
new shared resource core for the current funding 
cycle is called, Guiding U54 Investigators to 
Develop Sustainability (GUIDeS). The focus for this 
resource is to provide Native American trainees 
and early stage investigators with assistance on 
publications and grant applications that will 
facilitate their career development and transition 
to research independence. All of the Partnership 
activities are guided by NCI Program Directors and 
three oversight bodies: a Community Advisory 
Committee, Internal Advisory Committee and 
Program Steering Committee. 

Since the inception of NACP in 2002, a major shift 
in direction for the Partnership has been from basic 
bench research to community engaged research. 
This has been possible through a consistent focus 
on building relationships with Native American 
community members that increase their trust in the 
benefits of NACP’s cancer research efforts. NACP’s 
overall goal remains steadfast – to move the state 
of Arizona closer to cancer health equity for tribal 
communities. The Partnership’s approach is to 
expand capacity for culturally-sensitive and 
community-relevant research on cancer and 
continue to develop respectful collaborations that 
will empower sovereign Native American 
communities to define, implement, and achieve 
their goals for cancer health equity. 

Acknowledgements 
Cancer is a critical disease that affects hundreds of 
Native Americans and families. NACP acknowledges 
the struggles and challenges of Native American 
cancer survivors and caregivers and the need for 
timely outreach, research and education that is 
culturally appropriate. We also acknowledge the 



 
 
 
 
 

 
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efforts and contributions of the NACP researchers: 
Drs. Robin Harris, Priscilla Sanderson, Ken Batai, 
Julie Armin, Heather Williamson, Julie Baldwin, 
Hendrick Dirk de Heer, Anna Schwartz, Jennifer Bea, 
Fernando Monroy, Juanita Merchant, Gregory 
Caporaso, Naomi Lee, Melissa M. Herbst-Kralovetz, 
Narendiran Rajasekaran and William Montfort; and, 
NACP leaders and support: Drs. Andrew Kraft, 
Jason Wilder, Ron Heimark, and Ms. Maria Jackson 
and Debora Aguirre. 

Funding 
The work reported in this publication was 
supported by the National Cancer Institute of the 
National Institutes of Health under the awards for 
the Partnership of Native American Cancer 
Prevention U54CA143924 (UACC) and 
U54CA143925 (NAU). 

Conflict of Interest 
The authors declare that no competing or conflict 
of interests exists. The funders had no role in study 
design, writing of the manuscript, or decision to 
publish. 

Authors’ Contributions 
FCG, JCI, NIT-S and MMB jointly conceived of this 
article. FCG wrote the first draft. KL and ML-P 
double-checked the accuracy of the article’s 
content. All authors revised and approved the final 
version of the article. 

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