Are States Forgetting Indigenous Peoples in Cancer Control?

When we think about cancer, we often focus on breakthroughs in treatment, personal survival stories, and the hope that research brings. But what happens when entire communities are left out of the planning needed to prevent cancer in the first place?

A recent study led by Dr. Dornell Pete asks a critical question: Are state governments including American Indian and Alaska Native (AI/AN) people in their efforts to prevent and control cancer? The short answer: not nearly enough.

American Indian and Alaska Native communities face some of the most severe cancer disparities in the United States. Certain cancers such as lung, colorectal, and liver strike more often in these populations, and survival rates are generally lower than among non-Hispanic white Americans. But these aren’t just biological problems. They’re deeply tied to decades of underinvestment, poor healthcare access, systemic racism, and policies that have harmed Tribal communities.

One important strategy to address these disparities is through Comprehensive Cancer Control (CCC) plans. Every U.S. state and the District of Columbia is supported by the Centers for Disease Control and Prevention (CDC) to create these strategic documents. CCC plans are meant to guide how states prevent, detect, and treat cancer. They are supposed to offer a blueprint for public health programs and policy changes, shaped by community priorities and grounded in data. Including Indigenous communities in these plans is essential. It ensures that cancer prevention strategies account for the specific health challenges, cultural contexts, and sovereign rights of AI/AN nations.

This study is the first to systematically examine whether and how state CCC plans include Tribal people. The research team reviewed 51 plans—one from each state and the District of Columbia—looking for twelve indicators of Tribal inclusion. These ranged from basic mentions of Indigenous terms, to the presence of partnerships with Tribal organizations, to the inclusion of AI/AN-specific health goals.

The results were mixed—and deeply concerning. Only one state—New Mexico—met all 12 criteria. In contrast, 14 states made no mention of Tribal data, partners, or goals at all. Even among states with federally recognized Tribes within their borders, several (including Texas, Florida, and Virginia) had plans that completely ignored them. Among the more commonly met criteria were references to the terms “Indigenous,” “Tribal,” or “American Indian.” However, the researchers noted that the use of these terms varied widely in depth and context. Some plans simply acknowledged the demographic presence of AI/AN communities, while others incorporated more detailed information, such as stories from Native cancer survivors or AI/AN-specific health goals. Fewer than one in five states set any cancer control goals specifically for AI/AN communities.

One of the biggest blind spots was around Tribal data sovereignty. Very few states acknowledge that Tribes have the right to govern the collection and use of data about their members. This omission matters because data is power. Without accurate, respectful, and Tribe-controlled data, it’s almost impossible to understand the true burden of cancer in these communities or to design effective solutions. This lack of inclusion isn’t just a paperwork problem—it’s a public health emergency. When Indigenous communities are left out of state cancer control plans, they’re more likely to face preventable deaths, missed screenings, and care that doesn’t reflect their values or realities. That’s not just unjust—it’s deadly.

Despite all this, there are some hopeful examples. States like California and Montana did a better job of incorporating Native voices and priorities. Some even featured stories from Native cancer survivors and included culturally specific health goals. And in places where state plans fell short, some Tribes took the lead and created their own cancer control strategies—demonstrating resilience, leadership, and care for their communities.

So where do we go from here? This study doesn’t just highlight a problem; it points the way forward. States need to do more than check a box. Real inclusion means inviting Tribal leaders into the planning process, building relationships over time, and making sure Indigenous communities have the resources and respect they need to lead cancer prevention efforts that work for them. It also means collecting better data—data that is accurate, culturally relevant, and used with permission. It means writing specific, measurable goals that address the real gaps in care and outcomes. And it means acknowledging that you can’t address health equity without addressing the needs of Indigenous people. The truth is, cancer doesn’t impact everyone the same way. And the systems we’ve built to fight cancer don’t either. If we want to change that, we need to start by recognizing who’s missing—and making sure they’re not left behind again.

This work was supported in part by the National Institute of Health through the Cancer Prevention and Control Research Network (CPCRN).

Fred Hutch/UW/Seattle Children’s Cancer Consortium member Dr. Dornell Pete contributed to this work.

Pete, D., Farris, P. E., Adsul, P., Bea, J. W., Decker, D., Ingram, J., Semprini, J., Baker, H., Yellowhair, M., Blackwater, C., Dee, C., Briant, K. J., Parker, M., Zahnd, W. E., & Nash, S. H. 2025. The inclusion of tribes and American Indian and Alaska Native People in State comprehensive cancer control plans. Cancer causes & control: CCC, 10.1007/s10552-025-01981-w. Advance online publication.