BRISTOL BAY AREA HEALTH CORPORATION 2026-2030 Strategic Cancer Plan
Table of Contents
01
15
Introduction Purpose and Intent Approach and Methodology
Our Voices Cancer Survivors and Caregivers Internal Stakeholders
19
03
Our Action Blueprint Organizational Capacity Prevention Screening & Early Intervention Quality of Life
Call to Action Bristol Bay’s Strategic Cancer Plan Plan Mission and Vision
04
27
Our Region and People BBAHC Service Area Population Characteristics Patient Characteristics
Appendix
08
Cancer in Our Region Incidence Mortality Stage at Diagnosis Risk and Protective Factors
Introduction
The Bristol Bay Area Health Corporation is pleased to present the 2026-2030 Strategic Cancer Plan. This plan establishes a foundation for meaningful progress over the next five years to reduce the burden of cancer in the Bristol Bay region. It emphasizes improvement across the cancer continuum, with priority focus areas including prevention, screening, early detection, and quality of life. Cancer remains the leading cause of death in the region, profoundly affecting our communities. Through this plan, we seek to implement coordinated strategies to reduce cancer incidence and improve outcomes for our people in the 28 outlying communities we serve, including Dillingham. Together, we can make a difference!
ROBERT J. CLARK PRESIDENT/CHIEF EXECUTIVE OFFICER
Purpose and Intent
A community-informed, strategic, and sustainable cancer control plan can be a useful tool to prevent and control cancer, the leading cause of death in Bristol Bay. To address this cancer burden, Bristol Bay Area Health Corporation (BBAHC) identified the creation of a regional cancer plan as a top priority in their 2025-2026 Annual Quality Plan. Active steps were taken to develop a region-specific cancer control plan. This document is the result of those efforts. ACKNOWLEDGEMENTS Many individuals throughout the Bristol Bay Region contributed their time and attention to this work. We acknowledge those who participated including cancer survivors, their caregivers, health care providers, care coordinators, and administrators. Data analysts at BBAHC and the Alaska Native Tumor Registry (ANTR) informed this important work along with Alaska Native Medical Center (ANMC), Oncology Department personnel.
LAND ACKNOWLEDGEMENT We thank the Alutiiq/Sugpiaq, Dena’ina/Tanaina, and Yup’ik/Yupiaq peoples of the Bristol Bay Region for their ancestral knowledge, cultural values, and commitment to the future.
Did You KNOW?
For the past twenty years, more people in Bristol Bay have died from cancer than any other cause.
Strategic Cancer Plan | 1
Approach and Methodology The BBAHC Strategic Cancer Plan was developed through an informed, participatory process. Beginning in August 2025, BBAHC worked closely with McKinley Research Group (MRG) to facilitate plan development and ensure plan preparation, process, and product reflected the region’s context, needs, and opportunities. Plan development considered current tribal, statewide, and national cancer control plans and programs such as the Comprehensive Cancer Plan for Alaska Tribal Health System: 2025-2029; the Alaska Cancer Plan: Working toward a Cancer Free Alaska: 2021-2025 , and the Centers for Disease Control and Prevention’s (CDC) National Comprehensive Cancer Control Program, among others.
The interviews were designed to identify stakeholder priorities and inform plan development, including priority goals, objectives, and desired outcomes. FACILITATED WORK SESSION After completion of data collection and analysis, a half-day facilitated work session was held with key stakeholders at BBAHC. Work session participants reviewed project data and considered the region’s current state of cancer prevention, intervention, care, and support. Based on this information, the group identified regional cancer control plan priority areas of focus and set goals, strategies, and intended outcomes. This information was subsequently reflected in the plan and aligned action framework. DISTRIBUTION AND DISSEMINATION The plan is intended for distribution to internal stakeholders, community members and organizations, and will be available to the public.
SECONDARY DATA COLLECTION MRG collected and compiled the most current publicly available data specific to BBAHC’s service region and Alaska statewide. Secondary data related to service delivery (e.g., BBAHC cancer screening data) and regional cancer incidence were obtained through customized data requests. See Appendix B for data sources and additional data tables. PRIMARY DATA COLLECTION Through executive interviews, the project team gathered stakeholder input on perspectives related to cancer prevention and screening, cancer care and treatment, and associated challenges and opportunities. Interviewees included BBAHC and ANMC internal stakeholders (e.g., clinical providers, care/treatment coordinators), cancer survivors, and their caregivers. In total twenty-nine interviews were conducted by phone or video conference. See Appendix A for a list of cancer survivors and caregiver interviewees.
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Call to Action Cancer takes a significant toll on individuals, families, and communities affecting their physical, emotional, social, and economic well-being. In the absence of a cancer program at BBAHC, there is no coordinated effort to address the cancer burden in Bristol Bay. WHY HAVE A PLAN? A comprehensive cancer control plan serves as a roadmap for implementing effective strategies to prevent cancer, improve treatment outcomes, and enhance the quality of life for cancer survivors. A plan integrates the strategies that have worked, either in that area or in a similar place, and turns them into a blueprint for action. By identifying priorities and allocating resources effectively, a cancer control plan helps ensure that individuals have access to necessary cancer care services.
Bristol Bay’s Strategic Cancer Plan Developing a regional cancer control plan provides an opportunity for internal stakeholders and community members to create a vision and structured approach for providing the best possible cancer care for our communities. This plan will:
Guide BBAHC’s focus on the types of cancer most common in Bristol Bay
Foster cancer prevention efforts
Strengthen the coordination of cancer care and treatment
Support quality of life for individuals experiencing cancer
Did You KNOW?
Encourage early cancer screening and detection
Utilize strategies that align with cultural values and wellness promotion
Benefits of a cancer control plan include: • Improved cancer outcomes • Specific resource allocation • Community engagement
Plan Mission
Reduce the cancer burden in Bristol Bay
• Tailored strategies • Long-term impact on cancer outcomes
Plan Vision
Provide the best possible cancer prevention, screening, treatment, and life quality for our communities
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Our Region and People
Our Region Bristol Bay is a vast and ecologically rich region in southwestern Alaska, renowned for hosting the world’s largest sockeye salmon fishery. The region features braided river systems, expansive wetlands, and tundra landscapes, creating a pristine environment that remains largely undeveloped and accessible primarily by air or water. Our People The region is home to three distinct Indigenous cultures with strong ties to salmon: Central Yup’ik, Alutiiq/Sugpiaq, and Dena’ina. Deeply rooted Indigenous values such as quyurrluteng (i.e., taking care of each other, community, supportive) and piniq’ (i.e., ‘strength’ no matter what the obstacle, resilient, supportive community) are a foundational characteristic of Bristol Bay. The current population mix is characterized by a diverse ethnic composition. Racial distribution reflects a mix of indigenous heritage, Asian descent, and a range of other ethnic backgrounds. BBAHC Service Region BBAHC, a tribal health organization, provides a range of programs and services that support health and well-being in southwest Alaska. Our service region covers about 35,000 square miles and approximately 40 million acres. As a federally designated Medically Underserved Area and Health Professional Shortage Area, there is a recognized shortage of health care services overall. The region is challenged with provider availability, economic hardship, and geographic barriers to care, such as physical distance to health care facilities and availability of transportation options. The service region is comprised of four subregions with 28 villages scattered throughout. Dillingham, the largest village, is the health care hub. Our health care network includes the Bristol Bay Area Health Corporation campus — home to Kanakanak Hospital, a regional Critical Access Hospital, the Dillingham Community Health Center, and other health care services. We operate 21 village clinics staffed primarily by Community Health Aides. As a recognized health care provider throughout Bristol Bay, BBAHC provides health care to Indian Health Service (IHS) beneficiaries and non-tribal persons.
BBAHC’s Mission
We provide quality health care with competence, compassion, and sensitivity.
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6,041 total
Population Characteristics When developing a cancer plan, it is important to consider main characteristics of the region’s resident population. Population characteristics are not just background data—they are core inputs for cancer plan development. They enable planners to map the cancer landscape, allocate resources effectively, tailor interventions, monitor progress, and ensure that cancer control strategies are both effective and equitable. DEMOGRAPHICS Within BBAHC’s service region, about one-third of the population resides in Dillingham. Two-thirds are Alaska Native or American Indian; just over half are males. Adults comprise almost two-thirds of the population.
Bristol Bay Population, 2015-2024
35%
2,141
Dillingham Population
Race 2015-2024
3,987 | 66 % Alaska Native or American Indian
All Others
2,054 | 34 %
Gender, 2015-2024
Female 2,809 47 %
Male 3,202 53 %
Age, 2015-2024
785
3,564
1,752
Youth (under 17) 29 %
Adult (18-64) 59 %
13 %
Elders
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Household Income, 2019-2023
INCOME AND POVERTY Among regional households, just over one-third have an annual household income under $50,000; about one quarter have an income of $100,000 or greater. Slightly more than one quarter of individuals in the region are below 150% of the Alaska Federal Poverty Guidelines. About one-quarter of the region’s population (1,390 individuals or 24%) live in crowded or severely crowded housing. ACCESS TO CARE Most adults have some form of health insurance coverage. However, almost one quarter of the population reports unmet medical needs due to cost. Almost two thirds HOUSEHOLD SIZE AND HOUSING have a personal doctor or health care provider; just over half had a routine check-up in the last year.
36 % | 2,175 38 % | 2,296 26 % | 1,570
Over $100,000
$50,000 - $99,999
Under $50,000
Poverty, 2019-2023
27 % | 1,612 Below 150% Alaska Federal Poverty Guidelines
There are 1,799 households in BBAHC’s service region. The average household size is 2.85 people.
Did You KNOW?
Access to Care, 2022-2024
89 %
23 %
61 %
58 %
Health insurance coverage (adults 18-64)
Unmet medical needs due to cost
Personal doctor/ health care provider
Routine checkup in past year
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Unduplicated Patients, 2020 and 2024
BBAHC Patients Patient demographics are strategic inputs for cancer plan development. They enable personalized care, reduce disparities, inform strategies, and ensure that services are equitable, effective, and responsive to the needs of all patient populations. Integrating demographic data into cancer planning supports targeted prevention efforts, early intervention strategies, treatment, clinical outcomes and health equity priorities. In 2024 BBAHC provided care to 5,100 individuals, an increase of about 19% from 2020. From 2020 to 2024, over 80% of the patients were Alaska Native or American Indian. A slightly higher percentage of females received care, compared to males. In 2024, just under one third of patients were under 18 and about half (55%) were adults aged 18-64. Elders 65+ made up 14% of the patient population in 2024, a three precent increase from 2020.
4,300 5,100
2020
2024
Total number of patients
Patient Race, 2020 and 2024
86 %
Alaska Native or American Indian
2,898
87 %
3,646
14 % 13 %
1,402
All Others
1,454
2020 2024
Patient Gender, 2020 and 2024
2020
2024
2020
2024
48 % 2,056
52 % 2,244
51 % 2,595
49 % 2,505
Female
Male
Patient Age, 2020 and 2024
2024
2020
11 % 478 2020
14 % 722 2024
2020
2024
57 % 2,465
55 % 2,793
32 % 1,357
31 % 1,585
Youth (Under 18)
Adults (18-64)
Elders (65+)
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Cancer in Our Region Cancer is a group of diseases that involve abnormal cell growth and spread to other parts of the body. It can be caused by a combination of genetic, environmental, and lifestyle factors. Cancer remains a leading cause of death worldwide, but advancements in early detection and treatment have improved survival rates.
Incidence Cancer incidence refers to the number of new cancer cases diagnosed in a specific population during a defined period. It is expressed per 100,000 people per year. An annual age-adjusted rate is used so that incidence of one type of cancer may be compared to other cancers or other populations. Incidence rates reported in this document align with this definition. Considering all cancer sites, Alaska has a slightly lower five-year average incidence rate (432.6), compared to the U.S. overall at 448.6 (2018–2022). Within Alaska, regional cancer incidence rates vary, being influenced by demographic and lifestyle factors, among others. For nearly 40 years from 1969 to 2018, cancer rates among Alaska Native people were similar to those among US White people. However, cancer rates among Alaska Native people have increased over the last decade, even as cancer rates among US White people have decreased. Approximately 4 in 10 Alaska Native men and 5 in 10 Alaska Native women will be diagnosed with cancer in their lifetime. All Cancers Over a five-year period 2018 to 2022, 123 Alaska Native individuals in BBAHC’s service region were diagnosed with cancer resulting in an incidence rate of 544.0. This was slightly higher than Alaska overall (537.8). Cancer incidence was markedly higher after the age of 60 and higher among females (605.7) compared to males (486.9).
All Cancer Sites Incidence, Alaska Native People, 2018-2022 BBAHC Service Region
COUNT 123 RATE 544.0
Alaska
COUNT 2,738 RATE 537.8
All Cancer Sites Incidence by Age, Alaska Native People, BBAHC Service Region, 2018-2022
0-59 years
COUNT 41 RATE 236.8
60-80+ years
COUNT 83 RATE 2,096.6
All Cancer Sites Incidence by Sex, Alaska Native People, BBAHC Service Region, 2018-2022
Females
COUNT 70 RATE 605.7
Males
COUNT 53 RATE 486.9
Did You KNOW?
The three most common cancers among Alaska Native people in Bristol Bay are: Breast • Colorectal • Lung and Bronchus
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Common Cancers in Bristol Bay Region BREAST CANCER Between 2008 and 2022, 46 Alaska Native females in the service region were diagnosed with breast cancer resulting in an incidence rate of 128.1. During the five- year period from 2018-2022, breast cancer incidence was higher among Bristol Bay’s Alaska Native females than females statewide (198.1 and 150.3, respectively). Incidence among females age 60–80+ was over 4.5 times higher than those under age 59. Breast Cancer Incidence, Alaska Native Females, BBAHC Service Region and Alaska, 2018-2022 BBAHC Service Region
Colorectal Cancer Incidence by Age, Alaska Native People, BBAHC Service Region, 2018-2022 0-59 years
COUNT 7 RATE 45.3
60-80+ years
COUNT 18 RATE 497.4
Colorectal Cancer Incidence by Sex, Alaska Native People, BBAHC Service Region, 2018-2022 Females
COUNT 15 RATE 126.3
COUNT 22 RATE 198.1
Males
Alaska
COUNT 10 RATE 106.0
COUNT 407 RATE 150.3
LUNG CANCER The five-year incidence of lung cancer among Bristol Bay’s Alaska Native people was similar to Alaska statewide (86.9 and 84.7, respectively). Males had a higher incidence of lung cancer compared to females. Rates by age groups were suppressed due to fewer than 5 cases per year.
Breast Cancer Incidence by Age, Alaska Native Females, BBAHC Service Region, 2018-2022
0-59 years
COUNT 10 RATE 124.3
60-80+ years
COUNT 12 RATE 570.6
Lung Cancer Incidence, Alaska Native People, BBAHC Service Region and Alaska, 2018-2022
BBAHC Service Region COUNT 21 RATE 86.9
COLORECTAL CANCER Bristol Bay’s Alaska Native people had a higher colorectal cancer incidence rate, compared to Alaska overall (119.9 and 80.8, respectively). Incidence among individuals age 60–80+ was about 10 times higher than those under age 59. Females had slightly higher incidence rates than males.
Alaska
COUNT 403 RATE 84.7
Lung Cancer Incidence by Sex, Alaska Native People, BBAHC Service Region, 2018-2022 Females
Colorectal Cancer Incidence, Alaska Native People, BBAHC Service Region and Alaska, 2018-2022
BBAHC Service Region COUNT 25 RATE 119.9
COUNT 11 RATE 83.9
Males
Alaska
COUNT 10 RATE 98.2
COUNT 392 RATE 80.8
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Cancer Deaths, Alaska and Public Health Regions, 2020 and 2024 ALASKA OVERALL Statewide, cancer has been the leading cause of death each year since 1999. Mortality rates decreased slightly in the last five years from 146.7 to 142.3 (2020 and 2024, respectively). Cancer death rates vary notably between the state’s seven public health regions. In 2024 cancer mortality rate was highest in the Northern region (244.3) and lowest in the Interior (124.0). In the Southwest region, which BBAHC’s service region is part of, the rate was 157.0. Cancer Mortality Cancer mortality rates are the best measure of progress against cancer because they are less affected by changes in detection practice than incidence (new diagnoses) and survival rates.
Mortality Considering all causes of mortality, 321 individuals in BBAHC’s service region died in 2024, an increase of about 15% from 2020 (278 deaths).
Did You KNOW?
The three leading causes of death in Bristol Bay are: Unintentional Injuries • Cancer • Heart Disease
LEADING CAUSES OF DEATH IN BRISTOL BAY
2020 2024
COUNT 1,043 RATE 146.7 COUNT 1,137 RATE 142.3
UNINTENTIONAL INJURIES
2020 2024
COUNT 37 PERCENT 13 COUNT 53 PERCENT 17
ANCHORAGE
2020 2024
COUNT 421 RATE 153.0 COUNT 411 RATE 134.1
CANCER
2020 2024
COUNT 56 PERCENT 20 COUNT 52 PERCENT 16
GULF COAST
2020 2024
COUNT 115 RATE 119.1 COUNT 165 RATE 140.1
HEART DISEASE
2020 2024
COUNT 55 PERCENT 20 COUNT 41 PERCENT 13
INTERIOR
ALCOHOL-INDUCED
2020 2024
COUNT 133 RATE 132.5 COUNT 140 RATE 124.0
2020 2024
COUNT 15 PERCENT 5 COUNT 24 PERCENT 7
MAT-SU
DRUG-INDUCED
2020 2024
COUNT 155 RATE 144.7 COUNT 197 RATE 163.9
2020 2024
COUNT ** PERCENT ** COUNT 23 PERCENT 7
**Data not displayed due to fewer than 5 cases per year.
NORTHERN
2020 2024
COUNT 40 RATE 242.2 COUNT 43 RATE 244.3
SUICIDE
2020 2024
COUNT 14 PERCENT 5 COUNT 20 PERCENT 6
SOUTHEAST
2020 2024
COUNT 132 RATE 150.9 COUNT 136 RATE 147.5
CHRONIC LOWER RESPIRATORY DISEASE
2020 2024
COUNT 13 PERCENT 5 COUNT 12 PERCENT 4
SOUTHWEST
2020 2024
COUNT 45 RATE 154.0 COUNT 45 RATE 157.0
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Did You KNOW?
Statewide in 2020 and 2024 the most common type of cancer listed as the underlying cause of death was trachea, bronchus, and lung (251 deaths, rate 30.1).
Cancer has been the leading cause of death in Alaska for at least the past 25 years. In the Alaska Native community, cancer remains the top cause of death as it has for over 50 years.
Cancer Deaths by Top Five Types, Alaska, 2020 and 2024 TRACHEA, BRONCHUS, AND LUNG
2020 2024
COUNT 239 RATE 32.8 COUNT 251 RATE 30.1
COLON, RECTUM, AND ANUS
COLON, RECTUM, AND ANUS
2020 2024
COUNT 109 RATE 16.3 COUNT 120 RATE 15.5
2015-19 2020-24
COUNT 9 PERCENT 16 COUNT 10 PERCENT 19
PANCREAS
OTHER CANCERS
2020 2024
COUNT 88 RATE 11.8 COUNT 96 RATE 11.6
2015-19 2020-24
COUNT 32 PERCENT 57 COUNT 24 PERCENT 46
BREAST (FEMALE ONLY)
Stage at Diagnosis “Staging” measures the extent of disease at the time of initial diagnosis. Summary staging attempts to group cases with similar prognoses into categories of:
2020 2024
COUNT 60 RATE 7.6 COUNT 69 RATE 8.6
LIVER AND INTRAHEPATIC BILE DUCTS
Stage I In situ: Abnormal cells are present but have not spread to nearby tissue.
2020 2024
COUNT 54 RATE 7.3 COUNT 67 RATE 7.8
Stage II Localized: Cancer is limited to the place where it started.
Cancer Deaths by Top Three Types, BBAHC Service Region, 2015-2019 and 2020-2024 ALL CANCERS
Stage III Regional: Cancer has spread to nearby lymph nodes, tissues, or organs.
2015-19 2020-24
COUNT 56 COUNT 52
Stage IV Distant: Cancer has spread to distant parts of the body.
Unknown There is not enough information to determine the stage.
During the five-year period 2020-2024, about one third of all cancer deaths in Bristol Bay (35%) were caused by trachea, bronchus, and lung cancer.
TRACHEA, BRONCHUS, AND LUNG
2015-19 2020-24
COUNT 15 PERCENT 27 COUNT 18 PERCENT 35
WHY EARLY DETECTION? Benefits of detecting cancer in an early stage include:
Improved survival rates Reduced treatment costs Enhanced quality of life Better treatment outcomes Increased awareness and prevention
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BREAST CANCER About two thirds (68%) of breast cancers among Alaska Native females in Bristol Bay were diagnosed at Stage I (2018-2022). Statewide about two-thirds (68%) were diagnosed at Stage II (2022). COLORECTAL CANCER Among Alaska Native people in the region, about two-thirds (68%) of colorectal cancers were either Stage II (32%) or IV (36%) at diagnosis. Very few cases were diagnosed at Stage III. Statewide almost three- quarters (72%) were at Stage II (35%) and Stage III (37%).
Hope Stories of In 2011, Teresita Tanaka was diagnosed with Stage III breast cancer on a Monday and wheeled into surgery that Friday. The diagnosis came quickly after her doctor at BBAHC referred her to Providence Alaska Medical Center in Anchorage for a biopsy. Teresita spent the next eight months in Anchorage for treatment, only able to return home for a few short weekends. Five years earlier, she had lost her husband to liver cancer the same year he was diagnosed. Because of this, telling her son that she had cancer was one of the hardest parts of the experience. The American Cancer Society paid for her air fare to and from Anchorage, and the Walter J. and Ermalee Hickel House provided an affordable place to stay. Support from the community and her son helped her stay positive and hopeful. “People came through for me. They prayed for me. I had my son, who kept me going.” Teresita has been in remission for 14 years. She said early testing and a positive attitude are key. Getting tested is important. If my boss hadn’t forced me to go in, I wouldn’t be talking to you today.” “
Colorectal Cancer, Stage at Diagnosis, Alaska Native People and All Alaskans, BBAHC Service Region and Alaska, 2018-2022
*
Stage I
0%
32%
Stage II
35%
*
Stage III
37%
36%
Stage IV
22%
*
Other
7%
Alaska Native People, 2018-2022 BBAHC Region
All Alaskans
**Data not displayed due to fewer than 5 cases per year.
LUNG AND BRONCHUS Statewide over half (56%) of newly diagnosed lung and bronchus cancer was Stage II. Among Alaska Native people in Bristol Bay, about half (48%) were Stage III at diagnosis.
Lung and Bronchus Cancer Incidence, Stage at Diagnosis, Alaska Native People and All Alaskans, BBAHC Service Region and Alaska, 2018-2022
* *
Stage I
0%
Stage II
56%
48%
Stage III
13%
29%
Stage IV
17%
*
Other
15%
Alaska Native People, 2018-2022 BBAHC Region
All Alaskans
**Data not displayed due to fewer than 5 cases per year.
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Risk and Protective Factors Cancer can be caused by a combination of genetic, environmental, certain infections, and lifestyle factors. Key risk factors include:
Diet, Exercise, and Obesity: Poor diet, lack of fruits and vegetables, lack of exercise, and obesity are linked to various cancers
Tobacco and Alcohol Consumption: Responsible for a significant percentage of cancer deaths
Infections: Certain chronic infections such as human
Age: The risk of developing cancer increases with age due to accumulated genetic damage and exposure to risk factors
papillomavirus (HPV), Helicobacter pylori (H.pylori), hepatitis B and C virus, and the Epstein-Barr virus can increase cancer risk
Socioeconomic and Structural Inequities: Such as reduced access to healthy food, prevention services and quality health care and higher poverty rates in some communities
Lifestyle indicators linked to cancer risk, Bristol Bay adults, 2021-2024
35% (2024)
70% (2024)
52% (2024)
Regularly use tobacco
Have 1+ sugar/ sweetened beverage/day
Are overweight/obese
38% (2023)
12% (2024)
18% (2021)
Eat 5+ fruits and vegetables/day
Report heavy or binge drinking
Meet aerobic/ strengthening recommendation/week
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Alaska Native Specific Risks Alaska Native people experience distinct cancer risk patterns driven by a mix of lifestyle, infections, environmental, and structural factors. These cancer disparities are not due to a single cause, but to a combination of:
• High tobacco use • High prevalence of infectious agents (e.g., H. pylori) • Diet and lifestyle changes • Obesity and inactivity
• Limited access to health care and screening • Environmental and geographic factors • Socioeconomic inequities
Cancers like lung, colorectal, stomach, liver, kidney, and nasopharyngeal occur at higher rates in the Alaska Native population.
Modifiable Risk Factors Many risk factors are potentially modifiable. At least 42% of newly diagnosed cancers in the U.S. are potentially avoidable, including the 19% of cancers caused by smoking and at least 18% caused by a combination of excess body weight, alcohol consumption, poor nutrition, and physical inactivity. The biggest impact for reducing risk comes from:
Over 40% of newly diagnosed cancers in the U.S. are potentially avoidable.
Avoiding tobacco
Maintaining a healthy weight
Eating a balanced diet
Staying physically active
Limiting alcohol
Protecting against infections and UV exposure
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Our Voices Cancer Survivors and Caregivers
Interviews were conducted with 16 cancer survivors and caregivers to better understand their experience with existing services. Interviewees offered recommendations on the most significant opportunities for improvement in terms of improving care and saving lives. The following themes emerged from these interviews. Themes STRENGTHS AND ASSETS Interviewees identified three areas as local strengths or assets associated with their cancer journey.
CANCER SCREENING BBAHC staff regularly encourage patients to undergo cancer screening.
PROVIDER APPROACH Certain BBAHC physicians were praised for their clear communication, helpfulness, and concern when testing and delivering diagnoses.
CARING COMMUNITY
Our community was amazing. We had people taking care of us.” “
Bristol Bay area residents take good care of their neighbors and support each other.
CHALLENGES Cancer survivors and caregivers cited five distinct challenges associated with cancer care and services at BBAHC.
Trust: Residents lack trust in BBAHC physicians to complete cancer screening. Stakeholders described incidents in which doctors dismissed cancer symptoms, delaying treatment.
Case Management: Lack of adequate case management often forces patients to figure out travel arrangements, lodging, and funding options on their own.
Financial Burden: Finances are stressful even when patients have good incomes, because travel costs for cancer treatment are high. Medicaid allowances do not cover all food costs during travel.
Provider Engagement: Some BBAHC physicians were described as disengaged and uncaring, sometimes talking to patients as if they had no education.
Non-beneficiary Support: Non-Indian Health Service (IHS) patients sometimes said they received less logistical support than IHS beneficiaries.
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OPPORTUNITIES FOR IMPROVEMENT Interviewees identified four areas of cancer services and care as opportunties for improvement.
“
If I could change one thing, there would be follow- up with every single patient and community member about the importance of cancer screening.”
Prevention Education and Screening/Early Detection • Educate people about early detection, regular checkups, and awareness of their body. • Help elders and Alaska Natives who live traditionally feel more comfortable with Western medical care.
Diagnosis
• Offer more cancer information upon diagnosis; offer support groups and counselors. • Provide more interpreters for Indigenous speakers.
Survivorship and Quality of Life
• Proactively check on patients after they return from treatment in Anchorage. • Assign patients to ongoing care teams so providers know their patient’s history. • Provide support groups, nutrition support, meditation groups, and a healing touch unit. • Offer physical therapy to increase survivors’ strength and range of motion after treatment. • Support end-of-life care needs.
Access to Treatment and Coordination of Care
• Create an effective case manager/cancer navigator system to assist patients with scheduling, travel and lodging arrangements, and financial options for cancer treatment. • When planning for Anchorage cancer care, cluster appointments to reduce travel costs. • Provide patients with more information about financial support for travel and treatment.
Internal Stakeholders To inform cancer plan development, interviews were conducted with 13 internal stakeholders, including BBAHC physicians and Advanced Practice Practitioners, other clinical providers, service department managers, and personnel from ANMC’s Oncology department (e.g., patient navigator, social worker). The following themes emerged from these interviews. Themes STRENGTHS AND ASSETS Internal stakeholders cited three main factors as current assets and strengths essential to advance cancer control.
Model of Care: BBAHC’s model of care reflects cancer-related population and public health promotion priorities along with palliative and end-of-life care.
Leadership Support: BBAHC’s administrative and clinical leadership shares a commitment to addressing cancer.
End-of-Life Care: Community health aides are an integral asset to delivery of end-of-life care.
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CHALLENGES Interviewees cited five organizational challenges associated with effective cancer control.
PREVENTION EDUCATION Overall, cancer prevention education is limited. Except for colorectal cancer, there is no community-wide systematic prevention education, including cancer risk and protective factors. EHR UTILITY Certain EHR navigation and system features challenge provider utility, impacting cancer prevention, screening, and continuity of care.
CANCER CARE CONTACT AND COORDINATION There is no designated point of contact who external entities can contact and clinically coordinate cancer treatment and care.
BBAHC’s seasoned providers are good with patient communication; locums often flounder.” “
REACTIVE APPROACH Cancer care is described as reactive and fragmented. There are inconsistencies talking with patients about screening benefits, getting diagnostic results to patients in a timely manner, processing treatment referrals, and providing follow up post treatment.
COMMUNICATION AND HEALTH LITERACY Providers are challenged by patients with diverse communication styles and norms, limited health literacy, and/or an Indigenous language preference, including elders in the highest cancer-risk age groups.
Strategic Cancer Plan | 17
There is opportunity to strengthen trusting relationships with our patients.” “
OPPORTUNITIES FOR IMPROVEMENT Internal stakeholders identified three key areas as opportunities for improvements.
1
2
3
Cancer Plan Implementation
Prevention Education, and Screening/Early Detection
Diagnosis, Treatment, and Care Coordination
• Cancer Advisory Committee : Establish a Cancer Advisory Committee to implement, guide, and oversee BBAHC’s cancer plan. • Process Frameworks : Develop basic process frameworks in advance of having medical staff and case managers engage new responsibilities or activities. • Resource Effectiveness : Deploy current resources to be more effective. For example, improve EHR effectiveness and utility in aspects central to cancer prevention and care.
• Screening Completion Rates : Improve cancer screening rates by utilizing Artificial Intelligence (AI) for focused outreach. Conduct pre-visit chart reviews by case managers to inform focused, provider-led conversations during the medical visit. • CHA/P Engagement : Support CHA/P capacity for expanded engagement in population health strategies.
• Cancer Panel : Establish a cancer patient panel with RN case manager to coordinate clinical aspects of cancer care, including diagnostic testing, treatment, and post-treatment follow-up. • Cancer Navigator : Hire a cancer navigator to guide cancer patients and caregivers, including non- beneficiary patients, in treatment logistics (e.g., transportation, qualified escorts, housing, fiscal resources).
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Our Action Blueprint BBAHC’s Strategic Cancer Plan describes areas of focus, overarching goals, and intended outcomes. It is designed as an integrated, systems-based approach to cancer control.
Priority Focus Areas
Screening & Early Intervention
Organizational Capacity
Prevention
Quality of Life
Goals, Objectives, and Strategies Below are definitions of key terms used throughout the Plan.
Goals: Broad, overarching areas for addressing the impact of cancer in Bristol Bay
Objectives: Concrete steps the Plan aims to achieve, providing aligned direction toward goals
Strategies: Specific implementation actions towards meeting objectives
Targets: Progress milestones or measurements to be reached by 2030 or other anticipated dates
A Systems Approach BBAHC’s newly implemented Model of Care provides the foundational system to advance Cancer Plan goals and objectives. (See Appendix C: BBAHC Model of Care) Healthcare models of care designed around prevention, coordination, and patient- centered care significantly reduce cancer incidence and improve early detection, leading to better outcomes and lower healthcare costs. These models drive the control of cancer by:
Did You KNOW?
• Promoting healthy behaviors and vaccination • Embedding routine screening into care delivery
• Expanding access via community-based services • Engaging patients in proactive health management • Accelerating diagnosis through structured pathways
BBAHC’s Model of Care is patient-centered and essential to cancer control in Bristol Bay.
• Coordinating multidisciplinary services • Using data to identify and target risk
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Our Action Blueprint Organizational Capacity Cancer control plans require adequate organizational capacity to be meaningful and effective. Ensuring organizational capacity for Cancer Plan implementation is a priority focus for BBAHC.
Goal
Intended Outcome BBAHC will advance Cancer Plan implementation.
Strengthen BBAHC’s organizational capacity for strategic cancer control.
Objectives 1.1 Ensure strategic integration and implementation of the cancer plan 1.2 Strengthen cancer prevention and control knowledge 1.3 Expand access to and continuity of care throughout the service region 1.4 Enhance level of care in village clinics
Strategies
Targets • BBAHC Cancer Advisory Committee formed; staffing needs identified (2026) • Region-wide physician empanelment completed (2026) • Active engagement in a statewide cancer organization • Full deployment of BBAHC’s model of care region-wide (2027) • Increased number of permanent APP hires in village clinics
1.1 Establish Cancer Advisory Committee to advance Cancer Plan priorities, plan implementation activities, and monitor implementation progress. Identify additional staffing needs, if any, such as Cancer Program Director. 1.2 Actively engage with a statewide cancer organization such as the Alaska Cancer Partnership, ANTHC Cancer Advisory Committee, Alaska Tribal Cancer Advisory Network, etc. 1.3a Continue deployment of BBAHC’s new model of care 1.3b Continue region-wide physician empanelment 1.4 Hire additional Advance Practice Providers (APPs). Baseline: one permanent APP.
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Prevention Cancer prevention aims to lower the number of new cancer cases and deaths by addressing risk factors and promoting early detection. Our Action Blueprint
Goal
Intended Outcome BBAHC will foster a culture of cancer prevention and health.
Prevent cancer from occurring.
Objectives
2.1 Develop a robust prevention program 2.2 Strengthen communication resources for cancer prevention and early detection messaging 2.3 Build community-based health education and prevention capacity 2.4 Promote healthy behaviors among Bristol Bay residents 2.5 Reduce risk of cancer
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Strategies
2.1 Develop an organizational prevention plan to present leadership advocating for prevention and wellness more broadly—inclusive of cancer, injury prevention, etc. Create a specific “ask” that aligns with, leverages, and/or complements BBAHC’s current strategic plan, organizational priorities, initiatives, operating environment, and fiscal resources. 2.2 Evaluate BBAHC’s organizational capacity to develop and distribute cancer prevention and early detection messaging materials. Consider current media contract parameters. 2.3 Establish Community Health Representative (CHR) program to provide health education in village settings. Have a coordinator in Dillingham and CHRs in five villages. 2.4 Establish population health targets for lifestyle indicators linked to cancer risk, including tobacco and excessive alcohol use, obesity, and nutrition and physical activity. 2.5a Continue efforts to establish BBAHC as a tobacco-free healthcare campus. 2.5b Review clinical approaches to mitigate cancer risk for patients with H. pylori infections.
Number of patients with H.pylori (2018-2024)
108 Secondary Diagnosis
9 Primary Diagnosis
2.5c Monitor indicator data for immunizations known to reduce cancer risk (i.e., HPV, Hep B) per BBAHC’s Population Health Dashboard.
Targets
• Prevention program developed and approved (2027) • Adequate communication resources secured, if needed • CHR program implemented: CHR in five villages and Dillingham-based coordinator (2028)
• Improvement targets for lifestyle indicators set • Campus is tobacco-free • Clinical approaches to H. pylori infections reviewed • Immunization indicator data monitored routinely
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Early cancer detection through screening significantly improves survival, reduces treatment intensity, and lowers health care costs. Screening & Early Intervention Our Action Blueprint
Hope Stories of Avanelle Willis had not planned to get a colonoscopy until a BBAHC staff member suggested she take a simple home test to see if she needed one. That test came back positive, so she completed a colonoscopy and found out she had colon cancer. “Hearing you have cancer is really scary. I wished I knew more about early detection and that if you catch this really quickly, it’s not as bad as you think,” she said. “If I had waited another five or six years, it would have been a much different outcome.” She had surgery in Anchorage in 2024, and because the cancer was caught so early, she did not need chemotherapy or radiation. One year after treatment, she was clear of cancer, and she has become a big proponent of early screening. If you’re thinking about screening, just do it. It’s totally worth the peace of mind.” “
Goal Detect cancer at its earliest stages.
BBAHC will increase the proportion of cancers diagnosed at Stage I or II. Intended Outcome
Objectives
3.1 Decrease the percentage of diagnosed at late stage 3.2 Strengthen internal capacity and/or processes to advance cancer screening 3.3 Build community outreach and messaging for screenable cancers 3.4 Utilize data to guide and refine patient engagement strategies for screening 3.5 Ensure continued capacity to conduct colorectal cancer screening
Did You KNOW?
Screening-amenable cancers are those for which early detection is possible and beneficial, such as breast, colorectal, lung, cervical, and prostate cancers.
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Strategies 3.1 Establish five-year targets for Stage I and II diagnosis of breast, colorectal, and lung cancer. 3.2a Evaluate Alaska Native Medical Center (ANMC) patient navigator model (non-RN) for cancer-specific engagement at BBAHC, including potential role in cancer screening and early intervention. 3.2b Leverage opportunities to “max pack” screening when village patients are in Dillingham for another appointment. Develop process mapping to guide a uniform, consistent approach. 3.2c Continue to develop pre-visit planning capacities. Ensure responsibilities related to cancer screening, if any, are described with clear process flow. 3.3 Review effectiveness of current community outreach and messaging strategies for breast, colorectal, cervical, and lung cancer screening. Identity opportunities to integrate emerging technologies in outreach content and patient engagement. 3.4a Monitor screening rates for breast, colorectal, and cervical cancer and Hepatitis C. 3.4b Establish lung cancer screening targets, data collection, and monitoring protocols. 3.5 Plan for pending provider retirements; engage additional providers to perform colonoscopies.
Targets • Stage I and II diagnosis targets set • Patient navigator model evaluated • Process map for “max packing” appointments developed • Pre-visit planning with screening-related process flow implemented • Effectiveness of current outreach and messaging strategies assessed • Lung screening targets and data collection established • Regular organizational review of screening data
BBAHC Cancer Screening Rates (2025):
64.12%
Breast
(Goal 59%)
53.62%
Colorectal
(Goal 61%)
56.81%
Cervical
(Goal 53%)
64.1%
Hepatitis C Age 18+
(Goal 25%)
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Quality of Life Promoting quality of life for an individual diagnosed with cancer is important throughout their cancer journey Our Action Blueprint
Hope Stories of
Goal
Karen Shelden found out she had aggressive breast cancer in 2024, after she did a walk-in mammogram, which BBAHC offers every October. She had discovered a lump that morning and within hours a radiologist read her mammogram and told her she needed to get an ultrasound. “BBAHC worked rapidly, so I didn’t have to wait and stress.” She underwent chemo, radiation, and immunotherapy, and will remain on hormone suppression for five years. Some of her biggest challenges were flying to Anchorage every three weeks for treatment and dealing with the financial strain of so much travel. Treatment was difficult, but her prognosis is positive, especially with immunotherapy and other medical advances. “The doctor told me I have a 94.6% chance of kicking this in the butt the first time.” Her strength and stamina have recovered significantly since treatment, and she realized recently that her hair had grown back enough so she could feel the wind blow through it again. “I celebrate these milestones.” She said she feels a lot more confident about medical procedures. “You can get through it. You really can.”
Advance well-being and ability to carry out activities of daily living for individuals with cancer.
Intended Outcome BBAHC will support cancer treatment, survivorship, palliative care, and end-of-life care.
Objectives
4.1 Ensure continuity of patient care 4.2 Develop support and resources for cancer patients, survivors, and caregivers 4.3 Strengthen palliative care services 4.4 Enhance internal processes that support end-of-life care
PHOTO BELOW: Cancer survivors gathered to share personal stories, engage in cultural and outdoor activities, and strengthen support networks at Bristol Bay's Journey of Hope event held June 2026 at the Mission Lodge in Aleknagik.
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Strategies
4.2a Develop a treatment process map that begins with diagnostic testing and continues through post-treatment follow-up care. Include patient navigation in the map. SURVIVORSHIP 4.2b Support community capacity to address non- clinical needs of cancer patients and their caregivers (e.g., spiritual, lifestyle, emotional). PALLIATIVE CARE 4.3a Seek funding and professional consultation to develop palliative care infrastructure. 4.3b Develop a palliative care process map to understand components critical to infrastructure development. END-OF-LIFE CARE 4.4a Address identified EHR limitations associated with communicating daily patient status updates from village CHA/Ps. 4.4b Develop end-of-life care process map in collaboration with CHA/Ps to identify opportunities to strength care.
TREATMENT 4.1a Develop a cancer-specific panel for effective clinical case management and continuity of care. 4.1b Evaluate clinical navigator models (RN) to coordinate and manage clinical aspects of patient treatment and follow-up care. 4.1c Develop job description for a RN clinical cancer navigator, if desired. 4.1d Address continuity of care challenges and related implications when patients receive treatment in a setting other than ANMC. 4.e Establish coordination with AMNC (or other discharge planners) upon patient discharge from treatment. 4.2 Determine patient navigator structure and responsibilities to support IHS beneficiary, non-beneficiary, and non-Medicaid patients. Consider needs associated with transportation, housing, escort requirements and limitations, understanding This could include other health care facilities in Alaska or the Lower 48. and managing insurance coverage, and additional resource information for patients, caregivers, and survivors.
Targets
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Scan for more cancer resource information from BBAHC
• Cancer-specific patient panel developed • Clinical cancer navigator model assessed; position development advanced • Challenges associated with treatment external to AMNC addressed • Coordination with discharge planners established • Patient navigator structure and responsibilities
identified; trained navigator(s) in place • Palliative care infrastructure developed
• EHR limitations related to end-of-life updates addressed • Process maps completed for treatment, palliative care, and end-of life care
or visit bbahc.org/cancer-screening
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Appendix A: Interviewees
The following cancer survivors and caregivers shared their experiences and provided input for the BBAHC Strategic Cancer Plan:
Kortney Johnson Lisa Ilutsik Richard Asher Robyn Chaney Sean Brandon
August Johnson Avanelle Willis Barb Asher Berna Andrews Elizabeth Clark Irene Sorenson Jennifer Dewinne Karen Shelden
Sophie Johnson Teresita Tanaka Verna Berry-Brandon
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