In contrast to many other Native American groups in the United States, cancer incidence data are available for the Alaska Native population from 1969 to present. These data support the fact that cancer patterns in this population differ from all other U.S. populations and are most similar to Eskimos (Inuit) of other circumpolar countries. The unique cancer patterns and the distribution of the population far from sophisticated medical centers strongly impact the cost/benefit ratios of recommended cancer screening procedures. Cost/benefits of cancer screening and data showing that more than one-third of cancer cases and cancer deaths are tobacco related, necessitate that cancer control efforts in this population should focus on eradication of tobacco.