Abstract Background: American Indian (AI) women face persistent disparities across the breast cancer care continuum and remain critically underrepresented in cancer research. Breast cancer is the most commonly diagnosed cancer among AI women, who are more likely to be diagnosed at later stages, develop aggressive subtypes like triple-negative breast cancer, and experience lower survival rates compared to non-Latine White women. Only 59% of breast cancers among AI women are diagnosed at localized stages, compared to 67% in white women, and screening rates remain low; just 38.4% among those using Indian Health Service facilities. Over half of AI individuals live in rural areas, where barriers such as geographic isolation, under-resourced healthcare systems, and limited access to specialty care compound racialized disparities. Despite these structural challenges, AI communities remain underrepresented in cancer disparities research, leaving critical gaps in knowledge and practice. National organizations, including the American Association for Cancer Research, have explicitly called for increased efforts to include Indigenous communities in cancer research and to identify actionable strategies that address both structural barriers and community assets. Objective: Responding to this call, our study centers the voices of AI breast cancer survivors to better understand the factors shaping their cancer journeys and to guide the development of equity-driven solutions. Methods: Using interpretative phenomenological analysis, we conducted semi-structured interviews with AI breast cancer survivors from the Chickahominy Indian Tribe. Transcripts were coded inductively to identify themes related to health beliefs, care experiences, and support systems. Results: Five superordinate themes and eight sub-themes emerged, capturing a range of experiences from causal attributions to interactions with the healthcare system. Participants described delays in communication, difficulty accessing specialized care, and a lack of culturally responsive information. They also emphasized the vital role of familial and tribal support, trusted provider relationships, and personal resilience in navigating their care. These findings illustrate both structural barriers and social assets that shaped survivors’ engagement in the cancer care continuum. Conclusions: This study provides urgently needed insight into the breast cancer experiences of an underrepresented AI community. Findings highlight both systemic barriers and community strengths, highlighting the need for equity-driven, culturally grounded interventions. Amplifying survivor perspectives is essential to developing responsive strategies that improve care access, coordination, and survivorship outcomes among Indigenous populations. Citation Format: Bianca D. Owens, Maria Thomson, Susann Brown, Stephen Adkins, Katherine Y. Tossas. Survivorship in context: Structural and social drivers of breast cancer care among underrepresented American Indian women abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B064.
Owens et al. (Thu,) studied this question.