Abstract

Background

This study aims to measure cancer incidence and mortality rates of Registered First Nations people in Ontario and compare them with those of other people in Ontario from 1991 to 2010.

Data and methods

The federal Indian Register, the Ontario Cancer Registry and the Registered Persons Database were linked to develop a cohort of First Nations people diagnosed with cancer in Ontario. Sex-and site-specific age-standardized cancer incidence and mortality rates, and selected trends over time, were calculated. Rate ratios (RRs) were used to compare rates in First Nations peoples with those of other people in Ontario.

Results

The First Nations cohort comprised 194,392 people, with 6,859 cancer diagnoses. First Nations people had higher rates for certain cancers than others in Ontario: lung (males RR 1.19; females RR 1.47), colorectal (males RR 1.36; females RR 1.34) and kidney (males RR1.95; females RR 2.23). While lung cancer rates rose in First Nations females (annual percent change [APC] +2.67), they fell at a similar rate (APC -2.28) in males. Cervical cancer rates fell (APC -9.53) and approached the rate among other females in Ontario. Kidney cancer rates increased in First Nations people.

Interpretation

First Nations people in Ontario have higher incidence and mortality for certain cancers compared with other people in Ontario. However, the declines in cervical cancer rates in First Nations females and lung cancer rates in First Nations males illustrate the likely impact of Pap test uptake and smoking cessation programs. Community-led efforts to develop culturally appropriate prevention and screening programs are essential to further reduce cancer rates in First Nations people.

Keywords

First Nations, cancer, Indigenous

DOI: https://www.doi.org/10.25318/82-003-x202100600002-eng

Findings

There are three distinct Indigenous groups in Canada: First Nations, Inuit and M├ętis (FNIM). They have unique histories, languages, cultural practices and beliefs. First Nations comprise the largest of these groups, with over 230,000 people residing in Ontario (about 2% of the provincial population and about 24% of the national First Nations population). Many First Nations people face significant barriers to achieving good health, stemming in part from colonialism, racism and social exclusion. As a result, many experience poorer health compared with the general population (e.g., lower life expectancy, higher avoidable mortality). Other factors may also contribute to poorer health outcomes, including geographic challenges that limit accessibility to health services, affordable food and education. [Full article]

Authors

Sehar Jamal is with the Ontario Health (Cancer Care Ontario) Indigenous Cancer Care Unit, Toronto, Ontario, Canada. Carmen Jones is with the Chiefs of Ontario (Health Sector), Toronto, Ontario, Canada. Jennifer Walker is with the Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada. Maegan Mazereeuw is with the Canadian Institute for Health Information, Ottawa, Ontario, Canada. Amanda J. Sheppard (amanda.sheppard@ontariohealth.ca) is with the Ontario Health (Cancer Care Ontario) Indigenous Cancer Care Unit, Toronto, Ontario, Canada, and the University of Toronto (Dalla Lana School of Public Health), Toronto, Ontario, Canada. David Henry is with Bond University (Institute for Evidence-Based Healthcare), Robina,Queensland, Australia. Loraine D. Marrett is with the Ontario Health (Cancer Care Ontario) Indigenous Cancer Care Unit, Toronto, Ontario, Canada, and the University of Toronto (Dalla Lana School of Public Health),Toronto, Ontario, Canada.

Acknowledgements

Analytic contributions

The authors would like to acknowledge the foundational role of their esteemed colleague, Diane Nishi, in this project. In particular, the work benefited from her analytic expertise, her constant vigilance regarding flaws in logic and data quality, and her always insightful recommendations for improvement. Abigail Amartey also played a pivotal role in the initial development of the study cohort. Nelson Chong was responsible for the complex record linkage process.

Leadership contributions

Alethea Kewayosh and Tracey Antone brought organizational leadership and insight to the project while maintaining loyalty to the populations they serve.

The Chiefs of Ontario Health (Cancer Care Ontario), Health Canada (First Nations and Inuit Health), Indigenous Services Canada (formely Indian-and-Northern Affairs Canada), and ICES collaborated on this endeavour for over a decade.

Disclaimers

This publication was conducted with the support of Ontario Health (Cancer Care Ontario) through funding provided by the Ontario Ministry of Health. The opinions, results, view, and conclusions reported in this publication are those of the authors and do not necessarily reflect those of Ontario Health (Cancer Care Ontario). No endorsement by Ontario Health (Cancer Care Ontario) is intended or should be inferred.

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).  Parts of this material are based on data and information compiled and provided by: MOHLTC, CCO, CIHI. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

 

What is already known on this subject?

  • Prior to 1991, Registered First Nations people had lower cancer rates compared with the general population; however, rates for certain cancers (e.g., lung, colorectal) were rising more quickly over time than for other people in Ontario.
  • Follow-up studies found lower rates of cancer survival among First Nations people compared with other people, particularly for colorectal, female breast, male lung and prostate cancers.
  • Given the rising rates of certain cancers (e.g., lung, colorectal), updating cancer burden statistics in this population is important for providing more targeted prevention measures and programs.

What does this study add?

  • From 1991 to 2010, First Nations people had higher incidence and mortality rates for several cancers (e.g., lung, colorectal and kidney) compared with other people in Ontario.
  • While cervical cancer incidence was rising in First Nations females prior to 1991, findings from this study indicate a decrease over time, with convergence with the incidence rates of the general population.
  • This study presents important data for culturally appropriate cancer-control planning and priority-setting; however, data regarding cancer screening and follow-ups among First Nations in Ontario are needed to help inform health policies and programs.

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