Abstract
BackgroundGlobally, epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. Although historically cancer among First Nations (FN) peoples in Canada was relatively unknown, recent epidemiological evidence reveals a widening of cancer related disparities. However evidence at the population level is limited. The aim of this study was to explore cancer incidence, stage at diagnosis, and outcomes among status FN peoples in comparison with all other Manitobans (AOM).MethodsAll cancers diagnosed between April 1, 2004 and March 31, 2011 were linked with the Indian Registry System and five provincial healthcare databases to compare differences in characteristics, cancer incidence, and stage at diagnosis and mortality of the FN and AOM cohorts. Cox proportional hazard regression models were used to examine mortality.ResultsThe FN cohort was significantly younger, with higher comorbidities than AOM. A higher proportion of FN people were diagnosed with cancer at stages III (18.7% vs. 15.4%) and IV (22.4% vs. 19.9%). Cancer incidence was significantly lower in the FN cohort, however, there were no significant differences between the two cohorts after adjusting for age, sex, income and area of residence. No significant trends in cancer incidence were identified in either cohort over time. Mortality was generally higher in the FN cohort.ConclusionsDespite similar cancer incidence, FN peoples in Manitoba experience poorer survival. The underlying causes of these disparities are not yet understood, particularly in relation to the impact of colonization and other determinants of health.
Highlights
Epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern
Cancer among First Nations (FN) peoples in Canada was relatively unknown [2]; recent epidemiological evidence reveals increasing cancer incidence among FN peoples [3]. This evidence demonstrates that FN people are diagnosed at later stages of cancer, and their survival is poorer
Cancer mortality is higher among FN in Ontario than non-FN people [7], and while trends indicate the mortality for breast and colorectal cancers are decreasing among non-FN, they are increasing among FN people
Summary
Epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. In Canada, previous studies show an increase in cancer incidence in FN people compared to non-FN people, this observed trend seems to be cancer site. Cancer stage at diagnosis is an important prognostic indicator, and evidence suggests FN people are more likely to be diagnosed at later stages than nonFN Canadians [11,12,13]. FN people experience significantly poorer cancer survival than non-FN in multiple Canadian provinces [5,6,7, 12, 14,15,16], independent of stage at diagnosis [14], income, or rural residency [16]
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