Abstract
Historically, cancer has occurred at a lower rate in aboriginal populations; however, it is now dramatically increasing. Unless preventive measures are taken, cancer rates among aboriginal peoples are expected to soon surpass those in non-aboriginal populations. Because a large proportion of malignant disorders are preventable, primary prevention through socioeconomic interventions, environmental changes, and lifestyle modification might provide the best option for reducing the increasing burden of cancers. Such efforts can be further amplified by making use of effective cancer screening programs for early detection of cancers at their most treatable stage. However, compared with non-aboriginal Canadians, many aboriginal Canadians lack equal access to cancer screening and prevention programs. In this paper, we discuss disparities in cancer prevention and screening in aboriginal populations in Canada. We begin with the relevant definitions and a theoretical perspective of disparity in health care in aboriginal populations. A framework of health determinants is proposed to explain the pathways associated with an increased risk of cancer that are potentially avoidable. Major challenges and knowledge gaps in relation to cancer care for aboriginal populations are addressed, and we make recommendations to eliminate disparities in cancer control and prevention.
Highlights
Cancer is a leading cause of death worldwide
We propose a conceptual framework that uses critical theory and social–ecological and community engagement models to promote cancer prevention and screening in aboriginal populations (Figure 2)
The provincial and territorial governments are primarily responsible for creating awareness of cancer screening and prevention for aboriginal people, effective implementation of cancer education, awareness, and control programs can be achieved only in collaboration with aboriginal communities at multiple levels
Summary
Cancer is a leading cause of death worldwide. Each year, tens of millions of people are diagnosed with—and more than half eventually die from—cancer[1,2,3]. Among the groups at high risk for cancer, the aboriginal peoples of Canada face unique health challenges They have a lower life expectancy and experience higher rates of coronary artery disease, diabetes, tuberculosis, and hiv infection[9]. Self-reported data from the 2007 Canadian Community Health Survey demonstrated that obesity rates were higher among off-reserve aboriginal adults than among non-aboriginal people (24.8% vs 16.6%)[40]. Information about the incidence of hpv, Pap screening, and cervical cancer rates among First Nations, Inuit, and Métis peoples in Canada are limited. The incidence of cervical cancer has declined by 70% in Canada since the early 1960s (largely because of provincial screening programs), the rates of participation in Pap test screening for cervical cancer in many Canadian provinces have been lower among aboriginal women[10,60]. The poorer survival (for at least some cancers) among aboriginal people is not entirely
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