The BC Cancer Agency was recently a co-author for an important study examining cancer incidence and survival for First Nations people in British Columbia.
The study, conducted with the First Nations Health Authority and published in the journal Cancer Causes & Control, shows an overall lower incidence, but also indicates lower survival rates, for most cancers for First Nations people.
The 1993 to 2010 data set includes "Status Indian" peoples only and is not inclusive of all First Nations, Métis or Inuit peoples in BC.
The results show both First Nations men and women experience a higher incidence of colorectal cancer, with a 22 per cent higher age-standardized incidence rate for women and 39 per cent for men. There also appears to be a trend towards increasing incidence for both sexes. A 92 per cent higher incidence rate of cervical cancer was also observed among First Nations women.
Incidence rates of almost all other cancers were generally similar or lower in First Nations populations compared to non-First Nation populations. Trends in incidence rates over time were also similar, with the exception of lung cancer, which is rising at a rate among First Nations people that may soon overtake declining rates in non-First Nations people.
First Nations people are also less likely to survive a cancer diagnosis compared to non-First Nations people. Overall, poorer survival was seen in the First Nation population in 10 of the 15 cancer types examined in women and 10 of the 12 cancer sites examined in men.
According to the study authors, these results affirm the need for a system-wide response to improve cancer diagnosis and care for First Nations people in BC.
"This first of its kind study is a vital step in addressing health disparities for First Nations people in BC," says Dr. Nadine Caron, Associate Professor for UBC's Northern Medical Program and Co-Director of the UBC Centre for Excellence in Indigenous Health. Dr. Caron was corresponding author of the study.
"While the end focus of this study is on cancer incidence and survival, the answers to explain these differences lie in the impact of our history in Canada and its residential schools, the current inequities in a broad range of the social determinants of health and the access and utilization of BC's health care system by First Nations people."
The findings in this study suggest a complex basis for these disparities in cancer incidence and survival. The authors note that further studies along the entire spectrum of cancer care—from wellness and prevention, to screening, diagnosis and treatment—are required to better understand these results.
As the study concludes, lower survival rates could be influenced by a number of factors including challenges in access to high quality, timely, appropriate and effective cancer treatment, especially in rural and remote areas. Lower diagnosis may be impacted by limited access to screening programs.
For many First Nations peoples, their cancer journey is also negatively impacted through the experience of racism in health and social support settings.
"Within First Nations in BC, cancer is a very difficult issue to speak about, acknowledge or respond to due to the continued impacts of Residential Schools," says Preston Guno, Director of Indigenous Cancer Care for BC Cancer Agency.
The First Nations Health Authority, BC Cancer Agency, the BC Association of Aboriginal Friendship Centres and Métis Nation are working in partnership to complete an Indigenous cancer strategy to be released later this fall. The strategy will be informed by the findings in this study as well as other data sources and extensive engagement with communities, survivors and their families.
"This study was an important first step in an ongoing collaboration between the BC Cancer Agency and the First Nations Health Authority," says Dr. John Spinelli, Vice President of Population Oncology at BC Cancer Agency and co-author of the study.
"Given that research can be used to address disparities in health outcomes, it is vital that First Nation cancer data is collected, analyzed and becomes part of how we approach cancer control for First Nations people in BC."