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.

ancer and other chronic diseases are leading causes of morbidity and mortality among First Nations people in Canada, and addressing the cancer burden is a growing health priority among First Nations people. 1-4 Compared to non-Indigenous Canadians, First Nations people in Canada experience a higher incidence of cancers of the kidney, 2,5-9 liver, 2,7,10 gallbladder, 6,9,10 cervix, 2,5,7-12 and colon and rectum. 2,7,8,10,13 Emerging evidence also indicates that First Nations people are more likely to be diagnosed with cancers at later stages than non-Indigenous Canadians 13-16 and experience significantly lower survival. 8,10,17-19 Multiple factors contribute to these disparities, including individual patient factors, environmental exposures, socioeconomic factors (particularly income) and access to health care services. 2,8,20,21 About half of First Nations people in Manitoba live on designated tracts of land known as reserves 22 located throughout the province. The funding and delivery of health care services to First Nations living on reserves is limited, and the effects on health outcomes of limited access to some health care services for First Nations peoples (both Status and non-Status) living on reserve are not clear. Differences in the funding and delivery of health care services to First Nations on and off reserve can have important impacts on individual and population health. We report on the findings from a larger study of provincial health administrative data 16 to address 3 objectives: 1) to