Disparity in Cancer Prevention and Screening in Aboriginal Populations: Recommendations for Action

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.

Mortalidade por câncer em populações indígenas no Estado do Acre, Brasil

“…No presente estudo, identificou-se menor mortalidade entre indígenas em relação a todas as populações de referência, resultados coerentes com a análise que apontou menor risco de óbito por câncer de mama entre mulheres indígenas brasileiras quando comparadas a brancas em 2000 (RR = 0,25; IC95%: 0,13-0,47) e 2010 (RR = 0,09; IC95%: 0,03-0,22) 67 . Em países desenvolvidos, embora a taxa de incidência por câncer de mama entre mulheres indígenas seja inferior à identificada entre mulheres não indígenas, observa-se um ritmo elevado de óbitos em indígenas, sendo verificada detecção tardia, estadiamento avançado, menor participação no rastreamento e pior sobrevida como reflexo das disparidades de acesso ao tratamento 68,69 .…”

Screening for Cervical Cancer: Protocol for Systematic Reviews to Inform Canadian Recommendations

“…In Canada, 74% of women aged 25 to 69 years receive a Pap test every three years [54]; however, some population subgroups, including Indigenous populations [55], individuals with very low socioeconomic status [56], individuals living in rural or remote communities, new immigrants, and other underserved groups [57] are more likely to be inadequately screened. Transgender individuals (e.g., female-to-male transgender men) have also been identi ed as a group at risk for inadequate cervical cancer screening [58].…”

Ligne directrice sur le dépistage de l’adénocarcinome œsophagien chez les patients atteints de reflux gastro-œsophagien chronique

“…Des rapports canadiens montrent que les temps d'attente pour les endoscopies sont considérés comme trop longs et excèdent les objectifs recommandés 53,54 . L'application du dépistage augmenterait la demande et pourrait aggraver les problèmes d'équité en matière de santé, puisque les immigrants récents et les populations rurales ou éloignées, autochtones ou à faible revenu risqueraient de ne pas y avoir aussi facilement accès 55,56 . Étant donné l'incertitude des données et le manque de données probantes sur l'efficacité, nous sommes d'avis qu'il ne serait ni faisable ni acceptable de procéder au dépistage de tous les patients atteints de RGO, qui pourrait mobiliser à mauvais escient beaucoup de ressources en santé.…”