P e r c e n t

5 % o r l e s s5 . 1 - 1 0 %1 0 . 1 - 1 5 %1 5 . 1 - 2 5 %M o r e t h a n 2 5 %N o d a t a

Alaska US Canada (Métis) Canada (Registered Indian) Australia NZ0.1

1

10

0.1

1

10

Alaska US Canada (Métis) Canada (Registered Indian) Australia NZ

Alaskan Natives

Canada

Brazil

Greenland

Western Australia (Urban)

Western Australia (Isolated)

New Zealand

0 25 50 75 100

canceratlas.cancer.org canceratlas.cancer.org

25.1% or more15.1–25%10.1–15%5.1–10% No data5% or less

MAP 15.1

Indigenous peoples as percent of total population, 2010 or most recent data year

FIGURE 15.1

15 THE BURDEN

CANCER IN INDIGENOUS POPULATIONSHigher prevalence of risk factors, poor outcomes, and under-reporting are among the cancer control challenges for Indigenous peoples.

populations have not benefited equally from advances in early detection and treatment. Comprehensive, sustained efforts centered around indigenous leadership and participation are needed to improve cancer outcomes for Indigenous peoples. Cancer control planning by and for Indigenous peoples is progressing in some jurisdictions.

There are more than 370 million Indigenous people spanning at least 70 countries worldwide. Indigenous peoples generally face disadvantage and have worse health than non-Indigenous people. Data related to cancer in these populations tend to be absent or of poor quality making many Indigenous peoples statistically invisible, with the majority of data that exist coming from a few high-income countries. There is under-reporting of cancer incidence and mortality in many jurisdictions. Indigenous peoples often have higher incidence and mortality rates of cancers related to exposure to tobacco, alcohol, poor diet, physical inactivity, high BMI, and diabetes mellitus than non-Indigenous people living in the same countries, although cancer patterns vary from country to country.FIGURE 15.1 Cancer-causing infections such as Helicobacter pylori and hepatitis B virus, which are related to poverty and overcrowding, tend to be higher in Indigenous populations, particularly in regions where vaccination for hepatitis B is not occurring. FIGURE 15.2 Further, survival after diagnosis is lower, and its improvement is slower in Indigenous populations, suggesting Indigenous

Cancer mortality rates in Indigenous people

can be many times higher than those of non-Indigenous people

in some countries.

Relative risk of cancer-specific mortality for Indigenous compared with non-Indigenous peoples by country and site*

FIGURE 15.2

Prevalence (%) of H. pylori among Indigenous peoples, select studies*

Australia2012-2016

Canada (Métis)1991-2001

Canada (Registered Indian)

1991-2001

Alaska1999-2009

USA2012-2016

New Zealand 2006-2011

Australia2012-2016

Canada (Métis)1991-2001

Canada (Registered Indian)

1991-2001

Alaska1999-2009

USA2012-2016

New Zealand 2006-2011

MALE

FEMALE

StomachLungColorectum

Canada

Greenland

Mexico

GuatemalaHonduras

| El Salvador

Nicaragua

Costa RicaPanama

Colombia

Ecuador

Peru

Bolivia

Brazil

Paraguay

Argentina

Chile

Venezuela

United States of America

Nigeria

Cameroon

Kenya

India

Pakistan Nepal

China

Bhutan

Myanmar

Thailand

NorwaySweden

Russia

Russia—

Australia

New Zealand

New Zealand is the only country in the

world that routinely records and reports

national-level cancer statistics for its

Indigenous population.

NEW ZEALANDI N D I G E N O U S M ĀO R I P E O P L E

Hei Ahuru Mowai, Aotearoa/New Zealand’s Indigenous Māori cancer leadership group, aims to influence national cancer policy by ensuring participation and engagement with Māori from policy development to implementation across the cancer control continuum. The group has representatives on most of the country’s cancer groups and also partnered with the Ministry of Health on a Cancer and Racism seminar which will inform a new national cancer strategy. Hei Ahuru Mowai is currently working with the National Bowel Screening Programme to ensure equity is addressed in its national roll-out.

Indigenous peoples in many countries have a high prevalence of H. pylori, an infection which causes

stomach cancer.

ProstateBreastUterusCervix

ACCESS CREATES PROGRESS

*Source varies by country. See Sources and Methods, page 116

THE WORLD HEALTH ORGANIZATION HAS CALLED FOR THE ELIMINATION OF CERVICAL CANCER. While disease burden is highest in lower- and middle-income countries, significant disparities exist in high-income countries. In Australia, cervical cancer incidence in Indigenous women is double that of non-Indigenous women, with mortality rates over three times higher. Strategies and actions needed to accelerate cervical cancer elimination for Indigenous women globally must be led by Indigenous women and form part of the draft global strategy tabled at the 2020 World Health Assembly.

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