Cancer in Indigenous Populations
Cervical cancer screening rates among Aboriginal and Torres Strait Islander women in Australia are only half those of non-Indigenous women.
Cancer remains a stark example of the deep inequities in health care faced by Indigenous communities.
The United Nations reports that over 476 million Indigenous people reside in over 90 countries across the globe, representing 6.2% of the world’s total population. Despite being a numerical minority worldwide, Indigenous people contribute significantly to global cultural diversity, with an estimated 5,000 distinct cultures and over 7,000 languages (Figure 21.1).
The World’s Indigenous Peoples
Comprehensive cancer-related data for Indigenous populations is limited in many regions. Most reported information comes from a few high-income countries (e.g., Australia, Canada, New Zealand, the US, Norway, Sweden, and Finland) and some parts in Africa and South America.
“As long as cancer continues to have such a devastating impact on our people and communities, we will advocate for the changes needed to achieve health equity in cancer care.”
Indigenous people often experience greater disadvantages and poorer health outcomes compared to non-Indigenous people due to historic and ongoing systematic discrimination. Globally, Indigenous people experience higher incidence and lower survival for cancers such as lung, liver, and cervix. The incidence of these highly preventable and common cancers is markedly greater in Indigenous people compared with non-Indigenous people in Australia and New Zealand, with rates up to three times higher in Indigenous populations (Figure 21.2).
Preventable cancers are markedly higher in Indigenous people.
Cancer incidence rate ratios comparing Indigenous and non-Indigenous populations for common cancers in selected countries
A range of sociocultural and political factors, with varying relative importance across regions, contribute to the high cancer burden among Indigenous populations, including a high prevalence of smoking, consumption of alcohol, unhealthy diets, physical inactivity, and excess body weight (Figure 21.3).
Disparities in the prevalence of cancer risk factors are key drivers of the unequal burden of preventable cancers between Indigenous and non-Indigenous populations.
Smoking prevalence (%) among Indigenous adults in comparison to non-Indigenous adults in selected countries
Footnote
Indigenous populations for each country: Australia - Aboriginal and Torres Strait Islanders (2018-2019), USA – American Indian and Alaskan Native (2022), Canada - Aboriginal (First Nations, Inuit, Metis) (2022), New Zealand - Māori (2022-2023). Smokers are defined as persons who smoke daily, at least once a week, and less than weekly, except for Canadian smokers defined as smoking in the past 30 days.
Indigenous peoples have not fully benefitted from cancer screening programs, with screening participation rates generally lower compared to non-Indigenous people (Figure 21.4). For instance, cervical cancer screening rates were 28% among Aboriginal and Torres Strait Islander women, compared to 53% among non-Indigenous women in Australia. Similarly, 62% of Māori women underwent cervical cancer screening, compared to 77% of non-Indigenous women in New Zealand.
Cancer screening prevalence (%) among Indigenous and non-Indigenous populations in selected countries
AUSTRALIA
UNITED STATES
NEW ZEALAND
CANADA
Comprehensive and persistent initiatives driven by Indigenous leadership and engagement are crucial for enhancing cancer outcomes among Indigenous populations. Progress in cancer control planning tailored by and for Indigenous communities is underway in some regions.