Highlights
- The incidence of lung cancer is higher in First Nations people than other people in Ontario.
- Cancer Care Ontario works with Indigenous communities and other organizations to reduce risk factors for lung cancer in First Nations.
From 1991 to 2010, the incidence of lung cancer was higher in First Nations than other people in Ontario. Lung cancer was also the most commonly diagnosed cancer in First Nations people, but it was the third most commonly diagnosed cancer in other people during this time period.[1] The reasons for this disparity are vast, multi-faceted and complex, and relate directly to the impact of colonialism and colonial policies spanning many centuries.[1][2] It is vital to consider cultural and historical contexts when addressing the differences in cancer incidence between First Nations in Ontario and other people.
One risk factor for lung cancer is tobacco, which includes smoking cigarettes, commercial tobacco use and exposure to second-hand smoke.[1] In some First Nations communities, traditional tobacco has a spiritual significance,[1] but many communities still have a high commercial tobacco use. Nearly half (49%) of First Nations females living on-reserve and 41% living off-reserve used commercial tobacco from 1991 to 2010, compared to 18% of other females living in Ontario.[3] Among First Nations males, 50% living on-reserve and 44% living off-reserve used commercial tobacco, compared to 26% of other males living in Ontario.[3] Second-hand smoke exposure can also increase the risk of lung cancer among people who do not smoke by 2 to 4 times.[3]
To address the high commercial tobacco use in First Nations communities, the Indigenous Tobacco Program at Cancer Care Ontario works to enhance knowledge, build capacity and empower First Nations, Inuit, Métis and urban Indigenous communities with the skills and tools needed to address commercial tobacco use and reduce the incidence of cancer and other chronic diseases.[1]This includes smoking cessation and prevention programs for adults and youth-oriented Ultimate Frisbee workshops.[1]
Environmental risk factors, such as exposure to radon gas, particulate air pollution and asbestos, or ingesting foods and water containing arsenic, can also increase the risk of lung cancer.[1] In First Nations, an estimated 10% of lung cancer cases are from exposure to radon gas in houses and buildings,[1] which is why CAREX Canada has collaborated with First Nations communities and Cancer Care Ontario since 2009 to create educational resources and monitoring tools to address environmental risk factors, while building community capacity.
For example, the Mississauga First Nation and Timiskaming First Nation in Ontario use an online interactive map showing nearby emitters, active and inactive mine sites, federally contaminated sites, rivers and watersheds.[4]The community radon monitoring project encourages frequent testing of the air in homes, which is the only way to know if the radon gas levels are too high.[4]
In addition to addressing lung cancer risk factors, culturally safe, person-centred cancer care is essential for finding cancer in its early stages, when treatment has a better chance of working.[1][3] Many initiatives support culturally safe care across Ontario. The Indigenous Cancer Care Unit at Cancer Care Ontario has developed Indigenous Relationship and Cultural Safety courses to help healthcare professionals gain a better understanding of First Nations, Inuit, and Métis history, culture and health landscapes. These courses are important because culturally appropriate education and resources that recognize community cultures, histories and values can help reduce exposure to the specific cancer risk factors in First Nations communities.[1][2][5]
Indigenous Navigators at Cancer Care Ontario also provide support to First Nations, Inuit, and Métis people and families as they enter the healthcare system[1] and the Indigenous Tobacco Program and collaborative initiatives between CAREX Canada, Cancer Care Ontario and First Nations communities have met the self-determination criterion required for cultural safety by prioritizing First Nations decision-making.[1][6] By working directly with First Nations, Inuit, Métis and urban Indigenous communities, and co-developing culturally relevant research, initiatives and sustainable programming that allow community members to take ownership of their health, there is great potential to prevent and reduce new cases of lung cancer for First Nations peoples in Ontario.
You can find more information on cancer among First Nations people in 2 of our reports: Cancer in First Nations People in Ontario: Incidence, Mortality, Survival and Prevalence and Cancer in First Nations in Ontario: Risk Factors and Screening. The reports were produced as a collaboration between the Chiefs of Ontario, the Indigenous Cancer Care Unit at Cancer Care Ontario, and the Institute for Clinical Evaluative Sciences. You can find more information on the colonial, historical and social contexts relating to First Nations, Inuit, Métis and urban Indigenous communities in Health Inequalities and Social Determinants of Aboriginal Peoples’ Health.