Cancer Survival in First Nations and Métis: Follow-up of the 1991 Census Mortality Cohort! Diana Withrow! June 24 th, 2014! NAACCR Annual Conference! Ottawa, ON!
Outline & Goals! Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 1. To describe the data challenges that have led to a paucity of research about cancer survival in First Nations and Métis in Canada! 2. To describe how the 1991 Census Mortality Cohort overcomes some of these challenges! 3. To describe cancer survival in First Nations and Métis and compare it to that in the general population of Canada! 2!
First, some good to knows Who are the First Na4ons and Mé4s? 3
Who are the First Na4ons and Mé4s? Source: Sta4s4cs Canada. h@p://www.statcan.gc.ca/daily- quo4dien/130508/dq130508a- eng.htm 4
Who are the First Na4ons and Mé4s? Source: Sta4s4cs Canada. h@p://www.statcan.gc.ca/daily- quo4dien/130508/dq130508a- eng.htm 5
Who are the First Na4ons and Mé4s? Aboriginal Ancestry 1,319,890 Aboriginal Iden8ty 952,890 356,630 57,940 510,785 27,535 441,395 8,775 Status Indian 558,180 Canada 2001 11,080 Eric Guimond, Personal communica4on, 2011
First, some good to knows Who are the First Na4ons and Mé4s? Iden4ty vs. Ancestry vs. Registra4on There are no ethnic iden4fiers in provincial cancer registries Stage has not been rou4nely collected The results I m presen4ng today are from a preliminary version of the data Data release is tricky 7
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 8
What do we know about cancer burden among Aboriginal people? Mortality Incidence Survival 9
What do we know about cancer burden among Aboriginal people? Mortality Incidence Survival 10
Cancer mortality among Registered Indians and Mé4s in Canada Registered Indians Mé8s Male Female Male Female 1 Circulatory System Diseases Circulatory System Diseases Circulatory System Diseases Cancer 2 External causes Cancer Cancer Circulatory System Diseases 3 Cancer External causes External causes Respiratory Disease 11 11
Cancer mortality among Registered Indians and Mé4s in Canada Registered Indians Mé8s Male Female Male Female 1 Circulatory System Diseases Circulatory System Diseases Circulatory System Diseases Cancer (33%) 2 External causes Cancer (25%) Cancer (23%) Circulatory System Diseases 3 Cancer (18%) External causes External causes Respiratory Disease 12 12
What do we know about cancer burden among Aboriginal people? Mortality Incidence Survival 13
All cancer incidence, Ontario, 1968-2001, ages 15-74 Marrett, 7/15/14 LD Chaudhry, M. Cancer incidence and mortality in Ontario First Nations, 1968-1991 (Canada). Cancer Causes and Control. 2003.
Colorectal cancer incidence, Ontario, 1968-2001, ages 15-74 7/15/14
What do we know about cancer burden among Aboriginal people? Mortality Incidence Survival 16
Survival of Registered First Na4ons in 100 Ontario, 1992-2001 Five- year all- cause survival (%) 80 60 40 20 First Na4ons Other Ontarians 0 Male Female Male Female Female Female Male Colorectal Lung Cervix Breast Prostate Notes: Five- year age- standardized observed survival (%) by cancer site and sex comparing the First Na4ons popula4on to other Ontarians for cancers diagnosed between 1992-2001 with follow- up to December 31 st, 2007 and censoring at age 75. Source: Nishri ED, Sheppard A, Withrow DR, Marre@ LD. Cancer survival among First Na4ons people of Ontario, Canada (1968-2007). Interna4onal Journal of Cancer. May 2014. In press.
So what? Cancer burden appears to be significant and increasing Harder to iden4fy subgroups of Aboriginal people have been neglected in research to date No na4onal data Par4cularly limited knowledge of survival and survival dispari4es 18
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 19
Aims 1. Describe the survival from cancer among First Na4ons and Mé4s adults in Canada a) Compare these to the non- Aboriginal popula4on 2. Explore pa@erns in survival from cancer among First Na4ons and Mé4s a) Over 4me b) By region 20
Aims 1. Describe the survival from cancer among First Na4ons and Mé4s adults in Canada a) Compare these to the non- Aboriginal popula4on 2. Explore pa@erns in survival from cancer among First Na4ons and Mé4s a) Over 4me b) By region 21
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 22
Methods: The Cohort 1991 Census Long Form 1990-1991 Tax file 1991 Census Cohort Canadian Mortality Database (1991-2006) 1991 Census Mortality Cohort
Methods: The Cohort 1991 Census Long Form 1990-1991 Tax file 1991 Census Cohort Canadian Mortality Database (1991-2006) 1991 Census Mortality Cohort Canadian Cancer Database (1992 2003) Final Cohort N= 2.7 million FN: 62,400 Mé4s: 11,800
Methods: Rela4ve survival Ra4o of the observed survival in those diagnosed with cancer to the expected survival of a comparable group in the general popula4on Compared to cause- specific survival, Does not rely on accurate coding of cause of death Takes into account differences in background mortality between popula4ons Requires age-, sex-, 4me- and ethnicity- specific life tables 25
Methods: Rela4ve Survival Cancer cases arise from the census cohort Age-, sex-, and ethnicity- specific life tables were constructed Small sample modeling of expected mortality using flexible parametric modeling 26
Methods: Rela4ve Survival Four cancer sites: breast, prostate, lung, colorectal Dx- ed 1992-2003 Followed up un4l first of Death OR Age 95 OR 5 years post- diagnosis OR December 31 st, 2006 Age- standardized to Interna4onal Cancer Survival Standard Expected survival es4mated using Ederer II, cohort approach 27
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 28
LUNG 100 Age- standardized Rela8ve Survival (%) 80 PRELIMINARY 60 Non- Aboriginal 40 First Na4ons 20 0 0 1 2 3 4 5 Time since diagnosis (years) Source:1991 Census Mortality Cohort, Sta4s4cs Canada Notes: Men and women aged 40-95 diagnosed with lung cancer between January 1 st 1992 and December 31st 2003. Followed up for mortality un4l December 31 st 2006. Age- standardized to the Interna4onal Cancer Survival Standard. Produced by: Diana Withrow, Cancer Care Ontario and University of Toronto, June 2014.
COLORECTAL 100 Age- standardized Rela8ve Survival (%) 80 PRELIMINARY 60 Non- Aboriginal 40 First Na4ons 20 0 0 1 2 3 4 5 Time since diagnosis (years) Source:1991 Census Mortality Cohort, Sta4s4cs Canada Notes: Men and women aged 40-95 diagnosed with colorectal cancer between January 1 st 1992 and December 31st 2003. Followed up for mortality un4l December 31 st 2006. Age- standardized to the Interna4onal Cancer Survival Standard. Produced by: Diana Withrow, Cancer Care Ontario and University of Toronto, June 2014.
FEMALE BREAST 100 Age- standardized Rela8ve Survival (%) 80 PRELIMINARY 60 Non- Aboriginal 40 First Na4ons 20 0 0 1 2 3 4 5 Time since diagnosis (years) Source:1991 Census Mortality Cohort, Sta4s4cs Canada Notes: Women aged 40-95 diagnosed with breast cancer between January 1 st 1992 and December 31st 2003. Followed up for mortality un4l December 31 st 2006. Age- standardized to the Interna4onal Cancer Survival Standard. Produced by: Diana Withrow, Cancer Care Ontario and University of Toronto, June 2014.
PROSTATE 100 Age- standardized Rela8ve Survival (%) 80 PRELIMINARY 60 Non- Aboriginal 40 First Na4ons 20 0 0 1 2 3 4 5 Time since diagnosis (years) Source:1991 Census Mortality Cohort, Sta4s4cs Canada Notes: Men aged 40-95 diagnosed with prostate cancer between January 1 st 1992 and December 31st 2003. Followed up for mortality un4l December 31 st 2006. Age- standardized to the Interna4onal Cancer Survival Standard. Produced by: Diana Withrow, Cancer Care Ontario and University of Toronto, June 2014.
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 33
Strengths Na4onal perspec4ve Will include harder to iden4fy groups Rela4ve survival with appropriate life tables Number of cancers and length of follow- up 34
Limita4ons Number of cancers and follow- up Stage Ancestry rather than iden4ty concept for iden4fica4on of Aboriginal persons 35
Background! Aims! Methods! Results! Strengths & limitations! Conclusions & implications! 36
Conclusions and Implica4ons Cancer is a growing concern in Aboriginal populations! Lacking ethnic identifiers are one reason for limited survival research to date! Preliminary data show poorer survival among First Nations than the general population for four major cancer sites! Further analyses will elucidate potential areas for action! 37
Acknowledgements Supervisor: Dr. Loraine Marre@ Co- supervisor: Dr. Jason Pole Co- inves8gators: Michael Tjepkema, Diane Nishri, Donna Turner, Alethea Kewayosh Financial Support: Cancer Care Ontario Canadian Ins4tutes for Health Research Sta4s4cs Canada Health Canada 38