Lung cancer in First Nations, Inuit, and Métis peoples in Canada – a scoping review

Figures & data

Table 1. Summary of included studies.

Study Reference	Province or Territory	Period of Study	Methods	Population of Interest	Study Objective(s)	Key Findings
Asmis et al. [14]	Nunavut	2000–2010	Retrospective chart review	Inuit	To describe cancer referral patterns, etymology and survival rates for Inuit patient from the Baffin region being referred to the Ottawa Hospital Cancer Centre (TOHCC)	Lung cancer was the leading cause of referral for care at TOHCC, with 10-month median all-stage survival for lung cancer patients.
Carrière et al. [15]	Inuit Nunangat (Québec, Newfoundland & Labrador; Northwest Territories; Nunavut)	1998–2007	Geographic linkage between postal code and cancer cases	Inuit	To compare cancer incidence between residents of Inuit Nunangat and the rest of Canada	Lung cancer incidence was elevated in the Inuit Nunangat population compared to the rest of Canada.
Chan et al. [16]	Inuit Nunangat (Québec, Newfoundland & Labrador; Northwest Territories; Nunavut)	N/A	Literature Review	Inuit	To provide a overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions	Inuit Nunangat has an extremely high prevalence of lung cancer and is one of the leading causes of cancer mortality.
Chan et al. [17]	Inuit Nunangat (Québec, Newfoundland & Labrador; Northwest Territories; Nunavut)	2005–2014	Retrospective chart review	Inuit	To describe the time intervals from symptom onset to the start of palliative radiotherapy among Canadian Inuit patients treated at The Ottawa Hospital (TOH).	Of study population, 70% had stage IV disease and 72% were diagnosed with lung cancer. Late diagnosis and poor survival time were observed.
Kelly et al. [18]	Northwest Territories, Nunavut	1989–2003	Population registry review	Inuit	This is the second of 2 papers reporting on the result of the Circumpolar Inuit Cancer Review, an international collaborative effort involving researchers and health officials from Alaska, Canada and Greenland.	Lung cancer incidence is rising amongst Inuit, being 1.5 times higher among Inuit men and 2–3 times higher amongst Inuit women than the general Canadian population.
Friborg & Melbye [19]	Inuit Nunangat (Québec, Newfoundland & Labrador; Northwest Territories; Nunavut)	N/A	Review	Inuit	To briefly summarise the current knowledge on cancer epidemiology in Inuit populations, with emphasis on the characteristic Inuit types of cancer.	Smoking is a large contributor to lung cancer as well as changes in diet away from nutrient rich traditional foods.
Galloway et al. [20]	Nunavut	N/A	In-depth interviews	Inuit	To understand the experiences of families and patients in Nunavut in cancer and end-of-life care	Need for cultural awareness, and shared decision making in lung cancer diagnosis and treatment planning
Goss et al. [21]	Nunavut	2001–2011	Retrospective chart review; tumor pathologic/histologic confirmation	Inuit	To understand lung cancer’s mortality, histological and genomic characterization in Nunavut	Most cases were non-small cell lung cancer (81%) with 65% of these being squamous cell carcinoma. An elevated STK11 mutation unique to this population.
Jamal et al. [22]	Ontario	1991–2010	Three registries linked to create a cohort	First Nations	To measure cancer incidence and mortality rates of Registered First Nations people in Ontario and compare them with those of other people in Ontario from 1991 to 2010.	Lung cancer incidence is rising, and it is the second most common cancer amongst First Nations males and females.
Jull et al. [23]	Ontario; Nunavut	2019	Semi-structured interviews; process mapping &thematic analysis	Inuit	To understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care	Participants reported difficulties due to lack of shared decision making. Inuit men were less likely to be referred south for treatment.
Kirk et al. [24]	Nunavut	2005–2014	Retrospective chart review	Inuit	To provide Nunavut patients better contextual information for informed consent for the treatment of metastatic lung cancer and to explore travel patterns during systemic therapy.	Patients were treated with late-stage lung cancer, with 87% of participants being treated at stages III & IV. A large portion of patients unable to return home during palliative care.
Louchini & Beaupré [25]	Québec	1988–2004	Incidence and mortality extracted from provincial registries	First Nations (Aboriginal)	To estimate incidence and mortality rates among Aboriginal people living on reserves and in northern villages in Québec during the period 1988–2004, and to compare these estimates with those of the general population.	The leading cancer for new cases and total percentage of cancer deaths was lung cancer for both men and women.
Macaulay et al. [26]	Nunavut	1987–1996	Retrospective review of health records	Inuit	To determine the pattern of mortality in the Kivalliq region over a ten-year period	The Kivalliq region had a mortality rate 1.8 times that of the rest of Canada with lung cancer being a large contributor.
Marrett & Chaudhry [27]	Ontario	1968–1991	Review of provincial cancer and mortality registries	First Nations	To determine cancer incidence and mortality rates in Ontario First Nations (FN) people (native Indians) during 1968–1991 and to compare these with rates in the Ontario population.	Cancer incidence was lower for First Nations men and women for all cancers compared to general Canadian public. Lung cancer incidence along with breast, prostate, and colorectal was rising in this period.
Mazereeuw et al. [28]	Ontario	1992–2009	Linkage between long-form census and cancer databases	First Nations	To estimate site-specific cancer incidence rates for a wide range of cancers in First Nations adults in Canada, and compare these with rates in non-Aboriginal adults.	Lung cancer incidence was similar between First Nations and NIC, but this varied by region.
Mazereeuw et al. [28]	Alberta; Saskatchewan; Manitoba; Ontario; Québec	1992–2009	Linkage between long-form census and cancer databases	Métis	To estimate incidence rates and survival for the most common cancers among Métis adults	Métis adults had a higher incidence of lung cancer amongst both men and women.
McDonald & Trenholm [29]	Québec; Newfoundland & Labrador; Northwest Territories; Nunavut; Manitoba; Saskatchewan	2000–2001; 2004–2005	Logistic regression of data from Canadian Community Health Surveys and the 2001 Aboriginal People’s Survey	Inuit	To identify the extent to which demographic, socio-economic and geographic factors account for differences between Inuit and other Northern Canadian residents in health-related behaviours and health service use related to cancer incidence and diagnosis.	Inuit have higher rates of smoking and have less reported visits to a physician, coupled with higher than the national average rates of lung cancer.
McGahan et al. [30]	British Columbia	1993–2010	Linkage between all new cancers and First Nations Client File	First Nations	To explore cancer incidence and survival in the FN population of BC and compare it to the non-FN population.	Trends in ASIR for all cancers was similar between First Nations peoples and NIC, except lung which was increasing for FN.
Nishri et al. [31]	Ontario	1968–2007	Dataset linkage cohort	First Nations	To compare cancer survival in Ontario First Nations people to that in other Ontarians for five major cancer types: colorectal, lung, cervix, breast and prostate.	From 1968–1991, First Nations peoples had similar observed survival rates as non-Indigenous peoples in Ontario. From 1991–2001, First Nations individuals had an observe survival of 8% compared to 15.3 in other Ontarians.
Sanchez-Ramirez et al. [32]	Alberta	2007–2012	Four registries linked to create a cohort	Métis	To explore cancer incidence and mortality burden among Métis and to compare disease estimates with non-Métis population.	Métis men had a higher incidence of bronchus/lung cancer compared to non-Métis men.
Withrow et al. [33]	Ontario; Newfoundland & Labrador; Alberta; British Columbia; Northwest Territories; Nunavut; Yukon; Nova Scotia; New Brunswick; Prince Edward Island; Manitoba; Saskatchewan	1991–2009	Linkage between long-form census and cancer databases to create cohort	First Nations	To compare cancer survival among First Nations to that among non-Aboriginal adults in Canada in the first national study of its kind to date.	First Nations peoples diagnosed with lung cancer had poorer 5-year survival than NIC
Young et al. [34]	Northwest Territories; Nunavut; Yukon	1989–2008	Analysis of regional cancer registries	Inuit	To compare the incidence of cancer among eight Arctic states with special attention on three cross-national Indigenous groups	Compared to GLOBOCAN averages, Inuit are at comparatively high risk for lung cancer

Figure 1. PRISMA flowchart.

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