Cancer among circumpolar populations: an emerging public health concern

Figures & data

Table I. Mean age-standardized incidence rates of selected cancer sites in 8 Arctic States and their northern regions, 2000–2009

		All sites		Lung		Colon/rectum		Breast	Cervix	Prostate
Arctic state/Northern region	Mean population	M	F	M	F	M	F	F	F	M
United States	294,366,300	369.9	291.6	54.3	36.6	36.4	26.4	89.9	6.7	107.1
Alaska	662,061	361.9	303.1	52.9	39.0	37.7	29.1	96.9	6.7	104.4
Canada	32,143,213	332.7	273.7	48.9	34.3	42.4	28.6	80.0	6.3	88.9
Yukon	31,697	269.4	248.9	45.2	30.8	41.3	33.6	76.0	5.7	58.0
Northwest Territories	42,633	280.8	271.2	45.2	36.8	63.6	52.2	88.0	6.1	64.5
Nunavut	29,982	327.4	381.5	145.8	155.3	58.0	72.1	42.7	10.5	19.5
Denmark	5,417,146	320.4	306.5	45.4	34.5	42.4	32.0	92.5	10.4	60.4
Greenland	56,577	317.2	304.2	98.7	63.1	36.5	35.4	44.4	23.7	16.9
Faroe Islands	47,781	228.0	221.9	23.6	14.7	31.9	29.4	65.1	11.7	44.3
Iceland	298,582	310.1	282.2	34.0	32.0	32.0	23.9	87.9	8.5	95.6
Norway	4,628,970	323.8	271.5	36.3	22.7	42.7	34.7	75.1	9.5	92.9
Nordland	236,639	324.4	284.7	36.8	25.0	44.2	34.7	72.0	13.7	60.2
Troms	153,281	317.1	262.7	39.4	22.0	40.2	30.6	69.3	11.8	57.0
Finnmark	73,157	287.9	250.8	48.4	26.8	63.7	26.0	64.2	10.1	63.1
Sweden	9,042,112	279.8	244.0	20.3	16.8	31.2	24.3	80.2	7.0	101.3
Västerbotten	256,679	269.9	243.5	16.0	12.7	33.0	26.4	81.4	5.3	99.4
Norrbotten	252,754	220.5	219.2	14.8	14.5	23.3	19.6	70.5	7.7	73.4
Finland	5,245,935	287.7	234.5	34.6	10.8	26.9	19.9	83.2	4.1	94.7
Pohjois-Suomi	464,704	253.9	208.8	36.6	10.1	20.7	16.8	68.1	3.3	77.5
Lappi	187,033	271.0	208.3	38.6	12.2	21.8	15.3	68.4	4.3	89.8
Russia	143,784,868	267.6	192.8	58.6	6.9	27.6	20.2	40.7	12.0	20.1
Murmansk Oblast	877,503	300.9	212.2	67.4	7.7	38.6	26.4	45.7	11.1	26.9
Kareliya Republic	705,600	276.1	183.6	68.3	4.7	34.1	22.4	39.9	15.5	21.5
Arkhangelsk Oblast	1,310,255	285.3	188.8	67.0	6.0	30.1	23.5	35.0	10.7	20.5
Komi Republic	998,158	293.2	192.4	71.6	9.2	35.7	23.9	36.8	14.4	15.6
Sakha Republic	951,425	256.5	183.2	59.5	19.8	21.4	18.8	30.2	13.5	8.0
Magadan Oblast	176,652	321.3	209.5	74.5	14.2	35.3	27.9	43.3	16.3	15.3
Chukotka AO	52,399	268.7	224.1	60.9	23.4	26.0	35.8	40.7	19.7	10.6

Notes:

All rates are directly standardized to the IARC World Standard Population and expressed as per 100,000. Rates refer to the total national/regional population with all ethnicities combined.

Data for Denmark do not include Greenland or the Faroe Islands. For all other Arctic States, data for the northern regions are part of the national data. Northern regions refer to:

 United States – the State of Alaska.

 Canada – the 3 territories north of the 60^oN latitude – Yukon, Northwest Territories and Nunavut.

 Kingdom of Denmark – the self-governing territories of Faroe Islands and Greenland.

 Norway – the county (fylke) of Nordland, Troms and Finnmark.

 Sweden – the county (län) of Västerbotten and Norrbotten.

 Finland – the regional state administrative agency (aluehallintovirasto or AVI, formerly lääni) of Pohjois-Suomi and Lappi

 Russia – various republics, oblasts and autonomous okrugs; Due to administrative changes, data on several Russian Arctic autonomous okrugs [AO] with a significant indigenous population are not available: Nenets AO, Yamalo-Nenets AO, Khanty-Mansi AO, Taymyr AO, Evenki AO, Koryak AO.

Data sources:

United States – based on the National Program of Cancer Registries and retrieved from the CDC Wonder website of the Centers for Disease Control and Prevention.

Canada – based on the Canadian Cancer Registry of Statistics Canada (CANSIM and custom tabulations by special request.

National data for Denmark, Iceland, Norway, Sweden and Finland are from NORDCAN on the web v5.0.

Regional data for Norway, Sweden and Finland for the 2000–2004 period are from PC-NORDCAN v2.4, and for the 2005–2009 period are from the Norwegian, Swedish and Finnish Cancer Registry respectively.

Greenland and Faroe Islands – based on background tables for the annual publication Health Statistics in the Nordic Countries published by the Nordic Medico-Statistical Committee NOMESCO.

Russia – based on tables published in the annual report Malignant Neoplasms in Russia (Incidence and Mortality) published by the P.A. Hertzen Research Institute of Oncology in Moscow. Only 2007 and later years are available online; earlier editions are available only in hardcopy.

Fig. 1.  Age-standardized incidence rates of lung cancer among men and women in the Arctic States and their northern regions, 2000–2009. Note: AO=autonomous okrug.

All 8 Arctic States (in capital letters) and most of their northern regions are included in the chart – blue refer to Russia and its northern regions, yellow to the Nordic countries and their northern regions, red to Canada and USA and their northern regions, and green to Greenland.

Fig. 2.  Age-standardized incidence rates of cervical cancer among women in the Arctic States and their northern regions, 2000–2009.

Note: AO = autonomous okrug.

All 8 Arctic States and most of their northern regions are included in the chart – blue refer to Russia and its northern regions, yellow to the Nordic countries and their northern regions, red to Canada and USA and their northern regions, and green to Greenland.

Table II. Age-standardized incidence rates among Circumpolar Inuit by cancer site, sex and time period

	Circumpolar Inuit (M)					Circumpolar Inuit (F)
Site	89–93	94–98	99–03	04–08	1989–2008	89–93	94–98	99–03	04–08	1989–2008
Lip, oral cavity and pharynx
Salivary glands	4.9	3.8	1.4	1.5	2.9	2.6	3.5	1.7	0.9	2.2
Mouth	3.7	2.9	2.5	0.9	2.5	2.0	3.1	0.8	2.7	2.2
Nasopharynx	14.0	14.4	9.7	15.8	13.5	5.9	7.7	7.4	9.6	7.6
Digestive organs
Oesophagus	16.0	12.7	14.6	12.8	14.0	5.7	7.8	3.4	7.2	6.0
Stomach	30.7	24.3	27.3	28.2	27.7	12.3	7.5	8.6	15.8	11.1
Colon/rectum	42.5	49.3	54.6	78.3	56.2	39.3	51.5	69.2	67.1	56.8
Liver	8.4	7.8	8.3	9.3	8.4	3.4	4.7	3.1	5.4	4.2
Gallbladder/bile ducts	4.2	2.5	2.4	3.8	3.2	5.3	5.6	6.1	5.3	5.6
Pancreas	8.9	9.0	14.7	21.7	13.6	12.5	10.3	16.3	15.3	13.6
Respiratory and intrathoracic organs
Nasal cavities/sinuses	0.0	0.0	0.4	1.7	0.5	0.0	0.0	0.0	0.4	0.1
Larynx	4.0	1.0	3.5	4.4	3.2	0.5	0.5	0.0	0.5	0.4
Lung	95.2	103.3	108.5	135.4	110.6	51.0	69.1	68.4	96.0	71.1
Bone and soft tissues
Bone	2.7	1.2	0.9	1.7	1.6	0.9	1.3	0.5	0.5	0.8
Connective tissue	1.2	0.4	0.7	1.6	1.0	1.5	0.9	0.6	1.4	1.1
Skin
Malignant melanoma skin	0.0	0.4	0.8	0.4	0.4	1.0	1.2	0.8	1.0	1.0
Breast
Breast	0.0	0.0	0.9	1.1	0.5	42.9	60.9	55.0	78.3	59.3
Female genital organs
Cervix uteri						26.9	19.6	17.4	20.5	21.1
Corpus uteri						3.0	1.4	4.4	7.2	4.0
Ovary						10.5	11.5	9.3	15.5	11.7
Male genital organs
Prostate	13.1	10.5	13.4	22.7	14.9
Testis	1.8	1.8	2.5	2.4	2.1
Urinary tract
Kidney	14.5	12.2	13.4	18.7	14.7	12.3	11.3	6.2	10.0	9.9
Bladder	2.6	2.5	5.1	7.5	4.4	0.9	0.8	1.9	3.2	1.7
Eye, brain and other CNS
Eye	0.0	0.0	0.0	0.0	0.0	0.9	0.3	0.0	0.0	0.3
Brain/CNS	2.2	0.3	2.6	2.6	1.9	2.6	2.3	2.0	5.7	3.2
Endocrine glands
Thyroid	0.0	0.4	0.5	2.6	0.9	2.1	3.0	4.0	4.3	3.4
Lymphoid/haematopoietic tissues
Non-Hodgkin lymphoma	3.2	2.5	3.0	9.2	4.5	1.7	3.4	3.5	7.5	4.0
Hodgkin's disease	0.4	0.0	0.0	0.7	0.3	0.6	0.5	0.0	0.2	0.3
Leukaemia	1.8	5.9	2.7	3.7	3.5	3.0	2.8	1.1	6.4	3.3
Multiple myeloma	2.1	2.7	0.8	2.8	2.1	0.0	1.3	1.6	2.3	1.3
All others	25.8	31.1	36.3	44.9	34.5	37.4	39.7	34.1	41.0	38.0
All sites	304.6	302.9	331.1	436.6	343.8	288.8	333.6	327.7	431.0	345.3

Fig. 3.  Time trend in lung cancer incidence among circumpolar Inuit and Athabaskan/Dene, 1989–2008.

Fig. 4.  Time trend in colorectal cancer incidence among circumpolar Inuit and Athabaskan/Dene, 1989–2008.

Fig. 5.  Time trend in breast and cervical cancer incidence among circumpolar Inuit and Athabaskan/Dene women, 1989–2008.

Fig. 6.  Risk of cancer by site among circumpolar Inuit relative to the GLOBOCAN world average.

Note: Bars above the 1.0 line indicates excess risk among Inuit, whereas bars below the 1.0 line indicates reduced risk. Horizontal axis is in logarithmic scale.

Fig. 7.  Lung cancer incidence: Circumpolar Inuit and Athabaskans/Dene compared to global regions.

Table III. Age-standardized incidence rates among Athabaskans/Dene by cancer site, sex and time period

	Athabaskans/Dene (M)					Athabaskans/Dene (F)
Site	89–93	94–98	99–03	04–08	1989–2008	89–93	94–98	99–03	04–08	1989–2008
Lip, oral cavity and pharynx
Salivary glands	0.0	0.0	2.3	2.2	1.1	1.5	2.0	2.6	1.3	1.8
Mouth	0.0	2.7	1.9	1.9	1.6	1.0	3.0	0.0	1.6	1.4
Nasopharynx	5.8	3.7	6.4	3.1	4.7	3.2	2.3	0.0	2.2	1.9
Digestive organs
Oesophagus	2.5	9.5	12.4	6.3	7.6	0.0	2.1	3.5	7.5	3.3
Stomach	16.3	17.1	10.5	13.8	14.4	3.2	5.4	9.3	4.8	5.7
Colon/rectum	50.3	75.5	88.3	72.3	71.6	42.9	42.3	63.7	69.5	54.6
Liver	5.8	5.7	6.0	4.8	5.5	1.1	2.8	5.1	2.5	2.9
Gallbladder/bile ducts	2.5	3.9	8.1	6.4	5.2	4.8	1.6	7.9	1.3	3.9
Pancreas	9.0	7.3	12.0	8.9	9.3	9.4	8.5	8.9	10.4	9.3
Respiratory and intrathoracic organs
Nasal cavities/sinuses	0.0	0.0	0.0	1.1	0.3	0.0	0.0	0.0	0.0	0.0
Larynx	5.3	4.6	2.2	2.7	3.7	0.0	0.0	2.2	0.7	0.7
Lung	64.4	74.2	64.5	69.3	68.1	35.7	34.2	59.4	51.5	45.2
Bone and soft tissues
Bone	1.5	0.0	0.0	0.7	0.6	0.8	0.0	2.0	0.7	0.9
Connective tissue	0.0	2.2	0.7	2.7	1.4	0.0	1.1	3.5	3.5	2.0
Skin
Malignant melanoma skin	1.9	1.1	0.0	2.1	1.3	0.7	5.2	1.3	2.0	2.3
Breast
Breast	0.0	0.0	0.8	0.0	0.2	88.8	100.4	138.2	125.8	113.3
Female genital organs
Cervix uteri						19.1	5.6	7.9	7.3	10.0
Corpus uteri						11.7	12.5	13.2	12.8	12.6
Ovary						12.0	9.4	7.3	11.3	10.0
Male genital organs
Prostate	82.0	51.3	76.3	75.2	71.2
Testis	6.1	6.0	6.3	6.3	6.1
Urinary tract
Kidney	11.8	17.1	21.3	13.6	15.9	9.7	8.6	12.9	14.1	11.3
Bladder	7.0	12.9	13.9	11.3	11.3	2.8	4.1	2.6	5.0	3.6
Eye, brain and other CNS
Eye	0.0	0.7	1.2	0.9	0.7	0.0	0.0	0.0	0.0	0.0
Brain/CNS	2.8	3.3	2.5	10.2	4.7	0.0	4.1	3.9	12.2	5.0
Endocrine glands
Thyroid	0.8	2.5	2.0	2.1	1.9	10.9	4.5	13.3	4.1	8.2
Lymphoid/haematopoietic tissues
Non-Hodgkin lymphoma	4.5	11.5	15.1	10.3	10.3	6.4	3.5	6.8	10.1	6.7
Hodgkin's disease	0.7	0.0	1.8	1.3	1.0	0.0	1.3	0.7	0.0	0.5
Leukaemia	4.7	7.5	5.6	13.8	7.9	6.0	4.7	3.4	3.2	4.3
Multiple myeloma	5.8	1.1	4.7	5.1	4.2	4.5	1.7	10.3	7.0	5.9
All others	32.9	29.6	26.0	25.0	28.4	25.0	11.7	25.6	23.7	21.5
All sites	324.4	350.9	392.7	373.3	360.3	301.2	282.7	415.7	395.9	348.9

Fig. 8.  Risk of cancer by site among Athabaskans/Dene relative to the GLOBOCAN world average. Note: Bars above the 1.0 line indicates excess risk among Athabaskans/Dene, whereas bars below the 1.0 line indicates reduced risk. Horizontal axis is in logarithmic scale.

Table IV. Risk of cancer by site among Sami in Norway, Sweden and Finland relative to non-Sami in the same regions

	Norway [1970–1997]		Sweden [1961–2003]		Finland [1979–2010]
Site	M	F	M	F	M	F
Stomach	0.91	1.06	1.23*	1.53*	1.02	1.07
Colon	0.5	0.62	0.74	1.19	0.58	1.18
Rectum	1.06	0.72	0.89	1.24	0.73	0.62
Lung	0.63	0.6	0.81	0.84	0.89	0.98
Breast	–	0.85	–	1.01	–	0.38*
Ovary	–	0.88	–	1.51*	–	1.69
Prostate	0.57	–	0.76	–	0.32*	–
All sites	0.78	0.84	0.9	1.04	0.63*	0.77*

*Significantly different from unity, p<0.05.

Fig. 9.  Proportion of non-smokers among the adult population in selected Arctic indigenous populations. Note: Based on data in Results Table 288 of the Survey of Living Conditions in the Arctic www.arcticlivingconditions.org [cited 2014 Dec 20].