Indigenous people have disproportionally worse health and lower life expectancy than their non-indigenous counterparts in high-income countries. Cancer data for indigenous people are scarce and incidence has not previously been collectively reported in Australia, New Zealand, Canada, and the USA. We aimed to investigate and compare, for the first time, the cancer burden in indigenous populations in these countries.We derived incidence data from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the province of Alberta in Canada, and the Contract Health Service Delivery Areas of the USA. Summary rates for First Nations and Inuit in Alberta, Canada, were provided directly by Alberta Health Services. We compared age-standardised rates by registry, sex, cancer site, and ethnicity for all incident cancer cases, excluding non-melanoma skin cancers, diagnosed between 2002 and 2006. Standardised rate ratios (SRRs) and 95% CIs were computed to compare the indigenous and non-indigenous populations of each jurisdiction, except for the Alaska Native population, which was compared with the white population from the USA.We included 24 815 cases of cancer in indigenous people and 5 685 264 in non-indigenous people from all jurisdictions, not including Alberta, Canada. The overall cancer burden in indigenous populations was substantially lower in the USA except in Alaska, similar or slightly lower in Australia and Canada, and higher in New Zealand compared with their non-indigenous counterparts. Among the most commonly occurring cancers in indigenous men were lung, prostate, and colorectal cancer. In most jurisdictions, breast cancer was the most common cancer in women followed by lung and colorectal cancer. The incidence of lung cancer was higher in indigenous men in all Australian regions, in Alberta, and in US Alaska Natives than in their non-indigenous counterparts. For breast cancer, rates in women were lower in all indigenous populations except in New Zealand (SRR 1·23, CI 95% 1·16–1·32) and Alaska (1·14, 1·01–1·30). Incidence of cervical cancer was higher in indigenous women than in non-indigenous women in most jurisdictions, although the difference was not always statistically significant.There are clear differences in the scale and profile of cancer in indigenous and non-indigenous populations in Australia, New Zealand, Canada, and the USA. Our findings highlight the need for much-improved, targeted programmes of screening, vaccination, and smoking cessation, among other prevention strategies. Governments and researchers need to work in partnership with indigenous communities to improve cancer surveillance in all jurisdictions and facilitate access to cancer data.International Agency for Research on Cancer–Australia Fellowship.

Use of self-reported confidence ratings may be an efficient method for assessing recall bias. In this exploratory application of the method, the authors examined the relation between case-control status and self-reported confidence ratings. In 2002 and 2003, melanoma cases (n = 141) and controls (n = 143) aged 20-44 years residing in Ontario, Canada, estimated the amounts of time they had spent outdoors in summer activities when they were 6-18 years of age and indicated their confidence in the accuracy of each estimate. The generalized estimating equations extension of logistic regression was used to examine dichotomized confidence ratings (more confident vs. less confident) for activities reported for ages 6-11 years and 12-18 years. Types of activity were associated with more confident reporting for both age strata; as the number of stable outdoor activity periods (total number of similar outdoor periods within each activity) reported by respondents increased, confidence decreased. Cumulative time spent outdoors was also associated with more confidence but reached statistical significance only for the age stratum 12-18 years. There was no statistically significant association between case-control status and self-reported confidence for either age stratum (6-11 years: odds ratio = 0.91; 12-18 years: odds ratio = 1.32), which suggests an absence of recall bias for reported time spent outdoors.

This monograph on lung cancer has been prepared to provide information on patterns of practice to those directly involved in the provision of care to lung cancer patients. As well, it should be helpful to those who are responsible for managing aspects of the cancer system that impact on the care that lung cancer patients receive across the province of Ontario. The practice patterns are shown against the backdrop of the evidence-based guidelines developed by the Lung Disease Site Group of Cancer Care Ontario’s Program in Evidence based Care. In addition to information on patterns of practice, this monograph provides information on the timeliness of access to care, as well as a brief overview of the incidence and mortality of lung cancer, and the trends in the main risk factor for developing lung cancer, namely smoking. In brief, it provides a snapshot of the quality of care for lung cancer patients in the province of Ontario. It is hoped that this monograph will assist those responsible for care delivery to achieve the best possible results for patients with a diagnosis of lung cancer.