• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Modifiable Risk Factors in First Nations in Ontario


Key findings

Commercial tobacco use, exposure to second-hand smoke, alcohol consumption, excess body weight, physical inactivity and poor diet are modifiable risk factors associated with a number of different cancers. A significantly higher proportion of First Nation adults (on- and off-reserve) smoke cigarettes compared to non-Aboriginal adults. Also of concern is the high prevalence of cigarette smoking among on- and off-reserve First Nation adolescents, with rates that are 7 and 3 times higher than non-Aboriginal adolescents, respectively. First Nation adults and adolescents (on- and off-reserve) are also more likely to be obese compared to their non-Aboriginal counterparts. Vegetable and fruit intake levels are concerning, particularly among First Nation adults living on-reserve, where only 12% of men and 20% of women consume enough vegetables and fruit.

These findings have strong implications for greater risk and burden of cancer among First Nations in Ontario compared to the general population.

The findings related to Ontario First Nations presented in this section are from a recently published report, Cancer in First Nations in Ontario: Risk Factors and Screening. This report was a collaboration between the Chiefs of Ontario and Cancer Care Ontario in recognition of their shared goal of reducing the burden of chronic disease, and more specifically cancer, among First Nations in Ontario.

Who are the First Nation people of Ontario?

First Nations are one of three groups of people recognized by Canada’s Constitution Act of 1982 as “the Aboriginal peoples of Canada,” who are explicitly defined as “the Indian [now referred to as “First Nations”], Inuit, and Métis peoples.”

Prior to contact with Europeans, First Nations, in what is now defined as Ontario, represented diverse and stable communities whose economy and governance were sound and thriving. The arrival of Europeans and the resulting policies of assimilation—for example, the residential school system—dramatically impacted the First Nations’ way of life and all aspects of their health.

Today there are 133 First Nation communities in Ontario, 126 of which have independently recognized land bases. As of 2014, approximately 202,960 First Nations people reside in Ontario who are registered under the Indian Act, of whom 94,312 live on-reserve or on Crown lands (46%)1. While the greatest proportion of registered First Nations in Ontario live in urban communities (42,007, or 47%), over one quarter of those living on-reserve live in special-access communities with no year-round road access (24,993, or 28%)2. Additionally, Ontario is home to an estimated 75,540 First Nations people without registered Indian status3. Among First Nations living off-reserve, a large majority (80%) live in urban areas, which is similar to the percentage of non-Aboriginal Ontarians living in an urban area (86%).

What are modifiable risk factors?

Modifiable risk factors are behaviours and exposures that can lower or raise a person’s risk of cancer and that can, in theory, be changed.

The specific modifiable risk factors in this section include the following:

  • cigarette smoking
  • vegetable and fruit intake
  • excess body weight (being overweight or obese)
Percentage of on- and off-reserve First Nation and non-Aboriginal adolescents (ages 12-17 years) and adults (age 20+) who smoked cigarettes daily or occasionally, Ontario
Percentage of on- and off-reserve First Nation and non-Aboriginal adults (age 20+) who smoked cigarettes daily or occasionally
Percentage of on- and off-reserve First Nation and non-Aboriginal men and women (age 18+) who consumed at least two vegetables and two fruits a day, Ontario
Percentage of on- and off-reserve First Nation and non-Aboriginal adolescents (age 12-17) and adults (age 18+) who were obese, Ontario

What do the results show?

Cigarette Smoking

  • First Nation adults and adolescents living on-reserve reported a high prevalence of cigarette smoking (50% and 30%, respectively), followed closely by First Nation adults and adolescents living off-reserve (43% and 14%, respectively). These numbers are significantly greater than those among their non-Aboriginal counterparts (22% in adults and 4.2% in adolescents) (Figure 1).
  • The prevalence of cigarette smoking significantly declined from 2007 to 2013 for off-reserve First Nation and non-Aboriginal adults. A similar proportion of on-reserve and off-reserve First Nation adults were cigarette smokers in 2010 (Figure 2).

Vegetable and Fruit Consumption

  • On-reserve First Nation adult males (12%) and females (20%) were significantly less likely to consume at least 2 vegetables and 2 fruit per day, compared to First Nation adult males (27%) and females (40%) living off-reserve. Values for both groups are significantly lower than for non-Aboriginal adult males (35%) and females (52%) (Figure 3).

Overweight and Obesity

  • Almost half of First Nation adults (age 18 and older) living on reserve were classified as obese (49%), a significantly greater proportion than First Nation adults living off-reserve (30%). Both on- and off-reserve First Nation adults were significantly more likely to be obese than non-Aboriginal adults (17%). Among adolescents, First Nations living on-reserve were more than 3 times as likely to be obese compared to their non-Aboriginal counterparts (18% compared to 4.8%). The prevalence of obesity among First Nation adolescents living off-reserve and non-Aboriginal adolescents was also high (7.5% and 4.8%, respectively) (Figure 4).

Why is this important to Ontarians?

Healthier behaviour reduces cancer risk

  • Very little is currently known about cancer rates among First Nations in Ontario. Therefore, information about the prevalence of cancer risk factors offer perhaps the best approach for determining where cancer prevention resources can be directed most effectively in order to reduce the future burden of cancer and other chronic diseases.
  • With their current high rates of cigarette smoking, First Nations are expected to experience a substantial future burden of tobacco-related chronic disease. Therefore, strategies, policies and programs to reduce tobacco use should be a priority.
  • While traditional tobacco plays an important medicinal and ceremonial role in many First Nations communities, the spiritual use of traditional tobacco has no connection to the recreational use of commercial tobacco.1
  • Exposure to tobacco through cigarette smoking and second-hand smoke is associated with an increased risk of many types of cancer (especially lung cancer), chronic respiratory diseases and other serious chronic conditions (including cardiovascular disease and possibly diabetes).
  • While eating a diet rich in vegetables and fruits contributes to maintaining a normal body weight, it also confers independent health benefits for chronic disease and prevention of several types of cancer. Evidence shows that while plant-based foods (such as non-starchy vegetables and fruit, or dietary fibre) have protective effects, red and processed meats and salted or salty foods increase cancer risk.
  • So-called convenience foods that are higher in fat and lower in nutritional value are increasingly being integrated into modern First Nation diets, partly because they are less expensive and partly because access to traditional foods from the land (such as plants, berries, beans, vegetables, birds, wild game meat and fish) have become more limited.
  • Given the relatively low intake of vegetables and fruit—and the high levels of obesity—among First Nations compared to non-Aboriginal Ontarians, an increased burden of cancers and other chronic diseases related to these factors may be anticipated.

What is happening in Ontario?

Chiefs of Ontario

  • The Chiefs of Ontario continues to advocate for better health outcomes for First Nation peoples by partnering with organizations such as Cancer Care Ontario to build knowledge and evidence that can be used by First Nations both for taking control of their health, and for planning and prioritizing programs.
  • The Chiefs of Ontario Health Department has developed The COO Health Portal, an online resource that outlines The Chiefs of Ontario’s health priorities and amalgamates resources available to health practitioners and organizations serving Ontario First Nations communities.
  • The Chiefs of Ontario and Cancer Care Ontario have collaborated to produce Cancer in the First Nations in Ontario: Risk Factors and Screening. The report provides essential evidence that First Nations can use to support cancer prevention and screening.
  • Data collection for phase 3 of the Regional Health Survey is now complete at the national level. The national data are currently being processed for future use at the provincial/territorial level.

Cancer Care Ontario

  • The Aboriginal Cancer Strategy III, released by Cancer Care Ontario in 2015, aims to help cancer control stakeholders in Ontario jointly develop, fund and implement Aboriginal cancer control policies and programs that improve the performance of the cancer system for First Nations, Inuit and Métis peoples in a way that honours the Aboriginal Path of Well-being.
  • The Aboriginal Tobacco Program at Cancer Care Ontario addresses the high prevalence of non-traditional tobacco use and second-hand smoke exposure in First Nations, Inuit and Métis communities through culturally appropriate awareness and education initiatives that support capacity-building with (and in) these communities in order to address commercial tobacco prevention, cessation and protection.
  • Cancer Care Ontario’s Path to Prevention: Recommendations for Addressing Chronic Disease in First Nation, Inuit and Métis, outlines evidence-based policy recommendations to guide decision-making related to chronic disease prevention policy for First Nations, Inuit and Métis. The report focuses on the 4 major risk/protective factors for chronic disease: commercial tobacco use, alcohol consumption, physical activity and healthy eating. While the recommendations are aimed at the Government of Ontario, their implementation will involve full participation by First Nations, Inuit and Métis partners, as well as collaboration with relevant organizations.

Other Organizations

  • The Ontario Federation of Indigenous Friendship Centres, with funding from the MOHLTC, coordinates the Urban Aboriginal Healthy Living Program, which provides support to the urban First Nations, Inuit and Métis communities in the areas of nutrition, physical activity and smoking cessation.
  • The MOHLTC supports a number of initiatives designed to address the specific health needs of First Nations, Inuit and Métis people, including the Northern Fruit and Vegetable Program, which provides no-cost fresh fruit and vegetables alongside healthy eating and physical activity education for school-aged children in Northern Ontario.
  • Aboriginal Health Access Centres are community-based health centres that provide primary care, cultural support and health promotion programs to First Nations, Inuit and Métis communities at 10 sites across Ontario.
  • The Ontario Native Women’s Association hosts programs that support the well-being of Aboriginal women and their families in Ontario, including Community Health Outreach and the Aboriginal Diabetes Education Project. The ONWA department of Policy and Research also participates in advocacy to promote Aboriginal women’s “health, healing and wellness.”

View Notes

  1. Indigenous and Northern Affairs Canada. Registered Indian population by sex and residence 2014—Statistics and Measurement Directorate [Internet]. Ottawa: Government of Canada; 2015 [cited 2015 Sep 4]. Available from: http://www.aadnc-aandc.gc.ca/eng/
  2. Chiefs of Ontario and Cancer Care Ontario. Cancer in First Nations in Ontario: Risk Factors and Screening. Toronto, 2016.
  3. Statistics Canada. Aboriginal Peoples in Canada: First Nations people, Métis and Inuit: National Household Survey, 2011 [Internet]. Ottawa: Statistics Canada; 2013 [cited 2015 Sep 4]. Available from: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.cfm
  4. Statistics Canada. Aboriginal Identity (8), Area of Residence (6), Age Groups (12) and Sex (3) for the Population of Canada, Provinces and Territories, 2006 Census - 20% Sample Data. Catalogue no. 97-558-XCB2006006 [Internet]. Ottawa: Statistics Canada; [cited 2015 Sep 4]. Available from: http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/tbt/Rp-eng.cfm?LANG=
  5. Health Canada. First Nations and Inuit Health: Tobacco [Internet]. Ottawa: Health Canada; 2016 [cited 2017 Feb 17]. Available from: http://www.hc-sc.gc.ca/fniah-spnia/substan/tobac-tabac