Progress in cancer screening, yet gaps still affect First Nations people in Ontario

Toronto, July 10, 2026 — First Nations people are less likely to survive cervical, colon, and breast cancer after diagnosis compared to non-Indigenous Ontarians, despite improvements in incidence and mortality rates, according to a new study from ICES.

“Although our findings do suggest some improvements over time, it is clear that First Nations people in Ontario continue to experience significant disparities,” says Dr. Jill Tinmouth, a scientist at ICES and Sunnybrook Research Institute and Provincial Medical Director, Cancer Control, Ontario Health. “Recent changes to our screening programs, such as lowering the age to 45 to start screening for colon cancer, are an important first step, but we can do more to tackle risk factors that are disproportionally affecting First Nations people and remove barriers that prevent them from accessing cancer care in the first place.”

The study examined cancer incidence from January 1994 to December 2018, cancer mortality from January 1994 to December 2017, and cancer diagnosis to death from January 2007 to March 2019 in adults aged 18 years and older. Starting from diagnosis, each individual was followed until March 31, 2019.

Over time, cervical, colon, and breast cancer incidence and mortality improved for both First Nations people and other Ontarians, with most dramatic improvements noted in rates of cervical incidence and mortality. In addition, First Nations women had lower incidence and mortality rates of breast cancer compared to other Ontarians. That said, over the entire study period, rates of cervical and colon cancer incidence and mortality remained higher among First Nations people. First Nations people were also diagnosed with colon cancer at younger ages than other Ontarians, with it occurring at similar rates among individuals aged 40 to 49 and those aged 50 to 74.

Survival once diagnosed was worse for First Nations people compared to other Ontarians for all three cancers. After diagnosis, First Nations people were 51 per cent more likely to die from breast cancer, 60 per cent more likely to die from cervical cancer, and 19 per cent more likely to die from colon cancer.

These findings suggest that gaps in cancer care, both in screening and after diagnosis, persist for First Nations people across the province.

Indigenous people in Canada face significant systemic, economic and social barriers that stem in part from the lasting effects of colonialism. These barriers contribute to a range of issues that are complex and interconnected, including poorer health outcomes. For instance, many First Nations people live in rural or remote areas, which can further limit their access to timely, equitable care and treatment.

“There is a very real need to enhance cancer prevention strategies through approaches that are Indigenous-led and culturally safe,” says Dr. Amanda Sheppard, Senior Scientist at Ontario Health, and a professor at the Dalla Lana School of Public Health, University of Toronto. “Improving our understanding of how First Nations people experience and navigate the cancer care system could lead to improved long-term health outcomes and also help inform care delivery in other countries with distinct Indigenous populations, like the U.S. and Australia.”

The study “Population-level outcomes for screening program cancers in First Nations people in Ontario, Canada” is in the July issue of JAMA Network Open.

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on Facebook and LinkedIn: @ICESOntario

FOR FURTHER INFORMATION PLEASE CONTACT:
Charlotte Lam
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ICES
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