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Cancer patterns in Inuit populations
Reflection and Reaction
If you would like to respond to an article published in The Lancet Oncology, please submit your correspondence online at: http://ees.elsevier. com/thelancetoncology
1124
I wish to congratulate Friborg and Melbye1 on their informative review of cancer patterns in Inuit populations, published in the September issue of The Lancet Oncology. As a clinician working with Inuit in the Nunavik region of northern Quebec, I believe there are a few additional points worth mentioning. First, there are a few small, but noteworthy, caseseries describing Kaposi’s sarcoma in HIV seronegative Inuit individuals from Greenland and Nunavik. Although classic Kaposi’s sarcoma is associated with human herpesvirus-8 and is usually seen in elderly male patients of Mediterranian or Jewish descent, this disease has been described in eight immunocompetent Inuit patients since 1974.2 A similar combination of genetic susceptibility and viral factors, as described by the authors with respect to nasopharyngeal carcinoma and Epstein-Barr virus in the Inuit, might be responsible. Second, with respect to the high incidence of cancers of the nasopharynx and lung, two significant exposures were not mentioned. Although modern housing conditions have decreased exposure to fumes from lamps and open fires for cooking, it is important to recognise that many groups of Inuit still spend substantial amounts of time out on the land, cooking on open stoves inside their tents. Additionally, the epidemic of marijuana smoking in 85% of adults (according to 2004 Nunavik public-health data)3 might play a part in the high incidence of lung and nasopharyngeal cancers. Last, but not least, it is important to recognise that Inuit face substantial challenges with respect to access to healthcare, and that these challenges represent part of a more far-reaching social inequality. Similarly to the Australian Aboriginals, Canadian Inuit face barriers related to geographic isolation, education, cultural factors, language, and social disadvantage. Public-health statistics from the last 5-year case period in Nunavik suggest that both cancer incidence and mortality are higher overall for the subarctic Inuit of the region than for age-matched southern patients.4,5 With life expectancy for Canadian Inuit more than 12 years less than the national average,6 we must not forget that documents such as the Universal Declaration of Human Rights and the Recommendations for Worldwide Cancer
Lawrence Migdale/Science Photo Library
Cancer patterns in Inuit populations
Life expectancy for Inuit is less than national average
Control mentioned in a comment by John Seffrin7 need to be applied for minority populations within developed countries as well as throughout the global community. Barbara M Young General Internal Medicine Division, McGill University, Montreal, Quebec, Canada [email protected] The author declared no conflicts of interest. 1 2
3
4
5 6
7
Friborg JT, Melbye M. Cancer patterns in Inuit populations. Lancet Oncol 2008; 9: 892–900. Balachandra B, Tunitsky E, Dawood S, Hings I, Marcus VA. Classic Kaposi’s sarcoma presenting first with gastrointestinal tract involvement in a HIV-negative Inuit male—a case report and review of the literature. Pathol Res Pract 2006; 202: 623–26. Muckle G, Boucher O, Laflamme D. Nunavik Inuit Health Survey, 2004. Alcohol, drug use, and gambling among the Inuit of Nunavik: epidemiological profile. http://www.inspq.qc.ca/pdf/publications/ resumes_nunavik/anglais/AlcoholDrugUseAndGamblingAmongTheInuitO fNunavik.pdf (accessed Nov 7, 2008). Taux d’incidence pour l’ensemble des sieges, excluant le cancer de la peau sans melanoma 2000 à 2004. MSSS Fichier des Tumeurs (Québec), June 2007 (electronic version). Taux de mortalité de l’ensemble des tumeurs malignes, 2000 à 2003. MSSS Fichier des decès (Québec), October 2005 (electronic version). Wilkins R, Uppal S, Finès P, Senècal S, Guimond E, Dion R. Life expectancy in the Inuit-inhabited areas of Canada, 1989–2003. Health Report 2008; 19: 7–19. Seffrin JR. Cancer control as a human right. Lancet Oncol 2008; 9: 409–11.
Erratum Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008; 9: 1048–57. In this Article, the header of the second column in table 2 should have read: “Time since diagnosis (months)”.
www.thelancet.com/oncology Vol 9 December 2008
If you would like to respond to an article published in The Lancet Oncology, please submit your correspondence online at: http://ees.elsevier. com/thelancetoncology
1124
I wish to congratulate Friborg and Melbye1 on their informative review of cancer patterns in Inuit populations, published in the September issue of The Lancet Oncology. As a clinician working with Inuit in the Nunavik region of northern Quebec, I believe there are a few additional points worth mentioning. First, there are a few small, but noteworthy, caseseries describing Kaposi’s sarcoma in HIV seronegative Inuit individuals from Greenland and Nunavik. Although classic Kaposi’s sarcoma is associated with human herpesvirus-8 and is usually seen in elderly male patients of Mediterranian or Jewish descent, this disease has been described in eight immunocompetent Inuit patients since 1974.2 A similar combination of genetic susceptibility and viral factors, as described by the authors with respect to nasopharyngeal carcinoma and Epstein-Barr virus in the Inuit, might be responsible. Second, with respect to the high incidence of cancers of the nasopharynx and lung, two significant exposures were not mentioned. Although modern housing conditions have decreased exposure to fumes from lamps and open fires for cooking, it is important to recognise that many groups of Inuit still spend substantial amounts of time out on the land, cooking on open stoves inside their tents. Additionally, the epidemic of marijuana smoking in 85% of adults (according to 2004 Nunavik public-health data)3 might play a part in the high incidence of lung and nasopharyngeal cancers. Last, but not least, it is important to recognise that Inuit face substantial challenges with respect to access to healthcare, and that these challenges represent part of a more far-reaching social inequality. Similarly to the Australian Aboriginals, Canadian Inuit face barriers related to geographic isolation, education, cultural factors, language, and social disadvantage. Public-health statistics from the last 5-year case period in Nunavik suggest that both cancer incidence and mortality are higher overall for the subarctic Inuit of the region than for age-matched southern patients.4,5 With life expectancy for Canadian Inuit more than 12 years less than the national average,6 we must not forget that documents such as the Universal Declaration of Human Rights and the Recommendations for Worldwide Cancer
Lawrence Migdale/Science Photo Library
Cancer patterns in Inuit populations
Life expectancy for Inuit is less than national average
Control mentioned in a comment by John Seffrin7 need to be applied for minority populations within developed countries as well as throughout the global community. Barbara M Young General Internal Medicine Division, McGill University, Montreal, Quebec, Canada [email protected] The author declared no conflicts of interest. 1 2
3
4
5 6
7
Friborg JT, Melbye M. Cancer patterns in Inuit populations. Lancet Oncol 2008; 9: 892–900. Balachandra B, Tunitsky E, Dawood S, Hings I, Marcus VA. Classic Kaposi’s sarcoma presenting first with gastrointestinal tract involvement in a HIV-negative Inuit male—a case report and review of the literature. Pathol Res Pract 2006; 202: 623–26. Muckle G, Boucher O, Laflamme D. Nunavik Inuit Health Survey, 2004. Alcohol, drug use, and gambling among the Inuit of Nunavik: epidemiological profile. http://www.inspq.qc.ca/pdf/publications/ resumes_nunavik/anglais/AlcoholDrugUseAndGamblingAmongTheInuitO fNunavik.pdf (accessed Nov 7, 2008). Taux d’incidence pour l’ensemble des sieges, excluant le cancer de la peau sans melanoma 2000 à 2004. MSSS Fichier des Tumeurs (Québec), June 2007 (electronic version). Taux de mortalité de l’ensemble des tumeurs malignes, 2000 à 2003. MSSS Fichier des decès (Québec), October 2005 (electronic version). Wilkins R, Uppal S, Finès P, Senècal S, Guimond E, Dion R. Life expectancy in the Inuit-inhabited areas of Canada, 1989–2003. Health Report 2008; 19: 7–19. Seffrin JR. Cancer control as a human right. Lancet Oncol 2008; 9: 409–11.
Erratum Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008; 9: 1048–57. In this Article, the header of the second column in table 2 should have read: “Time since diagnosis (months)”.
www.thelancet.com/oncology Vol 9 December 2008