ID #457 Brain tumours in First Nations children worldwide: Global patterns of incidence, survival, and structural inequity

Abstract

Paediatric brain and central nervous system (CNS) tumours are the leading cause of cancer-related mortality in children. For First Nations, Indigenous and Tribal children worldwide, brain tumours impose a disproportionate and poorly quantified burden, marked by elevated incidence, persistently poorer survival, and systemic failures in data collection, biological investigation, and equitable care delivery. This review synthesises global registry data, clinical data, academic and grey literature describing brain tumours in First Nations children worldwide. In the United States, Native American and Alaska Native children experience comparable or higher incidence than national averages, but consistently poorer survival and higher mortality. In Canada, CNS tumours are among the most common cancers in First Nations children and adolescents. In Aotearoa New Zealand, Māori children experience substantially higher CNS tumour incidence than Europeans, alongside persistently poor survival and earlier post-diagnosis mortality, positioning CNS tumours as a key structural contributor to Māori childhood cancer inequity. For Polynesian and Pacific Islander populations from both US and NZ datasets, brain cancer data are poorly disaggregated, precluding meaningful epidemiological or outcome analyses. In Australia, CNS tumours are the leading cause of cancer death among Aboriginal and Torres Strait Islander children, with ongoing limitations in contemporary data quality and reporting. Across all First Nations paediatric populations, tumour subtype distributions and biological drivers remain poorly characterised. Collectively, paediatric CNS tumours represent a major and inequitable burden for First Nations children globally, with inferior outcomes driven by intersecting structural health system barriers, limited biological characterisation, and persistent under-representation in cancer registries and research. We provide recommendations to guide improvements in clinical care and research, supporting better outcomes for First Nations children with brain cancer.