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Statistical Reports

Ch 1: Estimated Current Cancer Incidence

Data Type:
Publication Series: Under Review
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Ontario Cancer Statistics 2020 Ch 1: Estimated Current Cancer Incidence

Incidence measures the number of new cases of cancer diagnosed within a specific timeframe. This chapter reports projections for the years 2017 to 2020.

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Incidence Overview

The number of new cancer cases diagnosed each year in Ontario (the incidence) and the incidence rate have increased each year since at least 1981. In general, the incidence of cancer is influenced by these factors:

  • Socio-demographic factors (e.g., age, place of residence)
  • The availability of early detection and screening for cancer
  • The prevalence of risk and protective factors

Risk factors can include the following:

  • Unhealthy behaviours (e.g., smoking, poor diet, alcohol consumption, physical inactivity)
  • Previous treatments (e.g., hormone-replacement therapy use)
  • Exposure to certain environmental and occupational carcinogens (e.g., radon, PM2.5 [fine particulate matter], UV [ultraviolet] rays, asbestos, diesel engine exhaust)
  • Medical conditions and infectious agents (e.g., Crohn’s disease, HPV)
  • Non-modifiable factors (e.g., age at first menstrual cycle, menopause, family history of cancer)
  • Genetic predispositions (e.g., BRCA1 and BRCA2 genes)

In 2020, Ontarians are expected to be diagnosed with an estimated 91,946 new cases of cancer (excluding non-melanoma skin cancer). This will result in an age-standardized incidence rate of 551.8 cases per 100,000 people (Figure 1.1).

The figure shows an abrupt increase in the count and incidence rate seen in 2010, which is a result of the Ontario Cancer Registry’s adoption of the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) Program’s rules for counting multiple primary cancers. Those rules were applied starting in diagnosis year 2010, which means the higher numbers observed starting that year reflect an adoption of these new rules and not a true increase in the incidence of cancer (see Analysis for more information).[1]

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond. Direct comparisons with rates for 2009 and prior years should generally not be made. Those years are shown to highlight the impact of the change in counting standards for multiple primary cancers.
  3. The shaded area indicates projected data for the years 2017 through 2020.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 1.1 Projected incidence counts and age-standardized rates by cancer type and sex, Ontario, 2020
Year Incidence count Incidence rate
1981 29649 476.1
1982 30346 475.9
1983 31885 488.2
1984 33003 491.5
1985 34267 497.4
1986 34660 490
1987 36469 500.4
1988 38054 508.1
1989 38269 496.5
1990 40264 507.9
1991 42462 523.7
1992 43421 522
1993 44447 523.4
1994 45164 519.3
1995 45021 507.2
1996 46388 511.1
1997 48106 519.4
1998 49756 525.3
1999 51483 532.7
2000 53131 537.7
2001 54795 542.7
2002 55428 532.8
2003 56055 525.1
2004 58269 531
2005 59716 531.5
2006 61299 531.7
2007 63816 540
2008 63893 526.1
2009 65515 525.9
2010 72933 570.6
2011 75659 577
2012 75415 559.4
2013 76424 550.7
2014 77439 544.1
2015 79653 544.7
2016 81409 542.2
2017 84753 549.5
2018 87338 551.5
2019 89658 551.9
2020 91946 551.8

 

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond. Direct comparisons with rates for 2009 and prior years should generally not be made. Those years are shown to highlight the impact of the change in counting standards for multiple primary cancers.
  3. The shaded area indicates projected data for the years 2017 through 2020.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Incidence by Sex

Among males, 45,494 cases of cancer are expected to be diagnosed in 2020 for an ASIR of 577.2 per 100,000 (Figure 1.2). The rapid drop in the count and rate after 2011 is partly because of the declining rate of prostate cancer. This decline followed recommendations from the U.S. Preventive Services Task Force against using prostate-specific antigen (PSA) testing for the routine screening of healthy males.[2] Similar recommendations for PSA testing in Canada were published by the Canadian Task Force on Preventative Health Care in 2014.[3]

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond. Direct comparisons with rates for 2009 and prior years should generally not be made. Those years are shown to highlight the impact of the change in counting standards for multiple primary cancers.
  3. Shading behind years 2017 onward indicates projected data.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 1.2 Projected incidence counts and age-standardized rates by sex for all cancers combined, Ontario, 1981 to 2020
Year New cases-males Incidence rate-males New cases-females Incidence rate-females
1981 15185 573.5 14464 419.3
1982 15530 571.1 14816 419
1983 16239 586 15646 431.3
1984 16908 591.9 16095 432.1
1985 17441 592 16826 441.7
1986 17811 592.5 16849 430.2
1987 18793 604 17676 438.6
1988 19393 604.8 18661 451.7
1989 19780 597 18489 434.6
1990 20907 612.4 19357 443.8
1991 22076 630.9 20386 458.3
1992 22968 638.7 20453 449.1
1993 23585 639.1 20862 447.4
1994 23879 629.5 21285 445.7
1995 23157 599.3 21864 450
1996 24084 607.2 22304 448.2
1997 25041 616.7 23065 454.8
1998 25492 613.8 24264 468.4
1999 26527 623.8 24956 471.8
2000 27698 635.5 25433 470.4
2001 28923 647.7 25872 468.8
2002 28488 618.1 26940 475.4
2003 28989 611.7 27066 464.7
2004 30210 618.4 28059 468.9
2005 31049 620.6 28667 468.1
2006 32041 620.6 29258 466.8
2007 33185 624.4 30631 478.3
2008 33010 603.2 30883 470.6
2009 33323 590.1 32192 479.5
2010 37348 645.5 35585 517.8
2011 38955 654.6 36704 523.1
2012 37985 616.3 37430 520.5
2013 37897 596.5 38527 521.7
2014 38141 582 39298 521.1
2015 39681 586.1 39972 517.8
2016 40628 581.6 40781 516.4
2017 42148 584.8 42605 526.6
2018 43295 582.5 44043 531.8
2019 44425 580.2 45233 533.9
2020 45494 577.2 46452 536

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond. Direct comparisons with rates for 2009 and prior years should generally not be made. Those years are shown to highlight the impact of the change in counting standards for multiple primary cancers.
  3. Shading behind years 2017 onward indicates projected data.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

The numbers are higher for females, with 46,452 cases diagnosed for an ASIR of 536.0 per 100,000 (Figure 1.2). The incidence rate has been higher for males than females every year since 1981. This sex difference has been observed in many other jurisdictions.[4,5] Higher rates of cancer among males have been attributed to differences in behaviour,[6,7] immunity,[8] hormones[9] and exposures (e.g., workplace exposures)[10,11] between the sexes[12,13].

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Incidence by Cancer Type

In 2020, the most commonly diagnosed cancer is expected to be female breast cancer (11,945 cases or 13.0% of all new cases), followed by lung cancer (10,592 cases or 11.5%) and colorectal cancer (9,245 cases or 10.1%) (Table 1.1). These 3 cancers alone are projected to account for almost 34.6% of all new cancers diagnosed in 2020.

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Among males, the most commonly diagnosed cancer is expected to be prostate cancer, with an ASIR of 103.8 per 100,000. Breast cancer (with an ASIR of 142.8 per 100,000) is projected to be the most commonly diagnosed cancer among females.

The ASIR is expected to be higher in males than females for all cancer types listed in Table 1.1. A higher prevalence of certain risk factors are suspected reasons for this discrepancy. These include:

  • obesity, alcohol and tobacco use among males
  • occupational exposure to carcinogens
  • lower use of medical services compared with females
  • the influence of sex hormones

Some notable differences exist between the sexes. The number of new thyroid cancer cases in females, for example, will outnumber male cases by nearly 3-to-1. Possible reasons for the higher incidence of this cancer include:

  • increased likelihood of diagnostic investigation in women for thyroid cancer[14]
  • women’s greater tendency in general to seek medical attention[6,7,13]
  • biological differences such as levels of thyroid stimulated hormone and sex steroids,[15-17] as well as female reproductive history[18]

The incidence of less aggressive types of thyroid cancer (e.g., papillary thyroid cancer) has been higher in females than males in a number of jurisdictions. However, the incidence of more aggressive types (e.g., anaplastic and medullary) is generally similar between the sexes.[14,19] As a result, thyroid mortality rates have been fairly equal between males and females (see Chapter 6: Cancer Mortality Rates and Trends).

In addition to thyroid cancer, bladder and liver cancers are expected to have the biggest differences in cancer incidence between the sexes:

  • For bladder cancer, the male incidence rate will be almost 4 times the female rate. One of the risk factors for bladder cancer is a history of smoking, with smokers being 2 to 3 times as likely to develop bladder cancer as non-smokers.[20,21] Tobacco use is more common in males, which may be one of the reasons bladder cancer incidence is much higher in males.[22]
  • For liver cancer, the male incidence rate is almost 2 times the female rate. Higher male prevalence of risk factors such as alcohol use and smoking may account for some of the discrepancy.[23-25] However, recent research suggests there may be genetic differences in the way males and females respond to chronic inflammation caused by infections such as hepatitis B or hepatitis C viruses, the most common liver cancer risk factors.[26-28]
Table 1.1 Projected incidence counts and age-standardized rates by cancer type and sex, Ontario, 2020
Cancer type Both sexes - new cases Both sexes - ASIR Males - new cases Males - ASIR Females - new cases Females - ASIR
All cancers 91,946 551.8 45,494 577.2 46,452 536.0
Bladder 4,320 24.7 3,329 41.9 991 10.5
Brain 1,214 7.7 695 9.2 519 6.3
Breast (female) 11,945 142.8 n/a n/a 11,945 142.8
Cervix 553 7.3 n/a n/a 553 7.3
Colorectal 9,245 54.4 5,047 64.1 4,198 45.9
Esophagus 984 5.8 755 9.5 229 2.4
Hodgkin lymphoma 398 2.7 209 2.9 189 2.5
Kidney 2,904 17.8 1,918 24.9 986 11.3
Larynx 402 2.4 342 4.3 60 0.7
Leukemia 2,796 16.8 1,621 20.9 1,175 13.3
Liver 1,802 10.5 1,181 14.7 621 6.8
Lung 10,592 60.8 5,127 64.0 5,465 58.5
Melanoma 4,364 26.4 2,539 32.8 1,825 21.5
Myeloma 1,526 8.9 877 11.1 649 7.0
Non-Hodgkin lymphoma 5,490 33.0 3,154 40.7 2,336 26.3
Oral cavity & pharynx 2,067 12.7 1,506 19.5 561 6.4
Ovary 1,277 15.2 n/a n/a 1,277 15.2
Pancreas 2,533 14.7 1,352 17.1 1,181 12.6
Prostate 8,528 103.8 8,528 103.8 n/a n/a
Stomach 1,826 10.8 1,161 14.8 665 7.4
Testis 490 7.0 490 7.0 n/a n/a
Thyroid 4,109 27.6 1,118 15.1 2,991 39.6
Uterus 3,355 39.4 n/a n/a 3,355 39.4

Abbreviations:

  • ASIR means age-standardized incidence rate.
  • N/a means not applicable.

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
  3. Projections are based on malignant cases only (excluding non-melanoma skin cancer).

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Incidence by Age

The greatest number of new cancer cases is expected in people ages 60 to 79. An estimated 54.5% of all cases in 2020 are projected to be diagnosed in this age group (Table 1.2). The next most common age group for new cancer cases will be people ages 40 to 59 (22.0%) followed by those 80 and older (18.7%). Only 4.8% of cases are expected to be diagnosed in those under the age of 40.

The incidence rate in 2020 is projected to range from 62.6 per 100,000 in those ages 39 and under to 2,501.4 per 100,000 in people ages 80 and older. The projected rates for 2020:

  • increase with advancing age for bladder, breast, colorectal, kidney, liver, lung and pancreatic cancers, and melanoma
  • increase with advancing age for cervical and thyroid cancers but peak in those 40 to 59 years, the ages at which these cancers are most common
  • increase with advancing age for prostate and uterine cancer but peak in those 60 to 79 years, the ages at which these cancers are most common.

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The incidence rates of the 23 cancers reported in Table 1.2 are projected to be very low in those under the age of 40. The exceptions are breast cancer, at 15.6 per 100,000, and thyroid cancer, at 10.8 per 100,000.

Table 1.2 Projected incidence counts and age-specific rates by cancer type and age group, Ontario, 2020
Cancer type Ages 0 - 39 years Ages 40 - 59 years Ages 60 - 79 years Ages 80 years or older
New cases Age-specific rate New cases Age-specific rate New cases Age-specific rate New cases Age-specific rate
All cancers 4,379 62.6 20,215 516.6 50,120 1,699.1 17,232 2,501.4
Bladder 30 0.4 480 12.3 2,509 85.1 1,301 188.9
Brain 241 3.4 311 7.9 519 17.6 143 20.8
Breast (female) 541 15.6 3,997 201.1 5,826 378.4 1,581 385.4
Cervix 142 4.1 239 12.0 144 9.4 28 6.8
Colorectal 156 2.2 1,724 44.1 5,005 169.7 2,360 342.6
Esophagus 7 0.1 180 4.6 580 19.7 217 31.5
Hodgkin lymphoma 207 3.0 87 2.2 83 2.8 21 3.0
Kidney 110 1.6 835 21.3 1,537 52.1 422 61.3
Larynx ** ** 72 1.8 258 8.7 68 9.9
Leukemia 314 4.5 481 12.3 1,366 46.3 635 92.2
Liver 27 0.4 301 7.7 1,110 37.6 364 52.8
Lung 50 0.7 1,314 33.6 6,657 225.7 2,571 373.2
Melanoma 305 4.4 990 25.3 2,126 72.1 943 136.9
Myeloma 12 0.2 256 6.5 869 29.5 389 56.5
Non-Hodgkin lymphoma 351 5.0 1,104 28.2 2,866 97.2 1,169 169.7
Oral cavity & pharynx 56 0.8 621 15.9 1,132 38.4 258 37.5
Ovary 84 2.4 391 19.7 604 39.2 198 48.3
Pancreas 35 0.5 398 10.2 1,410 47.8 690 100.2
Prostate 0 0.0 1,343 69.8 6,303 447.0 882 316.5
Stomach 41 0.6 364 9.3 974 33.0 447 64.9
Testis 335 9.5 127 6.6 25 1.8 ** **
Thyroid 757 10.8 1,838 47.0 1,373 46.5 141 20.5
Uterus 64 1.8 1,054 53.0 1,908 123.9 329 80.2

Symbol: ** Suppressed due to small case count (count less than 6).

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected incidence rates are based on the NCI SEER standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
  3. Projections are based on malignant cases only.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Among people ages 40 to 59, female breast cancer will account for the largest proportion of all cases in this age group (19.8%). In those ages 60 to 79, lung (13.3%), prostate (12.6%) and breast (11.6%) will be the most common cancers diagnosed. Among the oldest Ontarians — those 80 years and older — lung will be the most commonly diagnosed cancer (14.9%), followed by colorectal cancer (13.7%).

For more information on cancer incidence in Ontario, including data on more cancer types and trends over time, see Chapter 5: Cancer Incidence Rates and Trends.

 

References

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