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Statistical Reports

Ch 3: Estimated future burden of cancer

Data Type:
Publication Series: Under Review
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Ontario Cancer Statistics 2020 Ch 3: Estimated Future Burden of Cancer

Cancer is a heavy burden on individuals and families, on the healthcare system and on society as a whole. This chapter reports projected cancer incidence and mortality counts and rates from 2020 to 2030.

What's on this page

Future Burden Overview

Estimates of future cancer incidence and mortality can help with health services planning, redistribution of current health resources, policy considerations and development of infrastructure for better cancer control. The growing and aging of Ontario’s population continues to contribute to an increase in cancer incidence and prevalence. This requires forecasting of cancer estimates for effective planning to manage the growing burden of cancer.

Future predictions consider different combinations of potential age-specific, cohort-specific and period-specific trends, and assume that these past trends will continue into the future.

The statistical prediction models used for this report do not consider these changes individually:

  • Recent changes in the prevalence of cancer risk factors
  • Changes in medical practice
  • Advances in diagnostic procedures
  • Changes in cancer registration practices

For example, cancer screening can have a strong influence on rates of new cancer diagnoses and, as a result, on future incidence rates. However, projections of future cases will not account for any future implementation of population-level cancer screening programs, as is anticipated for lung cancer. Similarly, other interventions that have been recently implemented, such as school-based HPV vaccination programs for the prevention of cervical cancer, will not strongly influence the projections for the targeted cancer.

Because of their large numbers, projections for the most common cancers tend to have the biggest influence over the total projected number of cases and rates. Therefore, any uncertainty in the projection of these cancers will affect the projection of all cancers combined.

New cancer cases are predicted to increase by 25.4% over the next 10 years, from approximately 91,946 cases in 2020 to 115,306 in 2030 (Figure 3.1). In fact, starting in 2024, over 100,000 new cancer cases are expected to be diagnosed in Ontario every year. The growth in the number of new cases will represent an increase of 0.7% in the incidence rate between 2020 (551.8 per 100,000) and 2030 (555.5 per 100,000) (Figure 3.1).

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Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected and actual incidence rates for cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Start of SEER rules by the Ontario Cancer Registry is shown by the shading behind years 2010 to 2016. 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. Projections are based on malignant cases only (excluding non-melanoma skin cancer).
  4. The shaded area indicates projected data for the years 2017 through 2030.

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 3.1 Projected incidence counts and age-standardized rates for all cancers combined, Ontario, 1981 to 2030
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 490.0
1987 36469 500.4
1988 38054 508.1
1989 38269 496.5
1990 40264 507.9
1991 42462 523.7
1992 43421 522.0
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 531.0
2005 59716 531.5
2006 61299 531.7
2007 63816 540.0
2008 63893 526.1
2009 65515 525.9
2010 72933 570.6
2011 75659 577.0
2012 75415 559.1
2013 76424 550.4
2014 77439 543.6
2015 79653 545.8
2016 81409 544.0
2017 84753 549.5
2018 87338 551.5
2019 89658 551.9
2020 91946 551.8
2021 94214 551.7
2022 96477 551.6
2023 98741 551.4
2024 100980 551.1
2025 103444 551.9
2026 105864 552.5
2027 108209 553.2
2028 110534 553.7
2029 112819 554.1
2030 115306 555.5

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected and actual incidence rates for cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Start of SEER rules by the Ontario Cancer Registry is shown by the shading behind years 2010 to 2016. 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. Projections are based on malignant cases only (excluding non-melanoma skin cancer).
  4. Projected data shown for years 2017 onward.

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

The number of new cancer cases among males is expected to increase from 46,288 in 2020 to 57,482 by 2030. In females, new cases will grow from 47,738 in 2020 to 60,386 in 2030 (Figure 3.2).

However, the trend in incidence rates in each sex is expected to converge in the future as the male incidence rate declines and the female incidence rate increase over time (Figure 3.2). By 2030, the gap in incidence rates between males and females will have substantially narrowed, suggesting that women will be as likely as men to develop cancer.

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected and actual incidence rates for cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Start of SEER rules by the Ontario Cancer Registry is shown by the shading behind years 2010 to 2016. 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. Projections are based on malignant cases only (excluding non-melanoma skin cancer).
  4. The shaded area indicates projected data for the years 2017 through 2030.

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 3.2 Projected incidence counts and age-standardized rates by sex for all cancers combined, Ontario, 1981 to 2030
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 586.0 15646 431.3
1984 16908 591.9 16095 432.1
1985 17441 592.0 16826 441.7
1986 17811 592.5 16849 430.2
1987 18793 604.0 17676 438.6
1988 19393 604.8 18661 451.7
1989 19780 597.0 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 615.8 37430 520.3
2013 37897 596.0 38527 521.5
2014 38141 581.3 39298 520.8
2015 39681 587.6 39972 518.8
2016 40628 584.3 40781 517.7
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
2021 46540 574.1 47674 538.1
2022 47580 571.2 48897 540
2023 48598 568.1 50143 542
2024 49592 565.0 51388 543.7
2025 50793 564.2 52651 545.4
2026 51967 563.5 53897 547
2027 53083 562.8 55126 548.6
2028 54188 562.1 56346 549.9
2029 55259 561.3 57560 551.2
2030 56530 562.5 58776 552.4

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected and actual incidence rates for cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Start of SEER rules by the Ontario Cancer Registry is shown by the shading behind years 2010 to 2016. 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. Projections are based on malignant cases only (excluding non-melanoma skin cancer).
  4. Projected data shown for years 2017 onward.

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

By 2030, women will be as likely as men to develop cancer.

The declining male incidence rate will be driven largely by the prostate and lung cancer trends, and to a lesser extent by the colorectal cancer trend (Figure 3.3). The rates of all 3 cancers are expected to decline. The rising female incidence rate is expected to be due to rising trends for uterus, thyroid and liver cancers (see next section, Projected Incidence by Cancer Type).

Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
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 3.3 Projected age-standardized incidence rates by sex for the most common cancer types, Ontario, 2020 to 2030
Year Breast (females) Colorectal (males) Colorectal (females) Lung (males) Lung (females) Prostate
2020 142.8 64.1 45.9 64.0 58.5 103.8
2021 142.9 63.4 45.5 62.7 57.9 101.3
2022 143.0 62.7 45.1 61.5 57.3 98.7
2023 143.0 62.0 44.8 60.2 56.8 96.2
2024 143.1 61.3 44.4 59.0 56.2 93.7
2025 143.4 61.1 44.3 58.1 55.5 92.8
2026 143.7 60.9 44.3 57.3 54.7 92.0
2027 144.0 60.8 44.2 56.4 54.0 91.1
2028 144.2 60.6 44.1 55.6 53.3 90.2
2029 144.5 60.4 44.1 54.7 52.6 89.4
2030 145.0 60.7 44.3 54.2 51.9 89.8

Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Projected Incidence by Cancer Type

Table 3.1 shows that projected counts and incidence rates for new cancer cases are expected to differ by cancer type. In both sexes combined, the largest (more than 10%) relative increases in rates between 2020 and 2030 are expected for liver, thyroid, uterine, kidney and pancreatic cancers, and non-Hodgkin lymphoma. The largest (more than 10%) relative decreases in rates are expected for laryngeal, bladder, prostate and lung cancers.

Given these relative changes in rates, by 2030, non-Hodgkin lymphoma, pancreatic and liver cancers are expected to represent a larger percentage of all new cancer cases. In contrast, lung and bladder cancers are expected to represent a smaller percentage of all new cancer cases than in 2020.

Some notable differences in patterns exist between males and females. Specifically, the relative increase in the liver cancer incidence rate is projected to be higher in females than males. In contrast, the relative increases in projected incidence rates for kidney, pancreatic and thyroid cancers are higher in males than females.

The incidence rate projections for 5 of the most common cancers in Ontario – breast, prostate, lung, colorectal and bladder – generally show a direction in trends similar to a recent Canadian study that examined the future burden of cancer, with some exceptions.[1] For example, this report predicts a decreasing trend in prostate and colorectal cancers, while the study predicts an increase in these cancer types, although for a longer period of projection.

In males:

  • a substantial decrease in the projected incidence rate for prostate cancer is anticipated, although this trend may change due to the recent softening of recommendations against PSA to screen for prostate cancer in the US[2]
  • by 2030, non-Hodgkin lymphoma is expected to surpass bladder cancer as the fourth leading cancer

In females:

  • a large increase is expected for liver and uterine cancers in females
  • by 2030, the age-standardized incidence rate for 3 of the most common cancers in females – thyroid, uterine, and non-Hodgkin lymphoma – will have increased by over 10%

By 2030, non-Hodgkin lymphoma, pancreatic and liver cancers are expected to represent a larger percentage of all new cancer cases.

Table 3.1 Projected incidence counts and age-standardized rates by cancer type and sex, Ontario, 2020 and 2030
Cancer type Both sexes Males Females
New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR
All cancers 91,946 551.8 115,306 555.5 0.7 45,494 577.2 56,530 562.5 -2.5 46,452 536.0 58,776 552.4 3.1
Bladder 4,320 24.7 4,960 20.8 -15.8 3,329 41.9 3,898 35.3 -15.8 991 10.5 1,062 8.4 -20.0
Brain 1,214 7.7 1,383 7.4 -3.9 695 9.2 796 8.9 -3.3 519 6.3 587 6.0 -4.8
Breast (female) 11,945 142.8 14,365 145.0 1.5 n/a n/a n/a n/a n/a 11,945 142.8 14,365 145.0 1.5
Cervix 553 7.3 571 6.8 -6.8 n/a n/a n/a n/a n/a 553 7.3 571 6.8 -6.8
Colorectal 8,459 50.4 8,943 42.0 -16.7 4,656 59.9 4,944 49.4 -17.5 3,803 42.0 3,999 35.4 -15.7
Esophagus 984 5.8 1,280 5.8 0.0 755 9.5 997 9.7 2.1 229 2.4 283 2.3 -4.2
Hodgkin lymphoma 398 2.7 434 2.7 0.0 209 2.9 222 2.8 -3.4 189 2.5 212 2.6 4.0
Kidney 2,904 17.8 3,961 20.0 12.4 1,918 24.9 2,692 28.7 15.3 986 11.3 1,269 12.0 6.2
Larynx 402 2.4 399 1.8 -25.0 342 4.3 340 3.3 -23.3 60 0.7 59 0.5 -28.6
Leukemia 2,796 16.8 3,517 16.8 0.0 1,621 20.9 2,032 20.4 -2.4 1,175 13.3 1,485 13.6 2.3
Liver 1,802 10.5 2,714 12.0 14.3 1,181 14.7 1,659 15.5 5.4 621 6.8 1,055 8.8 29.4
Lung 10,592 60.8 12,235 53.0 -12.8 5,127 64.0 5,838 54.2 -15.3 5,465 58.5 6,397 51.9 -11.3
Melanoma 4,364 26.4 5,601 26.3 -0.4 2,539 32.8 3,350 32.5 -0.9 1,825 21.5 2,251 21.3 -0.9
Myeloma 1,526 8.9 2,096 9.3 4.5 877 11.1 1,228 11.7 5.4 649 7.0 868 7.3 4.3
Non-Hodgkin lymphoma 5,490 33.0 7,805 36.8 11.5 3,154 40.7 4,579 45.6 12.0 2,336 26.3 3,226 29.0 10.3
Oral cavity & pharynx 2,067 12.7 2,667 13.5 6.3 1,506 19.5 1,973 21.2 8.7 561 6.4 694 6.3 -1.6
Ovary 1,277 15.2 1,454 14.6 -3.9 n/a n/a n/a n/a n/a 1,277 15.2 1,454 14.6 -3.9
Pancreas 2,533 14.7 3,696 16.5 12.2 1,352 17.1 2,046 19.7 15.2 1,181 12.6 1,650 13.5 7.1
Prostate 8,528 103.8 9,392 89.8 -13.5 8,528 103.8 9,392 89.8 -13.5 n/a n/a n/a n/a n/a
Stomach 1,826 10.8 2,492 11.6 7.4 1,161 14.8 1,584 15.6 5.4 665 7.4 908 8.1 9.5
Testis 490 7.0 559 7.6 8.6 490 7.0 559 7.6 8.6 n/a n/a n/a n/a n/a
Thyroid 4,109 27.6 5,369 31.5 14.1 1,118 15.1 1,608 18.7 23.8 2,991 39.6 3,761 43.8 10.6
Uterus 3,355 39.4 4,494 45.0 14.2 n/a n/a n/a n/a n/a 3,355 39.4 4,494 45.0 14.2

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, which were 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)

Projected Incidence by Age

The anticipated change in incidence counts and rates will also vary by age group between 2020 and 2030.

Ages 0 to 39 years:

  • The largest relative increases (more than 10%) in incidence rate are expected for pancreatic, non-Hodgkin lymphoma, leukemia, breast, oral cavity and pharynx, and uterine cancers (Table 3.2).
  • The largest (more than 10%) relative decreases in rates are expected for bladder, cervical and lung cancers, and melanoma.
Table 3.2 Projected incidence counts and age-specific rates by cancer type and age group, Ontario, 2020 and 2030
Cancer type Ages 0 - 39 years Ages 40 - 59 years Ages 60 - 79 years Ages 80 years or older
New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate
All cancers 4,379 62.6 4,970 67.1 7.2 20,215 516.6 20,538 514.7 -0.4 50,120 1,699.1 64,046 1748.6 2.9 17,232 2501.4 25,752 2,394.6 -4.3
Bladder 30 0.4 19 0.3 -25.0 480 12.3 371 9.3 -24.4 2,509 85.1 2,775 75.8 -10.9 1,301 188.9 1,795 166.9 -11.6
Brain 241 3.4 258 3.5 2.9 311 7.9 300 7.5 -5.1 519 17.6 620 16.9 -4.0 143 20.8 205 19.1 -8.2
Breast (female) 541 15.6 649 17.8 14.1 3,997 201.1 4,188 204.2 1.5 5,826 378.4 7,052 371.7 -1.8 1,581 385.4 2,476 403.3 4.6
Cervix 142 4.1 127 3.5 -14.6 239 12.0 243 11.8 -1.7 144 9.4 165 8.7 -7.4 28 6.8 36 5.9 -13.2
Colorectal 194 2.8 258 3.5 25.0 1,713 43.8 1,630 40.8 -6.8 4,250 144.1 4,074 111.2 -22.8 2,302 334.2 2,981 277.2 -17.1
Esophagus 7 0.1 8 0.1 0.0 180 4.6 168 4.2 -8.7 580 19.7 759 20.7 5.1 217 31.5 345 32.1 1.9
Hodgkin lymphoma 207 3.0 214 2.9 -3.3 87 2.2 88 2.2 0.0 83 2.8 101 2.8 0.0 21 3.0 31 2.9 -3.3
Kidney 110 1.6 126 1.7 6.2 835 21.3 933 23.4 9.9 1,537 52.1 2,173 59.3 13.8 422 61.3 729 67.8 10.6
Larynx ** ** ** ** ** 72 1.8 57 1.4 -22.2 258 8.7 255 7.0 -19.5 68 9.9 83 7.7 -22.2
Leukemia 314 4.5 384 5.2 15.6 481 12.3 478 12.0 -2.4 1,366 46.3 1,742 47.6 2.8 635 92.2 913 84.9 -7.9
Liver 27 0.4 28 0.4 0.0 301 7.7 283 7.1 -7.8 1,110 37.6 1,674 45.7 21.5 364 52.8 729 67.8 28.4
Lung 50 0.7 48 0.6 -14.3 1,314 33.6 1,134 28.4 -15.5 6,657 225.7 7,486 204.4 -9.4 2,571 373.2 3,567 331.7 -11.1
Melanoma 305 4.4 287 3.9 -11.4 990 25.3 940 23.6 -6.7 2,126 72.1 2,673 73.0 1.2 943 136.9 1,701 158.2 15.6
Myeloma 12 0.2 15 0.2 0.0 256 6.5 258 6.5 0.0 869 29.5 1,186 32.4 9.8 389 56.5 637 59.2 4.8
Non-Hodgkin lymphoma 351 5.0 460 6.2 24.0 1,104 28.2 1,200 30.1 6.7 2,866 97.2 4,024 109.9 13.1 1,169 169.7 2,121 197.2 16.2
Oral cavity & pharynx 56 0.8 63 0.9 12.5 621 15.9 610 15.3 -3.8 1,132 38.4 1,560 42.6 10.9 258 37.5 434 40.4 7.7
Ovary 84 2.4 80 2.2 -8.3 391 19.7 399 19.5 -1.0 604 39.2 713 37.6 -4.1 198 48.3 262 42.7 -11.6
Pancreas 35 0.5 53 0.7 40.0 398 10.2 432 10.8 5.9 1,410 47.8 2,032 55.5 16.1 690 100.2 1,179 109.6 9.4
Prostate 0 0.0 0 0.0 0.0 1,343 69.8 955 49.2 -29.5 6,303 447.0 7,303 413.6 -7.5 882 316.5 1,134 245.7 -22.4
Stomach 41 0.6 45 0.6 0.0 364 9.3 408 10.2 9.7 974 33.0 1,361 37.2 12.7 447 64.9 678 63.0 -2.9
Testis 335 9.5 357 9.5 0.0 127 6.6 158 8.1 22.7 25 1.8 38 2.2 22.2 ** ** 6 1.3 **
Thyroid 757 10.8 754 10.2 -5.6 1,838 47.0 1,991 49.9 6.2 1,373 46.5 2,294 62.6 34.6 141 20.5 330 30.7 49.8
Uterus 64 1.8 74 2.0 11.1 1,054 53.0 1,172 57.1 7.7 1,908 123.9 2,625 138.4 11.7 329 80.2 623 101.5 26.6

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

Notes:

  1. Rates are per 100,000.
  2. Projected incidence rates are based on the NCI SEER standards for counting multiple primary cancers, which were 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)

Ages 40 to 59 years:

  • The largest projected increase (more than 10%) in incidence rate) will be limited to testicular cancer.
  • Decreases of more than 10% will be seen for prostate, bladder, laryngeal and lung cancers.

Differences exist between the under 60 and over 60 age groups in both the types of cancers and the number of cancer types for which changes are expected.

Ages 60 to 79 years (representing the largest proportion of cancers):

  • The relative increase in incidence rate is predicted to be highest for thyroid, testicular, liver, pancreatic, kidney, non-Hodgkin lymphoma, stomach, and oral cavity & pharynx cancers. Relative incidence rate decreases are projected to be largest for laryngeal, bladder and lung cancers.

Ages 80 years and older (the oldest age group):

  • This group is expected to experience the largest overall decrease in incidence rate between 2020 and 2030.
  • As with the 60 to 79 year age group, relative increases in projected incidence rates are greatest for thyroid, liver, uterine and testicular cancers, non-Hodgkin lymphoma and melanoma.
  • Relative decreases in the incidence rate are expected to be greatest for prostate, laryngeal, colorectal, cervical, bladder, ovarian and lung cancers.

Population-based cancer screening can have a strong influence on rates of new cancer diagnoses and, consequently, on future incidence rates. These projections do not take into account the expected influence of future population-based screening programs, such as the one anticipated for lung cancer.

Projected Trends in Cancer Mortality

Cancer deaths are predicted to increase by 22% over the next 10 years, from 30,975 deaths in 2020 to 37,351 deaths in 2030 (Figure 3.4).

null

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. The shaded area indicates projected data for the years 2017 through 2030.

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 3.4 Projected mortality counts and age-standardized rates for all cancers combined, Ontario, 1981 to 2030
Year Deaths Mortality rate
1981 14938 249.8
1982 15402 250.1
1983 15960 253.2
1984 16546 256
1985 17230 259.7
1986 17339 254
1987 18007 255.8
1988 18873 261
1989 19026 256.3
1990 19089 249.9
1991 19616 251.2
1992 20010 249.1
1993 20547 249.4
1994 21302 253.5
1995 21427 249.3
1996 21665 245.7
1997 21666 240.6
1998 21932 237.8
1999 22655 240.6
2000 23158 240.5
2001 23664 240.1
2002 23984 236.1
2003 24275 232.2
2004 24665 228.8
2005 24930 225.2
2006 24971 219.1
2007 25370 216.3
2008 25794 213.8
2009 26075 210
2010 26585 208.2
2011 27127 206.6
2012 27442 202.3
2013 27634 197.2
2014 28075 194.4
2015 28291 190.4
2016 29074 190
2017 29534 186.1
2018 30008 183.2
2019 30451 180.3
2020 30975 178
2021 31496 175.7
2022 32043 173.3
2023 32586 171
2024 33112 168.6
2025 33783 167
2026 34461 165.5
2027 35163 163.9
2028 35867 162.3
2029 36545 160.7
2030 37351 159.8

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Projected data shown for years 2017 onward.

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

The rising number of cancer deaths will reflect the increasing incidence. Among males, cancer deaths are expected to increase from 16,066 in 2020 to 19,563 by 2030. In females, the number of cancer deaths will grow from 14,909 in 2020 to 17,788 in 2030 (Figure 3.5).

However, when accounting for the growing population size, the cancer death rate is expected to decrease between 2020 (178.0 per 100,000) and 2030 (159.8 per 100,000). The decrease in overall death rates reflects a continuing decline in both male and female cancer death rates. The mortality rate is expected to decline slightly faster in males than females (Figure 3.5).

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. The shaded area indicates projected data for the years 2017 through 2030.

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 3.5 Projected mortality counts and age-standardized rates by sex for all cancers combined, Ontario, 1981 to 2030
Year Deaths-males Mortality rate-males Deaths-females Mortality rate-females
1981 8094 323.5 6844 202.8
1982 8338 323.4 7064 203.3
1983 8680 330.4 7280 204.2
1984 8941 331 7605 207.6
1985 9171 333.1 8059 214
1986 9366 328.9 7973 206.7
1987 9704 330.3 8303 208.8
1988 10312 342.9 8561 208.9
1989 10287 332.8 8739 207.7
1990 10349 323.2 8740 202
1991 10510 323.7 9106 205.4
1992 10799 321.8 9211 203.1
1993 10934 317.1 9613 206
1994 11423 324.6 9879 207.7
1995 11359 316 10068 206.6
1996 11421 309.5 10244 205.2
1997 11636 308.2 10030 196.6
1998 11584 300.4 10348 198.1
1999 11938 300.2 10717 201.2
2000 12118 300.2 11040 202.4
2001 12402 300 11262 201.3
2002 12599 295 11385 198.3
2003 12700 288.1 11575 196.4
2004 12816 281.2 11849 195
2005 12842 273.9 12088 193.4
2006 13124 271.4 11847 184.7
2007 13169 262 12201 184.5
2008 13409 259.9 12385 183
2009 13667 256.2 12409 178.3
2010 13839 251.8 12746 178.3
2011 14188 249.9 12939 176.3
2012 14360 243.5 13082 173.5
2013 14465 236.5 13169 169.5
2014 14799 234.1 13276 166.2
2015 14694 224.9 13597 166
2016 15136 224.4 13938 165.5
2017 15375 217.8 14159 162.7
2018 15591 213.1 14417 161
2019 15782 208.4 14669 159.3
2020 16066 205 14909 157.6
2021 16347 201.7 15149 155.8
2022 16638 198.3 15405 154.1
2023 16926 195 15660 152.4
2024 17196 191.6 15916 150.7
2025 17570 189.5 16213 149.4
2026 17948 187.4 16513 148.2
2027 18336 185.3 16827 146.9
2028 18726 183.2 17141 145.6
2029 19096 181.1 17449 144.4
2030 19563 180 17788 143.5

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Shading behind years 2017 onward.

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

The projected declines in mortality rates are expected to be largely driven by lung cancer (Figure 3.6). Smaller declines are also expected for breast and colorectal cancers.

Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
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 3.6 Projected age-standardized mortality rates by sex for the most common cancer types, Ontario, 2020 to 2030
Year Breast (females) Colorectal (males) Colorectal (females) Lung (males) Lung (females) Prostate
2020 21.9 21.8 15.4 45.7 36.4 21.7
2021 21.6 21.3 15.2 44.4 35.7 21.4
2022 21.2 20.9 15 43.2 34.9 21.2
2023 20.9 20.4 14.7 42 34.2 20.9
2024 20.5 20 14.5 40.8 33.5 20.6
2025 20.4 19.9 14.4 40 32.8 20.6
2026 20.2 19.8 14.3 39.2 32.1 20.5
2027 20 19.7 14.2 38.4 31.5 20.5
2028 19.8 19.5 14.1 37.6 30.8 20.5
2029 19.7 19.4 14 36.8 30.1 20.4
2030 19.6 19.6 14 36.4 29.5 20.4

Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Projected Incidence by Cancer Type

Table 3.1 shows that projected counts and incidence rates for new cancer cases are expected to differ by cancer type. In both sexes combined, the largest (more than 10%) relative increases in rates between 2020 and 2030 are expected for liver, thyroid, uterine, kidney and pancreatic cancers, and non-Hodgkin lymphoma. The largest (more than 10%) relative decreases in rates are expected for laryngeal, bladder, prostate and lung cancers.

Given these relative changes in rates, by 2030, non-Hodgkin lymphoma, pancreatic and liver cancers are expected to represent a larger percentage of all new cancer cases. In contrast, lung and bladder cancers are expected to represent a smaller percentage of all new cancer cases than in 2020.

Some notable differences in patterns exist between males and females. Specifically, the relative increase in the liver cancer incidence rate is projected to be higher in females than males. In contrast, the relative increases in projected incidence rates for kidney, pancreatic and thyroid cancers are higher in males than females.

The incidence rate projections for 5 of the most common cancers in Ontario – breast, prostate, lung, colorectal and bladder – generally show a direction in trends similar to a recent Canadian study that examined the future burden of cancer, with some exceptions.[1] For example, this report predicts a decreasing trend in prostate and colorectal cancers, while the study predicts an increase in these cancer types, although for a longer period of projection.

In males:

  • a substantial decrease in the projected incidence rate for prostate cancer is anticipated, although this trend may change due to the recent softening of recommendations against PSA to screen for prostate cancer in the US[2]
  • by 2030, non-Hodgkin lymphoma is expected to surpass bladder cancer as the fourth leading cancer

In females:

  • a large increase is expected for liver and uterine cancers in females
  • by 2030, the age-standardized incidence rate for 3 of the most common cancers in females – thyroid, uterine, and non-Hodgkin lymphoma – will have increased by over 10%

By 2030, non-Hodgkin lymphoma, pancreatic and liver cancers are expected to represent a larger percentage of all new cancer cases.

Table 3.1 Projected incidence counts and age-standardized rates by cancer type and sex, Ontario, 2020 and 2030
Cancer type Both sexes Males Females
New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR New cases (2020) ASIR (2020) New cases (2030) ASIR (2030) % change in ASIR
All cancers 91,946 551.8 115,306 555.5 0.7 45,494 577.2 56,530 562.5 -2.5 46,452 536.0 58,776 552.4 3.1
Bladder 4,320 24.7 4,960 20.8 -15.8 3,329 41.9 3,898 35.3 -15.8 991 10.5 1,062 8.4 -20.0
Brain 1,214 7.7 1,383 7.4 -3.9 695 9.2 796 8.9 -3.3 519 6.3 587 6.0 -4.8
Breast (female) 11,945 142.8 14,365 145.0 1.5 n/a n/a n/a n/a n/a 11,945 142.8 14,365 145.0 1.5
Cervix 553 7.3 571 6.8 -6.8 n/a n/a n/a n/a n/a 553 7.3 571 6.8 -6.8
Colorectal 9,245 54.4 11,184 52.1 -4.2 5,047 64.1 6,129 60.7 -5.3 4,198 45.9 5,055 44.3 -3.5
Esophagus 984 5.8 1,280 5.8 0.0 755 9.5 997 9.7 2.1 229 2.4 283 2.3 -4.2
Hodgkin lymphoma 398 2.7 434 2.7 0.0 209 2.9 222 2.8 -3.4 189 2.5 212 2.6 4.0
Kidney 2,904 17.8 3,961 20.0 12.4 1,918 24.9 2,692 28.7 15.3 986 11.3 1,269 12.0 6.2
Larynx 402 2.4 399 1.8 -25.0 342 4.3 340 3.3 -23.3 60 0.7 59 0.5 -28.6
Leukemia 2,796 16.8 3,517 16.8 0.0 1,621 20.9 2,032 20.4 -2.4 1,175 13.3 1,485 13.6 2.3
Liver 1,802 10.5 2,714 12.0 14.3 1,181 14.7 1,659 15.5 5.4 621 6.8 1,055 8.8 29.4
Lung 10,592 60.8 12,235 53.0 -12.8 5,127 64.0 5,838 54.2 -15.3 5,465 58.5 6,397 51.9 -11.3
Melanoma 4,364 26.4 5,601 26.3 -0.4 2,539 32.8 3,350 32.5 -0.9 1,825 21.5 2,251 21.3 -0.9
Myeloma 1,526 8.9 2,096 9.3 4.5 877 11.1 1,228 11.7 5.4 649 7.0 868 7.3 4.3
Non-Hodgkin lymphoma 5,490 33.0 7,805 36.8 11.5 3,154 40.7 4,579 45.6 12.0 2,336 26.3 3,226 29.0 10.3
Oral cavity & pharynx 2,067 12.7 2,667 13.5 6.3 1,506 19.5 1,973 21.2 8.7 561 6.4 694 6.3 -1.6
Ovary 1,277 15.2 1,454 14.6 -3.9 n/a n/a n/a n/a n/a 1,277 15.2 1,454 14.6 -3.9
Pancreas 2,533 14.7 3,696 16.5 12.2 1,352 17.1 2,046 19.7 15.2 1,181 12.6 1,650 13.5 7.1
Prostate 8,528 103.8 9,392 89.8 -13.5 8,528 103.8 9,392 89.8 -13.5 n/a n/a n/a n/a n/a
Stomach 1,826 10.8 2,492 11.6 7.4 1,161 14.8 1,584 15.6 5.4 665 7.4 908 8.1 9.5
Testis 490 7.0 559 7.6 8.6 490 7.0 559 7.6 8.6 n/a n/a n/a n/a n/a
Thyroid 4,109 27.6 5,369 31.5 14.1 1,118 15.1 1,608 18.7 23.8 2,991 39.6 3,761 43.8 10.6
Uterus 3,355 39.4 4,494 45.0 14.2 n/a n/a n/a n/a n/a 3,355 39.4 4,494 45.0 14.2

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, which were 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)

Projected Incidence by Age

The anticipated change in incidence counts and rates will also vary by age group between 2020 and 2030.

Ages 0 to 39 years:

  • The largest relative increases (more than 10%) in incidence rate are expected for pancreatic, non-Hodgkin lymphoma, leukemia, breast, oral cavity and pharynx, and uterine cancers (Table 3.2).
  • The largest (more than 10%) relative decreases in rates are expected for bladder, cervical and lung cancers, and melanoma.
Table 3.2 Projected incidence counts and age-specific rates by cancer type and age group, Ontario, 2020 and 2030
Cancer type Ages 0 - 39 years Ages 40 - 59 years Ages 60 - 79 years Ages 80 years or older
New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate New cases (2020) Age-specific rate (2020) New cases (2030) Age-specific rate (2030) % change in age-specific rate
All cancers 4,379 62.6 4,970 67.1 7.2 20,215 516.6 20,538 514.7 -0.4 50,120 1,699.1 64,046 1748.6 2.9 17,232 2501.4 25,752 2,394.6 -4.3
Bladder 30 0.4 19 0.3 -25.0 480 12.3 371 9.3 -24.4 2,509 85.1 2,775 75.8 -10.9 1,301 188.9 1,795 166.9 -11.6
Brain 241 3.4 258 3.5 2.9 311 7.9 300 7.5 -5.1 519 17.6 620 16.9 -4.0 143 20.8 205 19.1 -8.2
Breast (female) 541 15.6 649 17.8 14.1 3,997 201.1 4,188 204.2 1.5 5,826 378.4 7,052 371.7 -1.8 1,581 385.4 2,476 403.3 4.6
Cervix 142 4.1 127 3.5 -14.6 239 12.0 243 11.8 -1.7 144 9.4 165 8.7 -7.4 28 6.8 36 5.9 -13.2
Colorectal 156 2.2 164 2.2 0.0 1,724 44.1 1,813 45.4 2.9 5,005 169.7 6,126 167.3 -1.4 2,360 342.6 3,081 286.5 -16.4
Esophagus 7 0.1 8 0.1 0.0 180 4.6 168 4.2 -8.7 580 19.7 759 20.7 5.1 217 31.5 345 32.1 1.9
Hodgkin lymphoma 207 3.0 214 2.9 -3.3 87 2.2 88 2.2 0.0 83 2.8 101 2.8 0.0 21 3.0 31 2.9 -3.3
Kidney 110 1.6 126 1.7 6.2 835 21.3 933 23.4 9.9 1,537 52.1 2,173 59.3 13.8 422 61.3 729 67.8 10.6
Larynx ** ** ** ** ** 72 1.8 57 1.4 -22.2 258 8.7 255 7.0 -19.5 68 9.9 83 7.7 -22.2
Leukemia 314 4.5 384 5.2 15.6 481 12.3 478 12.0 -2.4 1,366 46.3 1,742 47.6 2.8 635 92.2 913 84.9 -7.9
Liver 27 0.4 28 0.4 0.0 301 7.7 283 7.1 -7.8 1,110 37.6 1,674 45.7 21.5 364 52.8 729 67.8 28.4
Lung 50 0.7 48 0.6 -14.3 1,314 33.6 1,134 28.4 -15.5 6,657 225.7 7,486 204.4 -9.4 2,571 373.2 3,567 331.7 -11.1
Melanoma 305 4.4 287 3.9 -11.4 990 25.3 940 23.6 -6.7 2,126 72.1 2,673 73.0 1.2 943 136.9 1,701 158.2 15.6
Myeloma 12 0.2 15 0.2 0.0 256 6.5 258 6.5 0.0 869 29.5 1,186 32.4 9.8 389 56.5 637 59.2 4.8
Non-Hodgkin lymphoma 351 5.0 460 6.2 24.0 1,104 28.2 1,200 30.1 6.7 2,866 97.2 4,024 109.9 13.1 1,169 169.7 2,121 197.2 16.2
Oral cavity & pharynx 56 0.8 63 0.9 12.5 621 15.9 610 15.3 -3.8 1,132 38.4 1,560 42.6 10.9 258 37.5 434 40.4 7.7
Ovary 84 2.4 80 2.2 -8.3 391 19.7 399 19.5 -1.0 604 39.2 713 37.6 -4.1 198 48.3 262 42.7 -11.6
Pancreas 35 0.5 53 0.7 40.0 398 10.2 432 10.8 5.9 1,410 47.8 2,032 55.5 16.1 690 100.2 1,179 109.6 9.4
Prostate 0 0.0 0 0.0 0.0 1,343 69.8 955 49.2 -29.5 6,303 447.0 7,303 413.6 -7.5 882 316.5 1,134 245.7 -22.4
Stomach 41 0.6 45 0.6 0.0 364 9.3 408 10.2 9.7 974 33.0 1,361 37.2 12.7 447 64.9 678 63.0 -2.9
Testis 335 9.5 357 9.5 0.0 127 6.6 158 8.1 22.7 25 1.8 38 2.2 22.2 ** ** 6 1.3 **
Thyroid 757 10.8 754 10.2 -5.6 1,838 47.0 1,991 49.9 6.2 1,373 46.5 2,294 62.6 34.6 141 20.5 330 30.7 49.8
Uterus 64 1.8 74 2.0 11.1 1,054 53.0 1,172 57.1 7.7 1,908 123.9 2,625 138.4 11.7 329 80.2 623 101.5 26.6

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

Notes:

  1. Rates are per 100,000.
  2. Projected incidence rates are based on the NCI SEER standards for counting multiple primary cancers, which were 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)

Ages 40 to 59 years:

  • The largest projected increase (more than 10%) in incidence rate) will be limited to testicular cancer.
  • Decreases of more than 10% will be seen for prostate, bladder, laryngeal and lung cancers.

Differences exist between the under 60 and over 60 age groups in both the types of cancers and the number of cancer types for which changes are expected.

Ages 60 to 79 years (representing the largest proportion of cancers):

  • The relative increase in incidence rate is predicted to be highest for thyroid, testicular, liver, pancreatic, kidney, non-Hodgkin lymphoma, stomach, and oral cavity & pharynx cancers. Relative incidence rate decreases are projected to be largest for laryngeal, bladder and lung cancers.

Ages 80 years and older (the oldest age group):

  • This group is expected to experience the largest overall decrease in incidence rate between 2020 and 2030.
  • As with the 60 to 79 year age group, relative increases in projected incidence rates are greatest for thyroid, liver, uterine and testicular cancers, non-Hodgkin lymphoma and melanoma.
  • Relative decreases in the incidence rate are expected to be greatest for prostate, laryngeal, colorectal, cervical, bladder, ovarian and lung cancers.

Population-based cancer screening can have a strong influence on rates of new cancer diagnoses and, consequently, on future incidence rates. These projections do not take into account the expected influence of future population-based screening programs, such as the one anticipated for lung cancer.

Projected Trends in Cancer Mortality

Cancer deaths are predicted to increase by 22% over the next 10 years, from 30,975 deaths in 2020 to 37,351 deaths in 2030 (Figure 3.4).

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References

  1. Poirier AE, Ruan Y, Walter SD, Franco EL, Villeneuve PJ, King WD, et al.; on behalf of the ComPARe Study Team. The future burden of cancer in Canada: long-term cancer incidence projections 2013–2042. Cancer Epidemiol. 2019 Apr;59:199-207.
  2. US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018 May 8;319(18):1901-13.