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Statistical Reports

Data Sources [Appendices 1]

Data Type:
Publication Series: Under Review
 

The Ontario Cancer Registry (OCR), maintained by Ontario Health (Cancer Care Ontario), is the main data source for this report. Its goals are to collect, analyze and disseminate timely and high-quality information describing cases of cancer diagnosed among Ontario residents.

The OCR is a dynamic database: new case information and updates to past cases may be added throughout the year. Consequently, the results of analyses vary based on when the data are extracted from the registry. The data in this report were extracted in December 2018.

Ontario Cancer Registry records are created using data collected for purposes other than cancer registration. This information comes from various administrative databases, laboratory reports and clinical records. Four primary sources are used to generate case records in the registry:

  • Provincial pathology reports from Ontario’s public hospital laboratories and private laboratories
  • Activity-level reporting database, containing data from Ontario’s 14 regional cancer centres and their associated hospitals, for selected systemic therapy and all radiation treatment
  • Admission and discharge information from the Canadian Institute of Health Information’s hospital abstracting databases (Discharge Abstract Database, National Ambulatory Care and Reporting System)
  • Cause-of-death data from the Office of the Registrar General for Ontario within the Ministry of Government and Consumer Services

Safeguarding confidential information is a guiding principle for Ontario Health (Cancer Care Ontario). All activities – from the initial registration of a new cancer case in the Ontario Cancer Registry, through research and reporting – are governed by the Personal Health Information Protection Act (PHIPA), 2004.[1] This Ontario law governs the collection and use of data, and the disclosure of personal health information. The Act designates Ontario Health as a prescribed entity, and authorizes the organization to collect, use and disclose personal health information for the purposes of managing and planning Ontario’s health system. See our Statement of Information Practices for details.

Data Quality

Death certificate only and microscopically confirmed cases

Table A.1 shows the percentage of cases in the Ontario Cancer Registry diagnosed based on a death certificate only (DCO) and the percentage microscopically confirmed.

Overall, 1.7% of cases diagnosed in 2016 were DCO. The percentage ranged from a low of 0% for testis cancer to a high of 7.1% for pancreatic cancer.

For all cancers combined, 90.9% of cases were microscopically confirmed. This falls slightly below the Surveillance, Epidemiology and End Results (SEER) Program’s recommendation of at least 93% of cases microscopically confirmed.[2] The percentage microscopically confirmed varied from a low of 59.2% for liver cancer to a high of 99.0% for thyroid cancer.

Table A.1: Percentage of death certificate only and microscopically confirmed cases by cancer type, Ontario Cancer Registry, 2016
Cancer type Death certificate only
Number of cases
Death certificate only
% of cases
Microscopically confirmed
Number of cases
Microscopically confirmed
% of cases
All cancers 1,411 1.7% 73,969 90.9%
Bladder 51 1.2% 4,135 97.6%
Brain 40 3.6% 914 82.7%
Breast 82 0.7% 10,999 98.3%
Cervix 4 0.7% 584 97.3%
Colorectal 166 1.9% 8,041 94.3%
Esophagus 23 2.8% 754 93.3%
Hodgkin lymphoma 1 0.2% 381 92.5%
Kidney 36 1.5% 2,278 93.4%
Larynx 4 1.0% 402 97.1%
Leukemia 22 0.9% 1,963 81.9%
Liver 65 5.1% 752 59.2%
Lung 306 3.1% 8,516 85.5%
Melanoma 12 0.3% 3,789 98.4%
Myeloma 17 1.2% 937 67.6%
Non-Hodgkin lymphoma 32 0.7% 3,565 81.8%
Oral cavity and pharynx 24 1.4% 1,618 95.7%
Ovary 17 1.4% 1119 90.0%
Pancreas 146 7.1% 1,391 67.7%
Prostate 56 0.7% 8,138 96.7%
Stomach 18 1.2% 1,446 94.6%
Testis 0 0.0% 443 94.9%
Thyroid 6 0.2% 2982 99.0%
Uterus 30 1.1% 2748 97.3%

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

Incidence-to-mortality ratio

The age-standardized incidence-to-mortality (I:M) ratio identifies areas of undercoverage within a registry. The I:M ratio for the Ontario Cancer Registry for 2016 was 2.9:1 (Table A.2). This ratio meets the Canadian Partnership Against Cancer’s recommended ratio of at least 2.3:1,[2] with variation by cancer type. An I:M ratio below the recommended level may indicate incomplete registration of cases.

Table A.2: Age-standardized incidence-to-mortality ratio by cancer type, Ontario, 2016
Cancer type I:M ratio
All cancers 2.9
Bladder 4.9
Brain 1.4
Breast 5.9
Cervix 3.8
Colorectal 2.6
Esophagus 1.0
Hodgkin lymphoma 9.7
Kidney 4.7
Larynx 3.4
Leukemia 2.3
Liver 1.1
Lung 1.5
Melanoma 7.9
Myeloma 2.6
Non-Hodgkin lymphoma 4.6
Oral cavity and pharynx 3.2
Ovary 2.0
Pancreas 1.1
Prostate 5.1
Stomach 2.0
Testis 35.0
Thyroid 34.5
Uterus 6.2


Abbreviation: I:M ratio is the ratio of the age-standardized incidence rate to the age-standardized mortality rate.
Analysis by: Ontario Cancer Registry, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data element completeness

All the data quality indicators met the minimal requirements from the Canadian Cancer Registry (CCR) guideline, the ‘Gold’ certification standard of the North American Association of Central Cancer Registries (NAACCR), and the Surveillance, Epidemiology and End Results (SEER) Program guideline:

  • Stage capture rates overall and for Collaborative Staging achieved the provincial target of 90% for breast, prostate, colorectal, lung and cervical cancers in 2016.
  • There were no cases missing information about “age at diagnosis,” “age at death,” or “sex,” thereby meeting NAACCR’s Gold standard of a maximum of 2% or less. Furthermore, 0% of cases were listed as ”alive with current age over 100” and cases listed as ”dead” with missing death date.
  • Postal codes were missing for 2% of the cases, under the 5% CCR threshold for this indicator.
  • The 2% percent of cases with unknown primary (C809) also met the less than 2.3% threshold of the SEER standard.

In 2016, 89% of discrete synoptic cancer pathology reports had all mandatory elements complete in accordance with the College of American Pathologist’s electronic Cancer Checklist.

There are no standards for the average number of sources or notifications per case or for the percentage of cases with unknown morphology. Cases with a greater number of supporting data sources or notifications are assumed to be considered more complete and credible. The high percentage of unknown morphology raises some concern about data quality and data collection. Table A.3 presents other data quality measures related to completeness of Ontario Cancer Registry case registration.

Table A.3: Data element completeness estimates, Ontario Cancer Registry, 2016
Measure Value
Average number of sources/notifications per case 14
Cases with unknown primary site of cancer 2.4%
Cases with unknown morphology† 5.6%
Cases staged‡ 90.5%
Completeness of CS data collection‡ 90.1%
Synoptic pathology reports with mandatory elements 89.0%
Cases missing "age at diagnosis/death" 0.0%
Cases missing "sex" 0.0%
Cases missing "postal code" at diagnosis 2.0%
Patients listed as "alive" with current age over100 0.0%
Patients listed as "dead" missing death date 0.0%

Symbols:

  • †Histology range 8000-8005 (Not Otherwise Specified)
  • ‡For lung, female breast, colorectal, cervix and prostate cancers only

Notes:

  1. For all malignant cases and in situ bladder.
  2. Total number of cases is 81,409 and represents 78,007 individuals.

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

Population Data

The population used in this report for age standardization is the 2011 Canadian Standard population (Table A.4), based on the 2011 Statistics Canada census.

Cancer Care Ontario surveillance reports published before 2016 used the 1991 Canadian Standard population. We do not recommend comparing age-standardized rates in this report with the rates in these earlier reports.

The 1991 standard population is no longer appropriate because the population age structure has changed considerably since then. Using the 2011 standard population results in age-standardized rates that are closer to the crude rate (i.e., rate unadjusted for age distribution).

Except where otherwise noted, population data used in denominators for cancer projections are from the Ontario Ministry of Finance (spring 2018 release).[3]

Table A.4: Population counts from the 2011 Canadian standard population used for age-standardized rates by age group, Canada, 2011
Age group (years) Population
0-4 1,899,064
5-9 1,810,433
10-14 1,918,164
15-19 2,238,952
20-24 2,354,354
25-29 2,369,841
30-34 2,327,955
35-39 2,273,087
40-44 2,385,918
45-49 2,719,909
50-54 2,691,260
55-59 2,353,090
60-64 2,050,443
65-69 1,532,940
70-74 1,153,822
75-79 919,338
80-84 701,140
85 and older 643,070

Note: Postcensal estimates are based on the 2011 census counts adjusted for census net undercoverage (CNU) (including adjustment for incompletely enumerated Indian reserves [IEIR]) and the components of demographic growth that took place since that census. Intercensal estimates use counts from 2 consecutive censuses adjusted for CNU (including IEIR and postcensal estimates).

Data source: Statistics Canada. Table 051-0001 – Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted)

Disease Site Grouping

The Ontario Cancer Registry uses disease site groupings based on the third edition of the International Classification of Diseases for Oncology (ICD-O-3).[4] These disease site groupings are recoded based on the Surveillance, Epidemiology and End Results (SEER) Program groups.[5]

Cancer deaths are classified according to the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10).[6]

The primary cancer groupings used in this report are in Table A.5.

Table A.5 Cancer definitions

Table A.5A Cancer definitions for incidence
Cancer type: short form / long form ICD-O-3 definition
Bladder C67
Brain and other nervous system C70-C72, C75.1-C75.3
Glioblastoma C71 with histologies 9440, 9441, 9442
Meninges C70.0-C70.1, C70.9
Pituitary, pineal and craniopharyngeal duct C75.1-C75.3
Breast (female) C50
Cervix C53
Colorectal / Colon and rectum C18.0, C18.2-C20, C26.0
Colon / Colon excluding rectum C18.0, C18.2-C18.9
Left-sided colon C18.5, C18.6, C18.7
Right-sided colon C18.0, C18.2, 18.3, C18.4
Rectum and rectosigmoid junction C19.9, C20.9
Rectosigmoid junction C19.9
Rectum C20.9
Esophagus C15
Adenocarcinoma C15 with histologies 8140-8573
Squamous cell carcinoma C15 with histologies 8050-8082
Kidney C64.9
Larynx C32
Leukemia C42.0, C42.1, C42.4 with histologies 9811-9818, 9837,9823 9827. Histologies 9826, 9835-9836, 9820, 9832-9834, 9940, 9840, 9861, 9865-9867, 9869, 9871-9874, 9895-9897, 9898, 9910-9911, 9920, 9891, 9863, 9875-9876, 9945-9946, 9860, 9930, 9801, 9805-9809, 9931, 9733, 9742, 9800, 9831, 9870, 9948, 9963-9964
Acute lymphocytic leukemia Histologies 9826, 9835-9836
C42.0, C42.1, C42.4 with histologies 9811-9818, 9837
Acute monocytic leukemia 9891
Acute myeloid leukemia Histologies 9840, 9861, 9865-9867, 9869, 9871-9874, 9895-9897, 9898, 9910-9911, 9920
Chronic lymphocytic leukemia C42.0, C42.1, C42.4 with histology 9823
Chronic myeloid leukemia Histologies 9863, 9875-9876, 9945-9946
Liver / Liver and intrahepatic bile duct C22.0, C22.1
Lung C34
Adenocarcinoma / Adenocarcinoma (NSCLC) C34 with histologies 8015, 8050, 8140-1, 8143-5, 8147, 8190, 8201, 8211, 8250-5, 8260, 8290, 8310, 8320, 8323, 8333, 8401, 8440, 8470-1, 8480-1, 8490, 8503, 8507, 8550, 8570-2, 8574, 8576
Large cell carcinoma / Large cell carcinoma (NSCLC) C34 with histologies 8012-4, 8021, 8034, 8082
Small cell carcinoma C34 with histologies 8022, 8041, 8045
Squamous cell carcinoma / Squamous cell carcinoma (NSCLC) C34 with histologies 8051-2, 8070-6, 8078, 8083-4, 8090, 8094, 8120, 8123
Lymphoma All sites with histologies 9650-9667; Histologies 9590-9597, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9689-9691, 9695, 9698-9702, 9705, 9708-9709, 9714-9719, 9727-9729;

All sites other than C42.0, C42.1, C42.4 with histologies 9823, 9827
Hodgkin lymphoma All sites with histologies 9650-9667
Non-Hodgkin lymphoma (NHL) Histologies 9590-9597, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9689-9691, 9695, 9698-9702, 9705, 9708-9709, 9714-9719, 9727-9729;

All sites other than C42.0, C42.1, C42.4 with histologies 9823, 9827
NHL - extranodal All sites except C02.4, C09.8-C09.9, C11.1, C14.2, C37.9, C42.2, C77.0-C77.9 with histologies 9590-9597, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9688, 9689-9691, 9695, 9698-9702, 9705, 9708-9709, 9712, 9714-9719, 9724-9729, 9735, 9737, 9738

All sites except C02.4, C09.8-C09.9, C11.1, C14.2, C37.9, C42.0-C42.2, C42.4, C77.0-C77.9 with histologies 9811-9818, 9823, 9827, 9837
NHL - nodal C02.4, C09.8, C09.9, C11.1, C14.2, C37.9, C42.2, C77 with histologies 9590-9597, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687-9691, 9695, 9698-9702, 9705, 9708-9709, 9712, 9714-9719, 9724-9729, 9735, 9737-9738, 9811-9818, 9823, 9827, 9837
Melanoma (non-cutaneous) C00-14, C20-C21, C30-31, C51-63, C69 with histologies 8720-8774
Mucosal C00-14, C20-C21, C30-31, C51-63
Ocular C69
Melanoma of the skin C44 with histologies 8720-8790
Myeloma 9731-9732, 9734
Oral cavity and pharynx C00-C06, C09-C14
Hypopharynx C12.9, C13
Lip and oral cavity C00, C02, C03, C04, C05.0, C06
Nasopharynx C11
Oropharynx C01.9, C05.1, C05.2, C09, C10
Ovary C56.9
Pancreas C25
Prostate C61.9
Stomach C16
Testis C62
Thyroid C73.9
Anaplastic carcinoma C73.9 with histologies 8012,8020-8021,8030-8032
Follicular carcinoma C73.9 with histologies 8290, 8330-8332, 8335
Medullary thyroid carcinoma C73.9 with histologies 8345, 8346, 8510
Papillary carcinoma C73.9 with histologies 8050,8260,8340-8344
Uterine C54, C55.9
Endometrial C54, C55.9 with histologies 8050,8140,8143,8210-8211,8255,8260-8263,8310,8323,8340, 8380-8384,8441,8460-8461,8560,8570,8950-8951,8980-8981
Uterine sarcoma C54, C55.9 with histologies 8800-8802,8805,8890-8891,8896,8900,8910,8930-8931

Abbreviations: ICD-O-3 means International Classification of Disease for Oncology, Third Edition; ICD-10 means International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Notes:

  1. Histology types 9590 to 9989 (leukemias, lymphomas and hematopoietic diseases), 9050 to 9055 (mesothelioma) and 9140 (Kaposi sarcoma) are excluded from other specific organ sites.
  2. Histology types 8720 to 8774 (mucosal melanoma) are excluded from the following sites (and selected subsites): colorectal, ovary, uterine, cervix, vagina, vulva, prostate, testis, penis, oral cavity and pharynx, nasal cavity and paranasal sinuses, major salivary glands, middle ear, and eye and orbit.
Table A.5B Cancer definitions for mortality
Cancer type: short form / long form ICD-10 definition
Bladder C67
Brain and other nervous system C70-C72, C75.1-C75.3
Breast (female) C50
Cervix C53
Colorectal / Colon and rectum C18.0,C18.2-C20, C26
Esophagus C15
Hodgkin lymphoma C81
Kidney C64
Larynx C32
Leukemia C90.1, C91.0-C91.7, C91.9, C92.0-C92.4, C92.6-C92.9, C93.0-C93.3, C93.7, C93.9, C94.0-C94.5, C94.7, C95.0-C95.2, C95.7, C95.9
Liver / Liver and intrahepatic bile duct C22.0, C22.2-C22.4, C22.7, C22.9
Lung C34
Melanoma of the skin C43
Myeloma C90.0, C90.2, C90.3
Non-hodgkin lymphoma (NHL) C82-C86, C96.3
Oral cavity and pharynx C00-C06, C09-C14
Ovary C56
Pancreas C25
Prostate C61
Stomach C16
Testis C62
Thyroid C73
Uterine C54-C55

Abbreviations: ICD-O-3 means International Classification of Disease for Oncology, Third Edition; ICD-10 means International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Notes:

  1. Histology types 9590 to 9989 (leukemias, lymphomas and hematopoietic diseases), 9050 to 9055 (mesothelioma) and 9140 (Kaposi sarcoma) are excluded from other specific organ sites.
  2. Histology types 8720 to 8774 (mucosal melanoma) are excluded from the following sites (and selected subsites): colorectal, ovary, uterine, cervix, vagina, vulva, prostate, testis, penis, oral cavity and pharynx, nasal cavity and paranasal sinuses, major salivary glands, middle ear, and eye and orbit.
Table A.5C Cancer definitions for the group of all “rare cancers” (Chapter 4)
Cancer type Incidence Mortality
ICD-O-3 definition ICD-10 definition
Acute lymphocytic leukemia "Histologies 9826, 9835-9836;
C42.0, C42.1, C42.4 with histologies 9811-9818, 9837
C91.0
Acute monocytic leukemia 9891 C93.0
Acute myeloid leukemia Histologies 9840, 9861, 9865-9867, 9869, 9871-9874, 9895-9897, 9898, 9910-9911, 9920 C92.0, C92.4-C92.6, C92.8, C94.0, C94.2
Aleukemic, subleukemic and NOS "Histologies 9733, 9742, 9800, 9831, 9870, 9948, 9963-9964;
C42.0, C42.1, C42.4 with histology 9827"
C90.1, C91.5, C94.1, C94.3, C94.7, C95.1, C95.2, C95.7, C95.9
Anus, anal canal and anorectum C21.0-C21.2, C21.8 C21
Appendix C18.1 C18.1
Bones and joints C40, C41 C40, C41
Breast (male) C50 C50
Chronic lymphocytic leukemia C42.0, C42.1, C42.4 with histology 9823 C91.1
Chronic myeloid leukemia Histologies 9863, 9875-9876, 9945-9946 C92.1
Cranial Nerves Other Nervous System C71 with histologies 9530-9539; C70, C72 C70, C72
Descending Colon C18.6 C18.6
Esophagus C15 C15
Eye and orbit C69 C69
Floor of Mouth C04 C04
Gallbladder and other biliary C23.9, C24 C23, C24
Gum and Other Mouth C03, C05, C06 C03, C05, C06
Hepatic Flexure C18.3 C18.3
Hodgkin lymphoma All sites with histologies 9650-9667 C81
Hypopharynx C12.9, C13 C12, C13
Intrahepatic Bile Duct C22.1 C22.1
Kaposi sarcoma 9140 C46
Large Intestine, NOS C18.8-C18.9, C26.0 C18.8
Larynx C32 C32
Lip C00 C00
Major salivary glands C07.9, C08 C07, C08
Mesothelioma Histologies 9050-9055 C45
Middle ear C30.1 C30.1
Nasal cavity and paranasal sinuses C30.0, C31 C30, C31
Nasopharynx C11 C11
Oropharynx C10 C10
Other Acute Leukemia Histologies 9801, 9805-9809, 9931 C94.4, C94.5, C95.0
Other Digestive Organs C26.8-C26.9, C48.8 C26.8-C26.9, C48.8
Other Endocrine C74, C75 C74, C75
Other Female Genital Organs C57, C58.9 C57, C58
Other Lymphocytic Leukemia Histologies 9820, 9832-9834, 9940 C91.2-C91.4, C91.6-C91.9
Other Male Genital Organs C63 C63
Other Myeloid/Monocytic Leukemia Histologies 9860, 9930 C92.2-C92.3, C92.7, C92.9, C93.1-C93.3, C93.7, C93.9
Other Non-Epithelial Skin C44 excluding 8000-8005, 8010-8046, 8050-8084, 8090-8110, 8720-8790, 9050-9055, 9140, 9590-9992 N/A
Other Oral Cavity and Pharynx C14.0, C14.2, C14.8 C14
Other Urinary Organs C68 C68
Penis C60 C60
Peritoneum, omentum and mesentery C48.1, C48.2 C45.1, C48.1, C48.2
Pleura C38.4 C38.4, C45.0
Rectosigmoid Junction C19.9 C19
Retroperitoneum C48.0 C48.0
Salivary Gland C07.9-C08 C07-C08
Small intestine C17 C17
Soft tissue including heart C38.0, C47, C49 C38.0, C45.2, C47, C49
Splenic Flexure C18.5 C18.5
Testis C62 C62
Thymus and mediastinum C37.9, C38.1, C38.2, C38.3 C37.9, C38.1, C38.2, C38.3
Tongue C01.9-C02 C01-C02
Tonsil C09 C09
Trachea C33.9 C33
Transverse Colon C18.4 C18.4
Ureter and renal pelvis C66.9, C65.9 C65, C66
Vagina C52.9 C52
Vulva C51 C51

Abbreviations: ICD-O-3 means International Classification of Disease for Oncology, Third Edition; ICD-10 means International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Notes:

  1. Histology types 9590 to 9989 (leukemias, lymphomas and hematopoietic diseases), 9050 to 9055 (mesothelioma) and 9140 (Kaposi sarcoma) are excluded from other specific organ sites.
  2. Histology types 8720 to 8774 (mucosal melanoma) are excluded from the following sites (and selected subsites): colorectal, ovary, uterine, cervix, vagina, vulva, prostate, testis, penis, oral cavity and pharynx, nasal cavity and paranasal sinuses, major salivary glands, middle ear, and eye and orbit.
Table A.5D Cancer definitions for rare cancers categorized by selected major groupings (Chapter 4)
Cancer type Incidence Mortality
ICD-O-3 definition ICD-10 definition
Anus, anal canal and anorectum C21.0-C21.2, C21.8 C21
Appendix C18.1 C18.1
Bones and joints C40, C41 C40, C41
Breast (male) C50 C50
Eye and orbit C69 C69
Gallbladder and other biliary C23.9, C24 C23, C24
Kaposi sarcoma 9140 C46
Major salivary glands C07.9, C08 C07, C08
Mesothelioma Histologies 9050-9055 C45
Middle ear C30.1 C30.1
Nasal cavity and paranasal sinuses C30.0, C31 C30, C31
Penis C60 C60
Peritoneum, omentum and mesentery C48.1, C48.2 C45.1, C48.1, C48.2
Pleura C38.4 C38.4, C45.0
Retroperitoneum C48.0 C48.0
Small intestine C17 C17
Soft tissue including heart C38.0, C47, C49 C38.0, C45.2, C47, C49
Thymus and mediastinum C37.9, C38.1, C38.2, C38.3 C37.9, C38.1, C38.2, C38.3
Trachea C33.9 C33
Ureter and renal pelvis C66.9, C65.9 C65, C66
Vagina C52.9 C52
Vulva C51 C51

Abbreviations: ICD-O-3 means International Classification of Disease for Oncology, Third Edition; ICD-10 means International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Notes:

  1. Histology types 9590 to 9989 (leukemias, lymphomas and hematopoietic diseases), 9050 to 9055 (mesothelioma) and 9140 (Kaposi sarcoma) are excluded from other specific organ sites.
  2. Histology types 8720 to 8774 (mucosal melanoma) are excluded from the following sites (and selected subsites): colorectal, ovary, uterine, cervix, vagina, vulva, prostate, testis, penis, oral cavity and pharynx, nasal cavity and paranasal sinuses, major salivary glands, middle ear, and eye and orbit.
Table A.5E Cancer definitions for the group of all “common cancers” (Chapter 4)
Cancer type Incidence (ICD-O-3 definition) Mortality (ICD-10 definition)
Bladder C67 C67
Brain and other nervous system C71 excluding histologies 9530-9539; C75.1-C75.3 C71, C75.1-C75.3
Breast (female) C50 C50
Cervix C53 C53
Colorectal C18.0, C18.2-C20, C26.0 C18.0,C18.2-C20, C26
Kidney C64.9 C64
Liver C22.0 C22.0, C22.2-C22.4, C22.7, C22.9
Lung C34 C34
Melanoma of the skin C44 with histologies 8720-8790 C43
Myeloma 9731-9732, 9734 C90.0, C90.2, C90.3
Non-Hodgkin lymphoma (NHL) "Histologies 9590-9597, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9689-9691, 9695, 9698-9702, 9705, 9708-9709, 9714-9719, 9727-9729;

All sites other than C42.0, C42.1, C42.4 with histologies 9823, 9827
C82-C86, C96.3
Ovary C56.9 C56
Pancreas C25 C25
Prostate C61.9 C61
Stomach C16 C16
Thyroid C73.9 C73
Uterine C54, C55.9 C54-C55

Abbreviations: ICD-O-3 means International Classification of Disease for Oncology, Third Edition; ICD-10 means International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Notes:

  1. Histology types 9590 to 9989 (leukemias, lymphomas and hematopoietic diseases), 9050 to 9055 (mesothelioma) and 9140 (Kaposi sarcoma) are excluded from other specific organ sites.
  2. Histology types 8720 to 8774 (mucosal melanoma) are excluded from the following sites (and selected subsites): colorectal, ovary, uterine, cervix, vagina, vulva, prostate, testis, penis, oral cavity and pharynx, nasal cavity and paranasal sinuses, major salivary glands, middle ear, and eye and orbit.

Non-Melanoma Skin Cancer

Data in this report exclude cases of basal cell and squamous cell carcinoma of the skin, the most common types of non-melanoma skin cancer.

These tumours are generally not life-threatening and are treated in out-patient settings. Although these cases are captured in pathology reports, their large number poses a challenge for data capture and quality assurance by the Ontario Cancer Registry, a requirement for meaningful surveillance.

Cancer Stage at Diagnosis

Cancer staging is essential for quality care. Stage data are vital for:

  • evaluating the effectiveness of screening and treatment programs
  • analyzing survival
  • research into new treatments
  • resource planning for healthcare management

The tumour-node-metastasis (TNM) system is the most widely used classification system for stage at diagnosis. It is recognized as the international standard for describing the anatomic extent of cancers. TNM definitions, now in their eighth edition, are maintained by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). The stage data in this report are based on the seventh edition of TNM, which was in use at the time of cancer staging by the cancer registry.[7]

Collaborative staging is a staging approach used by central cancer registries. Collaborative Staging brings together the principles of the following:

  • National Cancer Institute (NCI)’s Surveillance, Epidemiology and End Results (SEER) Program Summary Stage
  • TNM categories and stage groupings
  • SEER Extent of Disease coding structure

Most of the collaborative staging data items have traditionally been collected by some cancer registries. These items include tumour size, extension, lymph node status and metastatic status. Other data, such as site-specific or histology-specific factors (e.g., Gleason score and receptor status), are specific to collaborative staging. The data are used to derive the “best stage” grouping consistent with the AJCC Cancer Staging Manual (in its seventh edition).[7]

Collaborative Staging values for invasive cancer range from stage 1, which means the disease is in the early phase, to stage 4, which means the cancer has spread (or metastasized) to other organs or places in the body. An “unknown stage” is the result of limited stage work-up, limited documentation in the person’s health record or both. “Not staged” means no attempt at staging has taken place.

Starting with cases diagnosed on January 1, 2005, the Ontario Cancer Registry phased in various versions of collaborative staging by reporting hospital (see the list of contributing hospitals and regional cancer centres below) and selected cancer type. Collaborative Staging was fully implemented for breast, lung, colorectal and prostate cancers in 2010; for ovarian, uterine and cervical cancers and melanoma in 2011; and for thyroid cancer in 2013. Stage data included in this report are for the diagnosis years 2010 to 2016.

Approximately 10% to 20% of breast, colorectal, lung and prostate cancer cases in the Ontario Cancer Registry are missing information on stage at diagnosis and so are excluded from this analysis. Stage at diagnosis may be missing because of inadequate supporting information in a patient’s medical record to support a definitive stage at the time of diagnosis. Stage distributions may not be the same for the cases with missing data.

Contributing facilities to activity-level reporting data used for population-level staging, Ontario

Regional cancer centres

Grand River Regional Cancer Centre
Juravinski Cancer Centre
Cancer Centre of Southeastern Ontario
R.S. McLaughin Durham Regional Cancer Centre
London Regional Cancer Program
Simcoe Muskoka Regional Cancer Centre
Stronach Regional Cancer Centre at Southlake
Northeast Cancer Centre
Odette Cancer Centre
The Ottawa Hospital Regional Cancer Centre
Regional Cancer Care Northwest
Carlo Fidani Peel Regional Cancer Centre
Princess Margaret Hospital
Windsor Regional Cancer Centre

Hospitals

Grand River Hospital
Hamilton Health Sciences
Kingston Health Sciences Centre
Lakeridge Health
London Health Sciences Centre
Royal Victoria Regional Health Centre
Southlake Regional Health Centre
Health Sciences North Sudbury
Sunnybrook Health Sciences Centre
The Ottawa Hospital
Thunder Bay Regional Health Sciences Centre
Trillium Health Partners
University Health Network
Windsor Regional Hospital
Bluewater Health
Cambridge Memorial Hospital
Grey Bruce Health Services
Halton Healthcare Services
Headwaters Health Care Centre
Humber River Regional Hospital
Mackenzie Health (formerly York Central Hospital)
Markham-Stouffville Hospital
The Scarborough Hospital
Sinai Health System
North York General Hospital
Quinte Healthcare Corporation
Rouge Valley Health System
Sault Area Hospital
St. Joseph’s Health Centre
St. Michael’s Hospital
Toronto East General Hospital
William Osler Health Centre

Coding Rules for Multiple Primary Cancers

Different rules exist to determine if a cancer is a new primary cancer or an extension of a previous cancer. Following a recent rebuild, the Ontario Cancer Registry (OCR) adopted the Surveillance, Epidemiology and End Results (SEER) Program’s rules for counting multiple primaries and assigning histology,[8] similar to other North American cancer registries.

To identify multiple primary cancers, the SEER counting rules take into account histology, site, laterality and time since the initial diagnosis. The SEER rules are more liberal than the rules previously used in the OCR  for counting multiple primaries in their definition of a new primary case.

The SEER rules for multiple primary cancers have been applied to cases in the OCR  diagnosed on or after January 1, 2010.

Cases from the years before SEER adoption (i.e., 1964 to 2009) have been imported into the new OCR from the Ontario Cancer Registry Information System (OCRIS) for continued analytic use. OCRIS applied a modified version of the International Agency for Research on Cancer/International Association of Cancer Registries (IARC/IACR) rules,[9] which are more conservative than the SEER rules. Under the IARC/IACR rules, only 1 tumour is registered for an organ, irrespective of time, unless there are histological differences.

In this report, data were converted using the IARC/IACR rules when:

  • trend analyses span both the OCR (2010 onward) and OCRIS (1983 to 2009) eras
  • comparisons are made between data from the 2 registry systems

When data are presented only from 2010 onward, the SEER rules were applied.

Given that the SEER rules are more liberal than the IARC/IACR rules, applying the SEER rules results in an increase in the number of cases included in incidence counts. This is simply a result of using a different methodology and does not reflect an actual increase in the number of people diagnosed with cancer. For 2010 to 2016 in Ontario, an average of 4.2% of new cases were considered as multiple primaries.

Starting with diagnosis year 2019, the registry adopted new SEER solid tumour rules to replace the SEER multiple primary and histology rules. In addition, a new edition of staging was used for new cancer cases diagnosed from 2018 onward. However, these changes in coding and staging systems do not affect this edition of Ontario Cancer Statistics.

Childhood cancer data

The Pediatric Oncology Group of Ontario Networked Information System (POGONIS), maintained by the Pediatric Oncology Group of Ontario (POGO) and funded by the Ontario Ministry of Health, is the data source for the 0 to 14 years age group specifically. POGONIS is a reliable, validated data source used to estimate incidence, inform policy and planning, and provide essential data for research for childhood cancer cases in Ontario.

POGONIS, like the OCR, is a dynamic database. The childhood cancer data used in this report were extracted from POGONIS in October 2019.

POGONIS is a population-based registry and database that captures detailed demographic, diagnostic, treatment and outcome information since 1985 on all children and adolescents diagnosed or treated with cancer in a specialized childhood cancer program in Ontario. Standardized POGONIS data are actively collected by dedicated data managers or clinical research associates at each of the 5 tertiary centres with specialized childhood cancer programs across Ontario. The information comes from comprehensive hospital chart review, internal hospital information systems and direct connections with patients’ healthcare teams. Death information in POGONIS is validated and supplemented via annual record linkage to the OCR and the Ontario Registrar General Death File under a data sharing agreement with Ontario Health (Cancer Care Ontario) to systematically capture deaths in the entire cohort.

POGO is also designated as a prescribed entity under the Personal Health Information Protection Act. POGO has created and operationalized detailed policies and procedures that govern all aspects of the collection, use and disclosure of personal health information, which are detailed in POGO’s Privacy and Data Security Code and its procedures.

Classification

The POGONIS database classifies childhood cancer according to the International Classification of Childhood Cancer, third edition (ICCC-3).[10] This classification divides childhood cancer into 12 main diagnostic groups and 47 subgroups for additional refinement.

The classification of each case applied in this analysis is true to the timing of the diagnosis and the associated International Classification of Diseases for Oncology (ICD-O) morphology code for that period. Because the ICCC-3 (published in 2005) does not incorporate coding changes made in the updated version of the ICD-O-3 system (ICD-O-3.1, published in 2013), POGO has incorporated changes to the ICD-O-3.1 codes into an updated ICCC classification, based on Ontario clinical and epidemiological expertise. Details of the differences in coding between POGONIS and the ICCC-3 are available in the POGO Surveillance Report.

Population data

Included in incidence, mortality and survival analyses:

  • Children diagnosed between 0 to 14 years of age and residents of Ontario, who were treated in a specialized childhood cancer program in Ontario, with a diagnosis included in the POGO updated ICCC-3 classification system

Excluded from incidence, mortality and survival analyses:

  • Children who were not residents of Ontario but were diagnosed or treated in a specialized childhood cancer program in Ontario
  • Cases not diagnosed and fully treated in a specialized childhood cancer program in Ontario

The population used in this report for age standardization for childhood cancers is the 2011 Canadian Standard population (Table A.4), which is based on the 2011 census conducted by Statistics Canada.

References

  1. Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A (2004).
  2. Marrett LT, Hatcher J. A data quality assessment protocol for Canadian cancer surveillance. Toronto: Canadian Partnership Against Cancer; 2009.
  3. Ontario Ministry of Finance [Internet]. [Toronto]: Queen’s Printer for Ontario; c2012-2018. Ontario population projections update, 2017–2041. Table 7: Total population of Ontario by five-year age group, 2017–2041 – reference scenario; [cited 2018 Jun 26]. Available from: https://www.fin.gov.on.ca/en/economy/demographics/projections/table7.html
  4. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, et al., editors. International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization; 2000.
  5. Surveillance, Epidemiology and End Results Program [Internet]. Bethesda (MD): National Cancer Institute. Site recode ICD-O-3/WHO 2008 definition; [cited 2019 Sep 26]. Available from: https://seer.cancer.gov/siterecode/icdo3_dwhoheme/
  6. International statistics classification of diseases and related health problems, tenth revision (ICD-10). 2nd ed. Geneva: World Health Organization; 2004.
  7. Edge SB, Compton CC, Fritz AG, Greene FL, Trotti A, editors; American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
  8. Johnson CH, Peace S, Adamo P, Fritz A, Percy-Laurry A, Edwards BK. Mutiple primary and histology coding rules [Internet]. Bethesda (MD): National Cancer Institute, Surveillance, Epidemiology and End Results Program; 2007 [updated 2012 Aug 24; cited 2015 Oct 15]. Available from: https://seer.cancer.gov/tools/mphrules/download.html
  9. International Agency for Research on Cancer; World Health Organization; International Association of Cancer Registries; European Network of Cancer Registries. International rules for multiple primary cancers (ICD-O). 3rd ed. Lyon, France: International Agency for Research on Cancer; 2004. Internal Report No.: 2004/02.