Current estimates and future projections
In 2020, an estimated 91,946 new cases of cancer are expected to be diagnosed in Ontario (or about 252 new cases of cancer diagnosed every day). (Chapter 1)
- The age-standardized incidence rate is estimated to be 551.8 cases per 100,000 and is higher in males (577.2 per 100,000) than females (536.0 per 100,000).
- The most commonly diagnosed cancers will be breast (11,945), followed by lung (10,592) and prostate (8,528) cancers.
- The greatest number of new cancer cases will occur in people ages 60 to 79, with this age group accounting for more than half (54.5%) of all cancers.
The number of new cancer cases will continue to increase in the future but with little change in the rate of cancer. (Chapter 3)
- As Ontario’s population grows and ages, the annual number of new cancer cases is predicted to increase by 25% in the next 10 years (or by 23,000 new cancer cases), from an estimated 91,946 cases this year to 115,306 cases in 2030.
- Starting in 2024, over 100,000 new cancer cases are expected to be diagnosed in Ontario every year.
- The increase in new cases translates to only a small increase in the overall incidence rate (from 551.8 per 100,000 in 2020 to 555.5 in 2030). This is mainly because the gap between sexes is expected to narrow, as the male incidence rate continues its ongoing decline while the female incidence rate is projected to continue to increase over time. The result of these opposing trends is that women will be as likely as men to develop cancer in the future.
- The rankings of certain cancers are predicted to change over the next decade.
- In men, non-Hodgkin lymphoma will become the fourth leading cancer, surpassing bladder cancer.
Trends over time
Cancer incidence rates in the most recent decades have decreased in men, remained stable in women and increased in children (0 to 14 years of age). (Chapter 5)
- Although long-term cancer incidence trends in adults (i.e., between 1981 and 2016) show a stable rate for men and an upward trend in women, the more recent decade shows a more positive picture.
- The overall incidence rate in adults has been decreasing by 1.1% per year between 2011 and 2016. The main reason is the decreased incidence for men (of 1.6% per year since 2007) along with the stable incidence rate for women between 2012 and 2016.
- Starting in 2013, the number of new cancer cases diagnosed each year in women has been higher than the number in men.
- After several decades of increase, the female lung cancer incidence rate appears to be reversing (showing a statistically non-significant decline of 0.8% per year since 2012). This is contributing to the now stable overall incidence rate in women.
- The downward lung cancer incidence trend is expected to continue into the future and will mirror the pattern seen in men. The male incidence rate began to decline in 2012.
- The greatest decreases in incidence rates from 1981 to 2016 were in brain, cervical, colorectal, laryngeal, bladder and stomach cancers. The greatest increases were in thyroid, liver and kidney cancers, as well as melanoma and non-Hodgkin lymphoma.
- Based on POGONIS data, the childhood cancer incidence rate has increased by an average of 0.8% per year since 1986 (to 2016). The trend in the most recent period, between 2002 and 2016, shows an increase in the incidence rate of 1.7% per year.
Approximately 1 in 2 Ontarians is expected to be diagnosed with cancer in their lifetime. The probability of developing cancer is similar for both males and females. (Chapter 5)
- Among males, the probability is highest for prostate (1 in 8), lung (1 in 12) and colorectal (1 in 14) cancers.
- Among females, the probability is highest for breast (1 in 8), lung (1 in 14) and colorectal (1 in 17) cancers.
In 2016, the median age at cancer diagnosis was 67 years for both men and women. (Chapter 5)
- Over the past decade, incidence rates have been increasing among people under age 60 and decreasing among people age 60 and older.
Lung, colorectal, breast (female) and prostate cancers were responsible for almost 50% of the 81,409 new cancer cases diagnosed in 2016. (Chapter 5)
Young women are at higher risk for certain cancers. (Chapter 5)
- Among Ontarians under the age of 40 years, women have a higher incidence rate than men for all cancers combined, mainly due to the high incidence of breast and thyroid cancers at this age.
The detection of cancers at an earlier, more favorable stage for treatment is improving over time for some common cancers but not for others. (Chapter 5)
- The stage distribution for lung cancer has improved over time, with fewer cases seen at stage 4 in 2016 (46%) compared with 2010 (57%), and more at stage 1.
- The stage distribution for cervical cancer is getting worse, with more cases seen at stage 2 than at stage 1 in 2016 (21%) compared with 2010 (9%).
Current estimates and future projections
In 2020, an estimated 30,975 deaths from cancer are expected in Ontario (or about 85 cancer deaths every day). (Chapter 2)
- The age-standardized mortality rate is estimated to be 178.0 deaths per 100,000 and is higher in males (205.0 per 100,000) than females (157.6 per 100,000).
- Almost one quarter of all cancer deaths will be due to lung cancer (7,124), followed by colorectal (3,194), pancreatic (2,152), and breast cancers (1,980).
- More than half of all cancer deaths in 2020 are expected to occur in people ages 60 to 79, and more than one third are expected to occur in people age 80 and older.
The number of cancer deaths will continue to increase in the future but the death rate will continue to decline. (Chapter 3)
- With the growing incidence of cancer, the number of cancer deaths is predicted to increase by 21% in the next 10 years (or by 6,376 deaths), from an estimated 30,975 deaths this year to 37,351 deaths in 2030.
- The cancer mortality rate is expected to continue to decrease between 2020 and 2030 (from 178.0 to 159.8 per 100,000). The ongoing declines in cancer death rates in both men and women are largely due to declines in lung cancer deaths in both sexes, and to a smaller degree, declines for breast cancer in females and colorectal cancer in both sexes.
- By 2030, lung cancer is expected to represent a smaller percentage of all cancer deaths than it did in 2020, while liver cancer will represent a slightly higher percentage than it previously did.
Trends over time
Death rates for all cancers combined continue to decrease in Ontario’s men and women but are stable in children. The decline in men and women has accelerated in recent years. (Chapter 6)
- The overall cancer death rate in Ontario peaked in 1988 and has decreased every year since then.
- Between 2002 and 2016, the death rate for men declined by 1.9% per year and for women by 1.4% per year. The declines were driven largely by lung cancer, but also by other common cancers such as breast, prostate and colorectal.
- The death rate among individuals diagnosed with cancer as children (0 to 14 years of age) has been stable from 1991 to 2016.
Approximately 1 in 4 Ontarians is expected to die of cancer. Males have a slightly greater chance of dying (27.8%) than females (23.5%). (Chapter 6)
- Among males, the probability is highest for lung (1 in 16), prostate (1 in 28) and colorectal (1 in 32) cancers.
- Among females, the probability is highest for lung (1 in 19), breast (1 in 31) and colorectal (1 in 36) cancers.
Cancer was responsible for 29.3% of all deaths in Ontario in 2016, making it the province’s leading cause of death. (Chapter 6)
- Lung, colorectal, breast and prostate cancers were responsible for almost 50% of the 29,074 cancer deaths in 2016. While pancreatic cancer is less common, it accounted for 6.5% of cancer deaths.
In 2016, the median age of cancer death was 74 years for both men and women. (Chapter 6)
- 85% of all cancer deaths in Ontario were in people 60 years of age or older.
Death rates are on the rise for certain cancers. (Chapter 6)
- Between 1981 and 2016, increases in death rates were seen for liver cancer, melanoma, thyroid cancer (men), lung cancer (women), and more recently for brain, oral cavity (men), pancreas (men) and uterine cancers.
The 5-year survival for all cancers combined has continued to improve. (Chapter 7)
- In adults, the overall 5-year relative survival ratio is now 66.4% for the 2012 to 2016 period.
- Women continue to experience higher 5-year survival than men (68.3% versus 64.3%).
- The 5-year relative survival ratio for all cancers combined decreases with advancing age at diagnosis, from 87.9% for people diagnosed between the ages of 15 and 39 to 43.3% for people diagnosed at age 80 or older.
- The overall 5-year observed survival proportion for childhood cancer has increased by 9.3 percentage points, from 76.0% in the 1987 to 1991 period to 85.3% in the 2012 to 2016 period.
There continues to be large variation in 5-year relative survival by cancer type. (Chapter 7)
- Thyroid (99.0%), testicular (96.7%) and prostate (94.2%) cancers had the highest survival, while pancreatic (11.1%), esophageal (17.4%), lung (22.2%) and liver (23.3%) cancers had the lowest.
Trends over time
The improvement in survival for all cancers is slowing over time. (Chapter 7)
- The 5-year relative survival ratio for all age groups appears to be plateauing in the most recent decade between 2002 to 2006 and 2012 to 2016.
- A 7-percentage-point increase in 5-year relative survival for all cancers combined was seen during each decade between 1982 to 1986 and 2002 to 2006. However, this gain in survival fell to only 2.5 percentage points in the next decade, between 2002 to 2006 and 2012 to 2016.
Since the period 1982 to 1986, people diagnosed between the ages of 40 and 79 have shown the greatest improvements in 5-year relative survival. (Chapter 7)
- Over the same period, there was no significant improvement in 5-year relative survival for people diagnosed at age 80 or older.
Survival was improving at a faster pace for certain cancers compared with others between 1982 and 2016. (Chapter 7)
- Compared with other cancers, the 5-year relative survival ratio improved the most for hematological cancers between 1982 to 1986 and 2012 to 2016: Leukemia survival increased by 26 percentage points and myeloma survival increased by 24 percentage points.
- The 5-year relative survival ratio has declined most for non-cutaneous melanoma (by 7.6%) and bladder cancer (by 11.1%).
Survival depends on stage at diagnosis. (Chapter 7)
- For all of the 4 most common cancers, the greatest drop in 5-year survival occurs between stage 3 and stage 4 (ranging from a 15 percentage point difference for lung cancer to 56.9 percentage points for colorectal cancer).
There are now more cancer survivors than ever before. With increasing incidence and improving survival, the prevalence of cancer cases in Ontario has also been increasing over time. (Chapter 8)
- At the beginning of 2017, there were more than a half a million cancer survivors in Ontario (an estimated 638,087) who had a cancer diagnosed in the previous 30 years. Of those, 393,785 were diagnosed in the last 10 years.
- More women than men are long-term survivors of cancer. Women with breast cancer represent the largest group of cancer survivors, accounting for 74,689 prevalent cases diagnosed in the most recent decade, between 2007 and 2016.
Trends over time
The prevalence of survivors is changing over time for some cancers. (Chapter 8)
- Of people diagnosed with cancer in the previous 10 years, those diagnosed with liver and thyroid cancers were more likely to still be alive in 1996 and 2016 than those diagnosed with other cancers.
- The 10-year survival rates for liver and thyroid cancers increased between 1996 and 2016.
Approximately 1 in 5 new cases and deaths in Ontario are from rare cancers. (Chapter 4)
- Rare cancers represent approximately 20% of all new cancer cases each year (or 36,626 new cases in 2012 to 2016).
- Rare cancers represent approximately 23% of all cancer deaths each year (or 31,800 deaths in 2012 to 2016).
Among the major rare cancers, the leading causes of death were soft tissue (including the heart) followed by gallbladder and other biliary organs, and mesothelioma. (Chapter 4)
Trends over time
As with common cancers, the incidence rate of rare cancers is decreasing over time but at a lower rate. (Chapter 4)
- The age-standardized incidence rate of rare cancers began declining earlier and at a lower rate (0.8% per year since 1999) than the rate of common cancers (1.4% per year since 2011).
- The decline in rare cancers mainly reflects a decrease among males, as the female incidence rate has been stable since 2008.
The death rate of rare cancers is decreasing. (Chapter 4)
- Between 2002 and 2016, the age-standardized mortality rate of rare cancers decreased by 1.1% per year, similar to common cancers.
Rare-cancer patients tend to be younger. (Chapter 4)
- Between 2012 and 2016, people diagnosed with rare cancers were almost 3 times more likely to be 15 to 39 years old than those diagnosed with a common cancer.
The survival for rare cancers is worse than for common cancers, and little improvement has occurred over time. (Chapter 4)
- The overall 5-year relative survival ratio was significantly lower for rare cancers (56.6%) than for the common cancers (68.8%).
- Only 4 of the 23 selected rare cancers showed an increase in 5-year survival between the periods 1981 to 1985 and 2012 to 2016: gallbladder & other biliary, retroperitoneum, small intestine, and thymus and mediastinum.
There are few survivors of rare cancers. (Chapter 4)
- Given their low incidence and poor survival, prevalence for rare cancers is also low. Of Ontario cancer survivors still alive at the beginning of 2017 who were diagnosed in the previous 10 years, only 70,410 were survivors of rare cancers compared with 330,788 survivors of common cancers.
More work is needed to address the burden of rare cancers. (Chapter 4)
- Rare cancers are diverse and therefore can be difficult to track because they are less likely to be recognized.
- Based on findings from other jurisdictions, rare cancers lack well-established approaches to prevention, spending on drugs, research, and the organization of care and social support for patients.