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Statistical Reports

Ch 6: Cancer mortality rates and trends

Data Type:
Publication Series: Under Review
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Ontario Cancer Statistics 2020 Ch 6: Cancer Mortality Rates and Trends

Mortality measures the number of deaths caused by cancer. This chapter presents actual (non-projected) cancer mortality rates and trends over time. These statistics are based on counts complete as of 2016 – the latest available year.

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Cancer as a Leading Cause of Death

In 2016, cancer caused 29.3% of all deaths in Ontario, making it the province’s leading cause of death (Figure 6.1).[1] Cancer caused almost as many deaths as the next 3 leading causes of death combined: diseases of the heart, cerebrovascular diseases and accidents.

Notes: ICD-10 codes for causes of death: chronic lower respiratory diseases [J40-J47]; accidents (unintentional injuries) [V01-X59, Y85-Y86]; cerebrovascular diseases [I60-I69]; diseases of heart [I00-I09, I11, I13, I20-I51]; cancer (malignant neoplasms) [C00-C97]
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Leading causes of death: Statistics Canada. Table 13-10-0801-01 Leading causes of death, total population (age standardization using 2011 population)

Data for Figure 6.1 Leading causes of death, Ontario, 2016
CAUSE OF DEATHS Number of deaths PERCENTAGE OF DEATHS
All other causes 36651 36.9%
Cancer (malignant neoplasms) 29139 29.3%
Diseases of heart 19290 19.4%
Cerebrovascular diseases 5123 5.2%
Accidents (unintentional injuries) 5073 5.1%
Chronic lower respiratory diseases 4143 4.2%

Notes: ICD-10 codes for causes of death were as follows: Chronic lower respiratory diseases [J40-J47]; Accidents (unintentional injuries) [V01-X59, Y85-Y86]; Cerebrovascular
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Leading causes of death: Statistics Canada. Table 13-10-0801-01 Leading causes of death, total population (age standardization using 2011 population)

Probability of Dying From Cancer

The probability of dying from cancer represents the average chance of death due to cancer. This probability depends on many factors:

  • population characteristics (e.g., demographics)
  • prevalence of risk factors (e.g., smoking, obesity)
  • current life expectancy
  • treatment options available

These probabilities also reflect the average risks for the overall population and do not take into account personal risk. In other words, an individual’s risk may be higher or lower than the numbers reported here.

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In Ontario, 1 in 4, or 25.5% of people, will die from cancer (Table 6.1). Males have a greater chance of dying from cancer, at slightly more than 1 in 4 (27.8%), compared with females, at 1 in 4 (23.5%).

As with the chance of developing cancer, the probability of dying from cancer varies based on cancer type:

  • 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.
Table 6.1 Lifetime probability of dying of cancer, by cancer type and sex, Ontario, 2013 to 2016
Cancer type Both sexes Males Females
% 1 in % 1 in % 1 in
All cancers 25.5% 4 27.8% 4 23.5% 4
Bladder 0.9% 115 1.3% 75 0.5% 209
Brain 0.6% 171 0.7% 151 0.5% 194
Breast (female) 3.2% 31 n/a n/a 3.2% 31
Cervix 0.2% 455 n/a n/a 0.2% 455
Colorectal 3.0% 34 3.2% 32 2.8% 36
Esophagus 0.6% 164 0.9% 106 0.3% 328
Hodgkin lymphoma 0.0% 2639 0.0% 2165 0.0% 3322
Kidney 0.6% 181 0.7% 140 0.4% 250
Larynx 0.1% 909 0.2% 544 0.0% 2350
Leukemia 1.0% 101 1.2% 84 0.8% 124
Liver 0.9% 109 1.2% 86 0.7% 144
Lung 5.9% 17 6.5% 16 5.4% 19
Melanoma 0.4% 230 0.6% 167 0.3% 349
Myeloma 0.5% 196 0.6% 169 0.4% 229
Non-Hodgkin lymphoma 1.0% 101 1.1% 91 0.9% 112
Oral cavity & pharynx 0.4% 251 0.6% 182 0.3% 395
Ovary 1.1% 93 n/a n/a 1.1% 93
Pancreas 1.6% 64 1.6% 63 1.5% 65
Prostate 3.6% 28 3.6% 28 n/a n/a
Stomach 0.7% 153 0.8% 121 0.5% 199
Testis 0.0% 7070 0.0% 7070 n/a n/a
Thyroid 0.1% 1248 0.1% 1454 0.1% 1109
Uterus 0.7% 135 n/a n/a 0.7% 135

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

Mortality by Sex and Cancer Type

In 2016, 29,074 people died from cancer in Ontario, for an age-standardized mortality rate (ASMR) of 190.0 per 100,000 (Table 6.2).

The 4 most commonly diagnosed cancers (lung, colorectal, breast and prostate) were responsible for almost 50% of all cancer deaths in 2016.

The 4 most commonly diagnosed cancers (lung, colorectal, breast and prostate) were responsible for almost 50% of all cancer deaths in 2016. Lung, colorectal and prostate cancers accounted for 44% of all male cancer deaths, while lung, breast and colorectal cancers accounted for 49% of all female cancer deaths (Figure 6.2).

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 6.2 Proportion of cancer deaths by sex and cancer type, Ontario, 2016
  Males (%) Females (%)
Lung 23.1 23.7
Breast (female) n/a 14.6
Colorectal 11.0 10.4
Prostate 10.4 n/a
Pancreas 6.6 6.4
Liver 4.9 3.0
Ovary n/a 4.8
Uterus n/a 3.5
Leukemia 4.2 3.3
Bladder 4.1 1.8
Esophagus 3.9 1.3
Non-Hodgkin lymphoma 3.6 3.4
Stomach 3.2 2.0
Brain 3.2 2.6
Oral cavity & pharynx 2.5 1.2
Kidney 2.4 1.5
Melanoma 2.2 1.3
Myeloma 2.1 1.8
Cervix n/a 1.2
Larynx 0.7 0.2
Thyroid 0.3 0.4
Hodgkin lymphoma 0.2 0.1
Testis 0.1 n/a
All other types 11.4 11.5

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

Distribution of deaths, selected cancers, 2016: bladder at 3.0%, brain at 2.9%, female breast at 7.0%, colorectal at 10.7%, leukemia at 3.8%, lung at 23.4%, prostate at 5.4%

Some of the less commonly diagnosed cancers made a relatively large contribution to mortality because of their poor prognosis. For example, pancreatic cancer accounted for 6.5% of all cancer deaths in 2016 — more than prostate cancer and almost as much as breast cancer (Table 6.2).

The highest ASMR for cancers occurring in both sexes combined were for lung (44.2 per 100,000), colorectal (20.3 per 100,000) and pancreatic (12.3 per 100,000) cancers.

The ASMR for all cancers combined was significantly higher for males (224.4 per 100,000) than females (165.5 per 100,000). Among males, the highest ASMR was for lung (50.8 per 100,000), followed by colorectal (25.0 per 100,000) and prostate (24.4 per 100,000) cancers. For females, the highest ASMR was for lung (39.3 per 100,000), followed by breast (24.9 per 100,000) and colorectal (16.6 per 100,000) cancers.

Males had a consistently higher mortality rate than females for each type of cancer except thyroid. Thyroid cancer mortality rates were the same for both sexes.

The greatest differences between male and female mortality rates were seen in:

  • Hodgkin lymphoma, for which the male rate was 5 times the female rate
  • laryngeal cancer, for which the male rate was almost 5 times the female rate
  • esophageal cancer, for which the male rate was 4 times the female rate
  • bladder cancer, for which the male rate was over 3 times the female rate
  • oral cavity and pharynx cancer, for which the male rate was close to 3 times the female rate

Males with Hodgkin lymphoma have generally poorer prognoses than females.[2] This may be because of biological differences between the sexes that affect how the disease progresses.[3] Tobacco use is a major risk factor for the remaining 4 cancers (laryngeal, esophageal, bladder, and oral cavity and pharynx). The higher mortality rates in males likely result from their historically higher rates of tobacco use.[4]

Table 6.2 Mortality counts and rates, by cancer type and sex, Ontario, 2016
Cancer type Both sexes Males Females
Deaths % of deaths Crude rate ASMR† ASMR 95% CI Deaths % of deaths Crude rate ASMR† ASMR 95% CI Deaths % of deaths Crude rate ASMR† ASMR 95% CI
All cancers 29,074 100.0% 208.0 190.0 187.8 - 192.2 15,136 100.0% 220.4 224.4 220.8 - 228.0 13,938 100.0% 196.1 165.5 162.8 - 168.3
Bladder 876 3.0% 6.3 5.6 5.3 - 6.0 626 4.1% 9.1 9.6 8.9 - 10.4 250 1.8% 3.5 2.8 2.4 - 3.1
Brain 838 2.9% 6.0 5.6 5.3 - 6.0 480 3.2% 7.0 6.9 6.3 - 7.6 358 2.6% 5.0 4.5 4.1 - 5.0
Breast (female) 2,039 7.0% 28.7 24.9 23.8 - 26.0 n/a n/a n/a n/a n/a 2,039 14.6% 28.7 24.9 23.8 - 26.0
Cervix 172 0.6% 2.4 2.3 1.9 - 2.6 n/a n/a n/a n/a n/a 172 1.2% 2.4 2.3 1.9 - 2.6
Colorectal 3,124 10.7% 22.4 20.3 19.6 - 21.1 1,670 11.0% 24.3 25.0 23.8 - 26.2 1,454 10.4% 20.5 16.6 15.8 - 17.5
Esophagus 779 2.7% 5.6 5.1 4.7 - 5.4 595 3.9% 8.7 8.5 7.9 - 9.3 184 1.3% 2.6 2.1 1.8 - 2.5
Hodgkin lymphoma 43 0.1% 0.3 0.3 0.2 - 0.4 31 0.2% 0.5 0.5 0.3 - 0.6 12 0.1% 0.2 0.1 0.1 - 0.2
Kidney 573 2.0% 4.1 3.7 3.4 - 4.1 365 2.4% 5.3 5.4 4.8 - 6.0 208 1.5% 2.9 2.4 2.1 - 2.8
Larynx 127 0.4% 0.9 0.8 0.7 - 1.0 99 0.7% 1.4 1.4 1.2 - 1.7 28 0.2% 0.4 0.3 0.2 - 0.5
Leukemia 1,095 3.8% 7.8 7.2 6.8 - 7.6 633 4.2% 9.2 9.4 8.7 - 10.2 462 3.3% 6.5 5.5 5.0 - 6.0
Liver 1,161 4.0% 8.3 7.6 7.2 - 8.1 747 4.9% 10.9 10.9 10.1 - 11.7 414 3.0% 5.8 4.9 4.4 - 5.4
Lung 6,794 23.4% 48.6 44.2 43.2 - 45.3 3,494 23.1% 50.9 50.8 49.2 - 52.6 3,300 23.7% 46.4 39.3 38.0 - 40.7
Melanoma 512 1.8% 3.7 3.4 3.1 - 3.7 337 2.2% 4.9 5.0 4.5 - 5.6 175 1.3% 2.5 2.1 1.8 - 2.5
Myeloma 568 2.0% 4.1 3.7 3.4 - 4.0 311 2.1% 4.5 4.6 4.1 - 5.1 257 1.8% 3.6 3.0 2.7 - 3.4
Non-Hodgkin lymphoma 1,007 3.5% 7.2 6.6 6.2 - 7.0 539 3.6% 7.8 8.0 7.3 - 8.7 468 3.4% 6.6 5.5 5.0 - 6.0
Oral cavity & pharynx 548 1.9% 3.9 3.6 3.3 - 3.9 374 2.5% 5.4 5.4 4.8 - 6.0 174 1.2% 2.4 2.0 1.7 - 2.4
Ovary 675 2.3% 9.5 8.3 7.7 - 8.9 n/a n/a n/a n/a n/a 675 4.8% 9.5 8.3 7.7 - 8.9
Pancreas 1,880 6.5% 13.5 12.3 11.7 - 12.8 994 6.6% 14.5 14.5 13.6 - 15.4 886 6.4% 12.5 10.4 9.7 - 11.1
Prostate 1,568 5.4% 22.8 24.4 23.2 - 25.7 1,568 10.4% 22.8 24.4 23.2 - 25.7 n/a n/a n/a n/a n/a
Stomach 764 2.6% 5.5 5.0 4.7 - 5.4 487 3.2% 7.1 7.2 6.6 - 7.9 277 2.0% 3.9 3.3 3.0 - 3.8
Testis 15 0.1% 0.2 0.2 0.1 - 0.4 15 0.1% 0.2 0.2 0.1 - 0.4 n/a n/a n/a n/a n/a
Thyroid 93 0.3% 0.7 0.6 0.5 - 0.8 39 0.3% 0.6 0.6 0.4 - 0.8 54 0.4% 0.8 0.6 0.5 - 0.8
Uterus 494 1.7% 7.0 6.0 5.5 - 6.5 n/a n/a n/a n/a n/a 494 3.5% 7.0 6.0 5.5 - 6.5

Abbreviations: ASMR means age-standardized mortality rate; CI means confidence interval.
Symbol: †Rates standardized to the 2011 Canadian population.
Note: Rates are per 100,000.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Mortality by Age

Between 2014 and 2016, the median age at death for all cancers was 74 years for both males and females (Table 6.3). The median age at death varied by cancer type. Cancers with the lowest median age at death (under 60 years) were testicular and cervical. The median age for most other cancer types were above age 70.

In 2016, the median age of cancer death was 74 years.

Table 6.3 Median age at death, by cancer type and sex, Ontario, 2014 to 2016
Cancer type Age (years)
Both sexes Males Females
All cancers 74 74 74
Bladder 81 80 82
Brain 65 64 67
Breast (female) 71 n/a 71
Cervix 59 n/a 59
Colorectal 77 75 79
Esophagus 71 70 74
Hodgkin lymphoma 72 69 75
Kidney 74 72 78
Larynx 74 73 76
Leukemia 76 76 77
Liver 72 70 74
Lung 73 73 73
Melanoma 73 73 72
Myeloma 76 75 77
Non-Hodgkin lymphoma 76 74 77
Oral cavity & pharynx 69 67 73
Ovary 71 57 71
Pancreas 73 71 76
Prostate 82 82 n/a
Stomach 73 73 75
Testis 39 39 n/a
Thyroid 74 73 76
Uterus 71 n/a 71

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

In 2016, 85% of all people in Ontario who died of cancer were 60 years of age or older (Table 6.4). Mortality was distributed differently by age group.

Distribution of cancer deaths by age group: Age 0 to 39 at 1.4%, 40 to 59 at 13.6%, 60 to 79 at 49.3%, 80 and older at 35.6%

Ages 0 to 39

People younger than 40 years of age made up 1.4% of all cancer deaths (compared with 5.0% of all new cases), with brain cancer and leukemia as the leading causes.

In 2016, 0.3% of all cancer deaths occurred in individuals diagnosed with cancer as children (0 to 14 years of age). From 2012 to 2016, the majority of deaths in individuals diagnosed with cancer as children occurred in those with:

  • CNS and miscellaneous intracranial and intraspinal neoplasms (35.8%)
  • leukemias, myeloproliferative diseases and myelodysplastic diseases (24.4%)

For more information, please visit the POGO Surveillance Report.

Ages 40 to 59

People 40 to 59 years of age made up 13.6% of all cancer deaths (compared with 23.5% of all new cases), with breast and lung cancers as the leading causes.

Ages 60 to 79

People 60 to 79 years of age made up 49.3% of all cancer deaths (compared with 52.1% of all new cases).

This age group represented the greatest proportion of cancer deaths for 19 of the 23 types of cancer examined. The greatest proportions of deaths were from breast (43.5%) and lung (58.6%) cancers in this age group.

Ages 80 and older

People 80 years of age or older made up 35.6% of all cancer deaths (compared with 18.9% of all new cases), with lung and colorectal cancers as the leading causes.

While prostate cancer was diagnosed most frequently in males ages 60 to 79, most deaths caused by prostate cancer were in males 80 years or older. This reflects both the often slow progression of the disease and the higher frequency of later stage cancers in older males.

Cancer mortality increased significantly with age – from a rate of 6.1 per 100,000 in people age 39 or younger, to a rate of 1,719.0 per 100,000 in people age 80 or older (Table 6.4). Mortality varied by cancer type:

  • Significant increases with age for cancers of the bladder, breast, colorectal, kidney, pancreas, stomach and thyroid, as well as leukemia, melanoma, myeloma, Hodgkin lymphoma and non-Hodgkin lymphoma.
  • Non-significant increases with age for cancers of the brain, cervix, esophagus, larynx, liver, lung, oral cavity & pharynx, ovary, prostate and uterus.
  • Testicular cancer was highest in those ages 40 to 59.
Table 6.4 Mortality counts and rates, by cancer type and age group, Ontario, 2016
Cancer type Ages 0 - 39 years Ages 40 - 59 years Ages 60 - 79 years Ages 80 years or older
Deaths Age-specific rate 95 % CI Deaths Age-specific rate 95 % CI Deaths Age-specific rate 95 % CI Deaths Age-specific rate 95 % CI
All cancers* 421 6.1 5.6 - 6.7 3,958 100.1 97.0 - 103.3 14,335 562.2 553.0 - 571.4 10,360 1719.0 1,686.1 - 1,752.5
Bladder* ** ** ** 52 1.3 1.0 - 1.7 348 13.6 12.3 - 15.2 473 78.5 71.6 - 85.9
Brain 50 0.7 0.5 - 1.0 231 5.8 5.1 - 6.6 416 16.3 14.8 - 18.0 141 23.4 19.7 - 27.6
Breast (female)* 50 1.5 1.1 - 1.9 464 23.2 21.2 - 25.4 887 66.3 62.0 - 70.8 638 174.1 160.9 - 188.2
Cervix 17 0.5 0.3 - 0.8 68 3.4 2.6 - 4.3 52 3.9 2.9 - 5.1 35 9.6 6.7 - 13.3
Colorectal* 38 0.6 0.4 - 0.8 397 10.0 9.1 - 11.1 1,336 52.4 49.6 - 55.3 1,353 224.5 212.7 - 236.8
Esophagus 11 0.2 0.1 - 0.3 131 3.3 2.8 - 3.9 446 17.5 15.9 - 19.2 191 31.7 27.4 - 36.5
Hodgkin lymphoma* ** ** ** ** ** ** 23 0.9 0.6 - 1.4 12 2.0 1.0 - 3.5
Kidney* 7 0.1 0.0 - 0.2 65 1.6 1.3 - 2.1 284 11.1 9.9 - 12.5 217 36.0 31.4 - 41.1
Larynx 0 0.0 0.0 - 0.1 15 0.4 0.2 - 0.6 80 3.1 2.5 - 3.9 32 5.3 3.6 - 7.5
Leukemia* 53 0.8 0.6 - 1.0 110 2.8 2.3 - 3.4 498 19.5 17.9 - 21.3 434 72.0 65.4 - 79.1
Liver 13 0.2 0.1 - 0.3 181 4.6 3.9 - 5.3 639 25.1 23.2 - 27.1 328 54.4 48.7 - 60.6
Lung 12 0.2 0.1 - 0.3 796 20.1 18.8 - 21.6 3,978 156.0 151.2 - 160.9 2,008 333.2 318.8 - 348.1
Melanoma* 12 0.2 0.1 - 0.3 84 2.1 1.7 - 2.6 243 9.5 8.4 - 10.8 173 28.7 24.6 - 33.3
Myeloma* ** ** ** 50† 1.3 0.9 - 1.7 296 11.6 10.3 - 13.0 219 36.3 31.7 - 41.5
Non-Hodgkin lymphoma* 20 0.3 0.2 - 0.4 117 3.0 2.4 - 3.5 486 19.1 17.4 - 20.8 384 63.7 57.5 - 70.4
Oral cavity and pharynx ** ** ** 110† 2.8 2.3 - 3.3 290 11.4 10.1 - 12.8 147 24.4 20.6 - 28.7
Ovary 13 0.4 0.2 - 0.7 136 6.8 5.7 - 8.1 359 26.8 24.1 - 29.8 167 45.6 38.9 - 53.0
Pancreas* 6 0.1 0.0 - 0.2 272 6.9 6.1 - 7.7 987 38.7 36.3 - 41.2 615 102.0 94.1 - 110.4
Prostate ** ** ** 50† 2.5 1.9 - 3.4 582 48.0 44.2 - 52.1 934 395.3 370.4 - 421.5
Stomach* 15 0.2 0.1 - 0.4 127 3.2 2.7 - 3.8 369 14.5 13.0 - 16.0 253 42.0 37.0 - 47.5
Testis 6 0.2 0.1 - 0.4 7 0.4 0.1 - 0.7 ** ** ** ** ** **
Thyroid* ** ** ** 20† 0.5 0.3 - 0.8 37 1.5 1.0 - 2.0 35 5.8 4.0 - 8.1
Uterus ** ** ** 85† 4.2 3.4 - 5.2 258 19.3 17.0 - 21.8 147 40.1 33.9 - 47.2

Abbreviation: CI means confidence interval.

Symbols:

  • *Significant increasing trend in age-specific rate with increasing age.
  • **Suppressed due to small case count (count less than 6).
  • †Count has been rounded to ensure confidentiality; associated rate and confidence interval have been adjusted to reflect rounded count

Notes:

  1. Rates are per 100,000.
  2. Excludes cases of unknown age.

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

The cancer mortality rate for all cancers combined in Ontario has been decreasing over the past few decades, with the decline accelerating in recent years. Between 1985 and 2001, the age-standardized mortality rate (ASMR) decreased by 0.5% per year and fell a further 1.6% per year between 2001 and 2016 (Table 6.5).

Generally, the declines in mortality have been greater for males than females. For males, the mortality rate declined by 1.0% per year between 1988 and 2002, and then by 1.9% per year between 2002 and 2016. For females, the rate declined by 0.3% per year between 1985 and 2002, and then declined by 1.4% per year between 2002 and 2016. The following section examines some of the reasons for these changes.

Recent mortality trends for the 4 most common cancers

Prostate cancer

The prostate cancer ASMR decreased by 2.9% per year from 1994 to 2016 (Table 6.5). This decline is likely due to early detection, which decreased incidence, and to improved treatments -that increased survival from prostate cancer.

Breast cancer

The ASMR for breast cancer decreased by 2.4% per year from 1994 to 2016 (Table 6.5). This is likely because of:

  • greater regular participation in mammography screening, especially after the introduction of Ontario’s organized breast screening program[5,6]
  • improved primary treatment[7,8]
  • the use of more effective chemotherapies following breast cancer surgery[7,8]

Colorectal cancer

The colorectal cancer ASMR has consistently declined in both sexes since 1981 (Table 6.5). In males, the mortality rate declined 3.4% per year from 2005 to 2016. The rate decreased similarly among females by 2.7% per year from 2004 onward.

Reasons for these strong declines may be changes in risk and protective factors, earlier diagnosis due to greater uptake of screening, and improvements in treatment.[9]

Lung cancer

In males, the ASMR for lung cancer declined by 2.2% per year from 1988 to 2012, followed by a steeper decline of 4.2% from 2012 onward (Table 6.5). Among females, the mortality rate was stable from 1999 until 2008 then began a decrease of 1.4% per year onward.

Decreases in lung cancer mortality are largely attributable to decreased tobacco use, which began to decline in the late 1950s for males and in the mid-1970s for females.[4,10] This approximately 15-year gap in peak smoking rates between males and females corresponds to the gap in the stabilization of lung cancer mortality rates between the sexes.

Notable changes in trend for other cancers

Liver cancer

The liver cancer ASMR has been increasing at 2.4% per year from 1994 onward, following a previous rapid upward trend in the mortality rate (Table 6.5). This increase was probably at least partially because of the rise in the incidence rate over the same period.

Ovarian cancer

The ASMR for ovarian cancer was stable from 2003 to 2007 followed by a significant decline of 1.0% per year from 2007 onward (Table 6.5). This parallels the decrease in the ovarian cancer incidence rate since 2002.

Declines in ovarian cancer incidence and mortality likely result from changes in exposure to risk and protective factors, including the increasing use of oral contraceptives.[11] Declines in mortality may also reflect increasing survival due to improvements in treatment.[12]

Stomach cancer

The stomach cancer ASMR decreased by 3.6% per year until 1993, then by 2.3% per year from 1993 onward (Table 6.5).

Reasons for this decline include decreased exposure to Helicobacter pylori (H.pylori) infection, improvements in food preservation and refrigeration, lifestyle changes, and better treatment.[13]

Table 6.5A (Both sexes) Annual percent change in age-standardized mortality rates by cancer type and sex, Ontario, 1981 to 2016
Cancer type Both sexes
Period APC (%)
All cancers 1981 - 1985 1.1*
1985 - 2001 -0.5*
2001 - 2016 -1.6*
Bladder 1981 - 1996 -1.6*
1996 - 2000 2.6
2000 - 2016 -0.8*
Brain 1981 - 2006 -1.0*
2006 - 2010 4.3
2010 - 2016 -0.6
Breast (female) n/a n/a
n/a n/a
n/a n/a
Cervix n/a n/a
n/a n/a
Colorectal 1981 - 2004 -1.4*
2004 - 2016 -3.0*
Esophagus 1981 - 2000 0.7*
2000 - 2016 -0.8*
Hodgkin lymphoma 1981 - 1990 -6.7*
1990 - 2016 -2.9*
Kidney 1981 - 2008 0.0
2008 - 2016 -1.9*
Larynx 1981 - 2000 -1.3*
2000 - 2016 -4.7*
Leukemia 1981 - 2016 -0.8*
Liver 1981 - 1994 4.2*
1994 - 2016 2.4*
Lung 1981 - 1988 1.7*
1988 - 2010 -0.9*
2010 - 2016 -2.8*
Melanoma 1981 - 2016 0.9*
Myeloma 1981 - 1999 0.5
1999 - 2016 -1.4*
Non-Hodgkin lymphoma 1981 - 1999 2.0*
1999 - 2016 -2.1*
Oral cavity & pharynx 1981 - 2009 -1.8*
2009 - 2016 1.7
Ovary n/a n/a
Pancreas 1981 - 2006 -0.7*
2006 - 2016 0.8*
Prostate n/a n/a
Stomach 1981 - 1993 -3.6*
1993 - 2016 -2.3*
Testis n/a n/a
Thyroid 1981 - 2016 -0.3
Uterus n/a n/a
Table 6.5B (Males) Annual percent change in age-standardized mortality rates by cancer type and sex, Ontario, 1981 to 2016
Cancer type Males
Period APC (%)
All cancers 1981 - 1988 0.5*
1988 - 2002 -1.0*
2002 - 2016 -1.9*
Bladder 1981 - 2016 -0.7*
Brain 1981 - 1997 -1.5*
1997 - 2016 0.6*
Breast (female) n/a n/a
Cervix n/a n/a
Colorectal 1981 - 2005 -1.3*
2005 - 2016 -3.4*
Esophagus 1981 - 2009 0.4*
2009 - 2016 -1.9
Hodgkin lymphoma 1981 - 1990 -7.9*
1990 - 2016 -2.9*
Kidney 1981 - 2006 0.1
2006 - 2016 -1.5*
Larynx 1981 - 2001 -1.4*
2001 - 2016 -5.2*
Leukemia 1981 - 1996 0.0
1996 - 2016 -1.3*
Liver 1981 - 1995 4.7*
1995 - 2016 2.2*
Lung 1981 - 1988 0.4
1988 - 2012 -2.2*
2012 - 2016 -4.2*
Melanoma 1981 - 2016 1.2*
Myeloma 1981 - 1996 0.6
1996 - 2016 -1.1*
Non-Hodgkin lymphoma 1981 - 2000 1.9*
2000 - 2016 -2.1*
Oral cavity & pharynx 1981 - 2008 -2.2*
2008 - 2016 1.7
Ovary n/a n/a
Pancreas 1981 - 2005 -1.2*
2005 - 2016 1.0*
Prostate 1981 - 1994 1.7*
1994 - 2016 -2.9*
Stomach 1981 - 2016 -2.8*
Testis 1981 - 2016 -2.9*
Thyroid 1981 - 2016 0.8*
Uterus n/a n/a
Table 6.5C (Females) Annual percent change in age-standardized mortality rates by cancer type and sex, Ontario, 1981 to 2016
Cancer type Females
Period APC (%)
All cancers 1981 - 1985 1.0
1985 - 2002 -0.3*
2002 - 2016 -1.4*
Bladder 1981 - 1997 -1.5*
1997 - 2004 2.3
2004 - 2016 -1.9*
Brain 1981 - 2006 -1.0*
2006 - 2016 2.0*
Breast (female) 1981 - 1986 1.3
1986 - 1994 -1.0*
1994 - 2016 -2.4*
Cervix 1981 - 2002 -3.5*
2002 - 2016 -1.4*
Colorectal 1981 - 2004 -1.8*
2004 - 2016 -2.7*
Esophagus 1981 - 1995 0.6
1995 - 2016 -1.4*
Hodgkin lymphoma 1981 - 2016 -3.3*
Kidney 1981 - 2010 -0.2
2010 - 2016 -3.5*
Larynx 1981 - 2016 -2.7*
Leukemia 1981 - 2016 -0.9*
Liver 1981 - 2016 2.6*
Lung 1981 - 1985 7.4*
1985 - 1999 1.9*
1999 - 2008 0.1
2008 - 2016 -1.4*
Melanoma 1981 - 2016 0.4*
Myeloma 1981 - 1999 0.6
1999 - 2016 -1.9*
Non-Hodgkin lymphoma 1981 - 1998 2.1*
1998 - 2016 -2.2*
Oral cavity & pharynx 1981 - 2016 -1.3*
Ovary 1981 - 1999 -0.8*
1999 - 2003 2.2
2003 - 2007 -4.7
2007 - 2016 -1.0*
Pancreas 1981 - 2016 -0.1
Prostate n/a n/a
Stomach 1981 - 1993 -4.2*
1993 - 2016 -2.0*
Testis n/a n/a
Thyroid 1981 - 2016 -0.8*
Uterus 1981 - 1993 -1.8*
1993 - 2016 1.2*

Abbreviation: APC means annual percent change

Notes:

  1. Statistically significant changes in trend and their direction are indicated by corresponding arrows.
  2. Rates are standardized to 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)

Thirty-Five Year Trend in Mortality

Over the most recent 35-year period of 1981 to 2016, the average annual percent change (AAPC) in the age-standardized mortality rate (ASMR) for males (Figure 6.3):

  • decreased for most types of cancer, including Hodgkin lymphoma (4.2% per year), laryngeal cancer (3.1%) and testicular cancer (2.9%)
  • increased for liver cancer (3.2%), melanoma (1.2%) and thyroid cancer (0.8% per year)
  • was stable for brain, kidney and esophageal cancers, as well as myeloma and non-Hodgkin lymphoma

null

Over the same period, the AAPC in the ASMR for females:

  • decreased for most types of cancer, including Hodgkin lymphoma (3.3% per year), and cervical (2.7%) and laryngeal (2.7%) cancers
  • increased for liver (2.6%) and lung (1.3%) cancers, and melanoma (0.4%)
  • was stable for pancreatic, brain and uterine cancers, and non-Hodgkin lymphoma

null

For some cancers, such as liver cancer and melanoma, the increases in mortality rates likely reflect increases in incidence rates.

Abbreviation: AAPC means average annual percent change.

Note:

  1. Rates are standardized to the age distribution of the 2011 Canadian population.
  2. The AAPCs for the following cancer types were not statistically significant among males: brain, kidney, myeloma, esophagus and non-Hodgkin lymphoma.
  3. The AAPCs for the following cancer types were not statistically significant among females: pancreas, brain, non-Hodgkin lymphoma and uterus.

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 6.3 Average annual percent change in age-standardized mortality rates by cancer type and sex, Ontario, 1981 to 2016
  Male Female
Liver 3.2 2.6
Melanoma 1.2 0.4
Thyroid 0.8 -0.8
Uterus n/a 0.1
Non-Hodgkin lymphoma 0 -0.1
Esophagus -0.1 -0.6
Myeloma -0.4 -0.6
Kidney -0.4 -0.8
Brain -0.4 -0.2
Pancreas -0.5 -0.1
Bladder -0.7 -0.9
Leukemia -0.8 -0.9
Ovary n/a -1
All cancers -1.1 -0.6
Prostate -1.2 n/a
Oral cavity & pharynx -1.3 -1.3
Breast (female) n/a -1.6
Lung -1.9 1.3
Colorectal -2 -2.1
Cervix n/a -2.7
Stomach -2.8 -2.7
Testis -2.9 n/a
Larynx -3.1 -2.7
Hodgkin lymphoma -4.2 -3.3

Abbreviation: AAPC means average annual percent change.
Symbol: *Statistically significant AAPC.
Note: Rates are 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)

The ASMR for the 1981 to 2016 period for bladder, breast, colorectal, liver, lung, melanoma, pancreatic and prostate cancers are shown in Figure 6.4. These cancers represent the 4 most common cancers plus those with an important trend in mortality.

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 6.4 Age-standardized mortality rates over time by cancer type and sex for selected cancers, Ontario, 1981 to 2016
Year Lung Breast (female) Prostate Colorectal Pancreas Liver Bladder Melanoma
1981 55.4 41.6 38.2 40.3 13.3 3 7.4 2.6
1982 57.7 41.4 34.4 39 13.2 2.9 7.1 2.5
1983 60.3 41.8 38.3 38.3 13.2 2.2 6.6 2.8
1984 61.9 43.6 37.5 38.8 12.9 3.3 6.8 2.4
1985 61.7 43.5 39.2 39.5 13.5 2.8 6.8 3
1986 60.5 44.5 38.8 38.3 13.4 3.1 5.8 2.4
1987 61.4 43.6 41.9 37.1 13 3.1 6.4 2.4
1988 64.2 42.6 42.9 38.1 12.6 4 6.8 2.4
1989 62.5 43.9 40.9 36.5 12.7 3.6 6.7 2.9
1990 62.2 41.3 41.2 34.9 12 3.7 5.9 2.7
1991 62.1 41 42.1 34.6 12.1 4.2 6.4 3.1
1992 61 40.8 44.3 34.3 12.5 4 5.2 3.1
1993 62.9 40.5 44.4 32.9 12.5 4.5 5.8 2.6
1994 62.1 41.5 44.1 32.9 12.9 4.8 6.6 3
1995 59.5 40.8 44 34.3 11.5 4.9 5.6 3.3
1996 59.8 39.5 41.9 32.8 11.9 4.8 5.4 3.3
1997 57.8 37.9 41 32 11.7 5 5.8 3.2
1998 58.8 34.5 40.6 30.9 11.4 5 5.8 3
1999 60.2 34.4 38.3 31.2 11.4 5.2 6.2 3.4
2000 57.8 35.8 37.7 31.2 11.7 4.8 6.5 3.3
2001 59.1 34.2 38.1 29.7 11.9 5.3 6.4 3.2
2002 57.8 33.5 37 30.6 11.4 5.5 6.1 3.4
2003 55.8 32.9 35.5 28.9 11.8 5.6 6.1 3
2004 55.1 32.3 34.9 28.6 11.9 5.5 6 3.1
2005 55.1 32 31.6 28.9 11.4 6.2 5.7 2.8
2006 55.9 29.2 32.1 26.5 10.9 5.4 6 3.5
2007 53.1 30 30 26.5 11.8 5.9 5.6 3.3
2008 52.8 28.2 30.1 26 11.5 6 5.8 3.4
2009 52.2 27.4 29.1 25.1 11.8 6.2 5.8 3.6
2010 52.8 26.9 29.3 23.7 11 7 5.8 3.4
2011 50.2 26.8 27.7 24.2 11.8 7.2 5.7 3.1
2012 49.9 25.7 26 22.6 12.1 7.4 5.5 3.4
2013 48.1 24.4 26.3 21.4 12.2 7.5 5.4 3.7
2014 47.2 25 24.8 21.7 12 7.1 6 3.5
2015 45.9 24.2 23.7 20.7 11.9 7.5 5.3 3.3
2016 44.2 24.9 24.4 20.3 12.3 7.6 5.6 3.4

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)

Mortality rates across all age groups have been declining significantly over the last decade. In younger people, they have declined fairly equally between the sexes. However, among people age 60 or older, the declines in mortality have been greater among males (Figure 6.5).

Ages 0 to 39

While incidence rates have been increasing among younger people, mortality rates have been stable or decreasing. Among males under 40, the mortality rate declined by 1.7% per year between 1981 and 1991. Among females in this age group, mortality rates declined by 1.9% per year between 1981 and 2007, and have been stable from 2007 onward.

Age-standardized mortality rates (ASMR) among individuals diagnosed with cancer as children (0 to 14 years of age) have been stable over the period between 1991 and 2016 (see Spotlight: Childhood Cancer Mortality Trend, Figure 6.S1).

For details about childhood cancer mortality trends, visit the POGO Surveillance Report.

Period APC
1991-2016 -0.3

Abbreviations: APC means annual percent change.

Notes:

  1. Rates are per 1,000,000.
  2. APC trend was not significant.
  3. Includes cases diagnosed since 1986 to align with POGONIS data capture.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario (POGO)
Data source: Pediatric Oncology Group of Ontario Networked Information System (POGONIS, October 16, 2019), POGO

Data for Figure 6.S1 Annual percent change in age-standardized mortality rates, all cancers combined in individuals diagnosed with cancer as children (0 to 14 years), Ontario, 1991 to 2016
Year Age-standardized mortality rate
1991 35
1992 38
1993 41
1994 41.6
1995 32.4
1996 39.7
1997 35
1998 37.9
1999 36.2
2000 32.6
2001 38.9
2002 34.1
2003 31.2
2004 41.6
2005 30.4
2006 34.8
2007 38.9
2008 27.6
2009 37.1
2010 34.6
2011 30.9
2012 34.3
2013 38.1
2014 33.2
2015 38.5
2016 35.6

Notes:

  1. Rates are per 1,000,000.
  2. Includes cases diagnosed since 1986 to align with POGONIS data capture.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario (POGO)
Data source: Pediatric Oncology Group of Ontario Networked Information System (POGONIS, October 16, 2019), POGO

 

Ages 40 to 59

For people ages 40 to 59, the mortality rate was stable until 1987, when it started to decline by 2.1% per year until 2016. Similar trends were seen for males and females as separate groups.

Ages 60 to 79

Among those ages 60 to 79, the mortality rate increased until 1988, after which it decreased by 0.8% per year until 2002. Between 2002 and 2016, the rate decreased by 2.0% per year. The rate of decrease has been greater for males (2.4% per year) than females (1.7% per year).

Ages 80 and older

Similar to people ages 60 to 79, mortality among those 80 or older increased by 0.5% per year between 1981 and 2002, followed by a decrease of 0.7% per year between 2002 and 2016. The decline in mortality has been greater for males, at 1.2% per year after 2001. Among females, the mortality rate was stable between 1997 and 2001, after which it decreased by 0.7% per year.

Both Sexes APCs

0 to 39 Years
Period APC
1981-2016 -1.6*
40 to 59  Years
Period APC
1981-1987 -0.1
1987-2016 -2.1*
60 to 79 Years
Period APC
1981-1998 0.9*
1998-2002 -0.8*
2002-2016 -2.0*
80 or older
Period APC
1981-2002 0.5*
2002-2016 -0.7*

 

 

 

 

Male APCs

0 to 39 Years
Period APC
1981-2016 -1.7*
40 to 59  Years
Period APC
1981-1988 -0.5
1988-2016 -2.2*
60 to 79 Years
Period APC
1981-1998 0.7*
1998-2002 -1.3*
2002-2016 -2.4*
80 or older
Period APC
1981-2001 0.3*
2001-2016 -1.2*

 

 

 

 

Female APCs

0 to 39 Years
Period APC
1981-2007 -1.9*
2007-2016 0.2
40 to 59  Years
Period APC
1981-1987 -0.1
1987-2016 -2.0*
60 to 79 Years
Period APC
1981-1995 2.2*
1985-2002 -0.2
2002-2016 -1.7*
80 or older
Period APC
1981-1997 0.4*
1997-2001 2.2
2001-2016 -0.7*

Symbol: *Statistically significant APC
Abbreviation: APC means annual percent change
Note: Rates are per 100,000.
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 6.5A (Both sexes) Average annual percent change in mortality rates by sex and age group, Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 10.0 181.6 762.7 1,673.6
1982 10.7 174.9 777.7 1,658.9
1983 10.0 176.6 788.5 1,688.8
1984 10.4 175.2 796.5 1,731.8
1985 9.3 178.2 807.6 1,773.6
1986 9.6 179.1 793.7 1,675.4
1987 9.3 175.7 805.4 1,700.9
1988 9.7 170.1 835.4 1,743.4
1989 9.0 170.8 803.4 1,761.9
1990 8.2 166.6 790.4 1,694.3
1991 7.7 159.1 790.2 1,792.1
1992 9.0 159.9 791.7 1,711.1
1993 8.2 157.1 793.1 1,744.1
1994 8.0 158.5 802.4 1,802.1
1995 7.8 154.2 782.1 1,813.3
1996 8.4 148.2 776.3 1,783.7
1997 7.7 140.7 760.2 1,787.1
1998 8.0 138.2 747.7 1,784.1
1999 7.5 140.1 752.7 1,824.2
2000 7.7 135.4 745.8 1,883.5
2001 7.2 133.1 738.0 1,930.3
2002 6.9 128.6 738.4 1,865.8
2003 6.8 127.9 717.4 1,862.2
2004 7.1 123.6 711.1 1,829.3
2005 6.5 123.2 689.3 1,838.9
2006 6.0 117.4 678.6 1,779.0
2007 6.2 117.4 657.3 1,793.0
2008 6.5 113.2 651.9 1,781.1
2009 6.3 111.4 632.4 1,783.1
2010 6.8 109.3 621.9 1,790.9
2011 6.2 107.4 616.2 1,794.9
2012 6.4 107.9 599.2 1,751.9
2013 6.1 101.0 588.3 1,722.7
2014 5.8 102.3 568.0 1,729.1
2015 6.5 97.7 562.0 1,679.6
2016 6.1 96.2 558.8 1,699.1


Data for Figure 6.5B (Males) Average annual percent change in mortality rates by sex and age group, Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 9.6 187.2 996.3 2535.0
1982 9.9 175.7 1032.3 2463.2
1983 9.8 179.7 1049.1 2544.6
1984 9.7 180.1 1054.9 2534.0
1985 8.6 182.0 1036.8 2662.7
1986 9.5 182.6 1029.1 2571.4
1987 9.5 176.8 1048.2 2570.2
1988 9.2 173.8 1097.1 2714.3
1989 8.3 171.9 1049.2 2683.7
1990 7.5 172.9 1027.8 2530.8
1991 7.4 161.7 1004.3 2728.6
1992 8.7 160.8 1011.0 2642.4
1993 7.5 160.0 996.8 2601.9
1994 8.2 159.7 1016.1 2706.3
1995 7.1 156.1 983.2 2665.7
1996 8.4 144.0 967.5 2639.6
1997 7.5 146.0 953.8 2660.7
1998 8.0 135.5 929.7 2637.4
1999 7.2 141.8 932.6 2583.9
2000 7.7 132.2 913.7 2728.1
2001 6.5 137.0 902.2 2750.9
2002 6.3 127.5 899.5 2709.5
2003 6.8 126.7 863.2 2686.0
2004 6.6 121.8 852.2 2593.7
2005 6.2 122.6 818.7 2546.7
2006 6.0 116.9 812.6 2555.3
2007 5.8 122.5 781.2 2407.4
2008 6.4 111.0 770.4 2477.0
2009 5.8 113.5 754.2 2440.2
2010 6.8 107.5 735.1 2442.0
2011 6.2 108.4 727.0 2427.6
2012 6.2 104.9 710.6 2358.2
2013 5.1 103.1 681.4 2332.0
2014 5.2 100.1 670.3 2337.8
2015 5.6 94.2 649.8 2227.5
2016 5.8 93.5 641.5 2252.3


Data for Figure 6.5C (Females) Average annual percent change in mortality rates by sex and age group, Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 10.4 176.8 581.0 1268.2
1982 11.4 175.0 580.4 1283.3
1983 10.3 174.2 588.9 1291.2
1984 11.2 170.7 597.5 1358.4
1985 10.0 174.7 630.9 1365.0
1986 9.6 175.9 610.2 1262.8
1987 9.0 174.9 617.8 1298.1
1988 10.2 166.5 630.6 1295.7
1989 9.6 169.9 610.6 1332.3
1990 8.8 160.4 602.5 1300.4
1991 8.0 156.6 621.1 1350.2
1992 9.3 159.0 617.2 1272.1
1993 8.9 154.2 630.9 1329.6
1994 7.7 157.3 630.6 1367.3
1995 8.5 152.4 621.6 1403.4
1996 8.4 152.3 622.2 1367.6
1997 7.9 135.5 603.0 1362.3
1998 8.0 140.8 598.6 1376.7
1999 7.9 138.4 604.1 1451.9
2000 7.8 138.6 606.5 1473.7
2001 7.9 129.3 601.7 1533.0
2002 7.6 129.7 603.2 1452.6
2003 6.8 129.1 594.6 1453.1
2004 7.6 125.3 592.0 1447.4
2005 6.8 123.9 579.1 1481.1
2006 5.9 118.0 563.9 1380.4
2007 6.6 112.5 550.6 1463.9
2008 6.6 115.5 549.4 1405.3
2009 6.7 109.6 527.1 1421.4
2010 6.9 111.2 523.3 1426.0
2011 6.1 106.5 519.2 1436.5
2012 6.5 110.9 501.8 1400.3
2013 7.1 99.1 506.4 1359.8
2014 6.5 104.5 478.1 1361.5
2015 7.4 101.2 484.5 1344.1
2016 6.4 98.8 485.9 1356.3

Abbreviation: APC means annual percent change
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

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