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Statistical Reports

Ch 1: Estimated Current Cancer Incidence [2022]

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Ontario Cancer Statistics 2022 Ch 1: Estimated Current Cancer Incidence

Incidence measures the number of new cancer cases diagnosed in a specific timeframe. This chapter reports projections for 2019 to 2022. The projected statistics do not account for the effects of the COVID-19 pandemic.

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Incidence Overview

The number of new cancer cases diagnosed in Ontario (the incidence) and the incidence rate have increased each year since at least 1984. In general, the incidence of cancer is influenced by:

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

Risk factors can include:

  • unhealthy behaviours (e.g., smoking, poor diet, alcohol consumption, physical inactivity)
  • previous treatments (e.g., hormone replacement therapy)
  • exposure to certain environmental and occupational carcinogens (e.g., radon, fine particulate matter, ultraviolet rays, asbestos, diesel engine exhaust)
  • medical conditions and infectious agents (e.g., Crohn’s disease, human papillomavirus)
  • non-modifiable factors (e.g., age at first menstrual cycle, menopause, family history of cancer)
  • genetic predispositions (e.g., BRCA1 and BRCA2 genes)

In 2022, people in Ontario are expected to be diagnosed with an estimated 95,325 new cases of cancer (excluding non­melanoma skin cancer), which will result in an age-standardized incidence rate of 556.3 cases per 100,000 people (Figure 1.1).

Figure 1.1 shows an abrupt increase in the count and incidence rate in 2010, which is a result of the Ontario Cancer Registry's adoption of the National Cancer lnstitute’s Surveillance, Epidemiology and End Results Program rules for counting multiple primary cancers. These rules were applied to the registry for people diagnosed from 2010 onward, so the higher numbers starting in that year reflect an adoption of the new rules and not a true increase in the cancer incidence (See Appendix 2: Analysis).[1]

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.
  2. Observed incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward. Direct comparisons between rates for 2010 onward and prior years should generally not be made. The years before 2010 are shown to highlight the impact on new cases and rates from the change in counting standards for multiple primary cancers.
  3. The shaded area indicates projected data for the years 2019 onward.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March 2021), Ontario Health (Cancer Care Ontario)

Figure 1.1 Projected incidence counts and age-standardized rates for all cancers combined, Ontario, 1984 to 2022
Year of diagnosis Incidence count Incidence rate
1984 33004 491.5
1985 34266 497.4
1986 34660 490
1987 36469 500.4
1988 38053 508.1
1989 38269 496.5
1990 40264 507.9
1991 42461 523.7
1992 43421 522
1993 44446 523.4
1994 45169 519.4
1995 45023 507.2
1996 46387 511
1997 48108 519.2
1998 49759 524.9
1999 51481 532
2000 53133 536.8
2001 54795 541.4
2002 55443 531.9
2003 56057 524.2
2004 58268 530.3
2005 59740 531.2
2006 61284 531
2007 63806 539.3
2008 63890 525.5
2009 65522 525.4
2010 73245 572.5
2011 75669 576.8
2012 75251 559.1
2013 76047 550.2
2014 76940 543.8
2015 79422 549.1
2016 80602 543.9
2017 84536 555.2
2018 84816 543.1
2019 88566 552.6
2020 91025 554.4
2021 93224 556.3
2022 95325 556.3

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.
  2. Observed incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward. Direct comparisons between rates for 2010 onward and prior years should generally not be made. The years before 2010 are shown to highlight the impact on new cases and rates from the change in counting standards for multiple primary cancers.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March 2021), Ontario Health (Cancer Care Ontario)

Incidence by Sex

Among males, 49,221 cancer cases are expected to be diagnosed in 2022 for an age-standardized incidence rate of 603.6 per 100,000 (Figure 1.2). The rapid drop in the count and rate after 2011 is partly due to the decreasing rate of prostate cancer. This decrease followed recommendations from the U.S. Preventive Services Task Force against using prostate-specific antigen testing for the routine screening of healthy men.[2] The latest statement by the task force made the same recommendations for men age 70 and older and modified them to include a choice for men ages 50 to 69.[3] Similar recommendations for prostate-specific antigen testing in Canada were published by the Canadian Task Force on Preventive Health Care in 2014.[4]

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.
  2. Observed incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward. Direct comparisons with rates for 2010 onward and prior years should generally not be made. The years before 2010 are shown to highlight the impact on new cases and rates from the change in counting standards for multiple primary cancers.
  3. The shaded area indicates projected data for the years 2019 onward.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March 2021), Ontario Health (Cancer Care Ontario)

Figure 1.2 Projected incidence counts and age-standardized rates by sex for all cancers combined, Ontario, 1984 to 2022
Year of diagnosis New cases-males Incidence rate-males New cases-females Incidence rate-females
1984 16909 591.9 16095 432.1
1985 17440 592 16826 441.7
1986 17811 592.5 16849 430.2
1987 18793 604.1 17676 438.6
1988 19393 604.8 18660 451.7
1989 19780 597 18489 434.6
1990 20907 612.4 19357 443.8
1991 22076 630.9 20385 458.3
1992 22968 638.7 20453 449.1
1993 23584 639 20862 447.4
1994 23885 629.7 21284 445.7
1995 23158 599.3 21865 450
1996 24082 607.1 22305 448.2
1997 25040 616.1 23068 454.7
1998 25496 612.9 24263 468.1
1999 26525 622.1 24956 471.4
2000 27698 633.2 25435 469.9
2001 28922 644.4 25873 468
2002 28497 615.6 26946 474.9
2003 28986 609.2 27071 464.3
2004 30211 616.4 28057 468.5
2005 31061 619.1 28679 468.1
2006 32026 618.7 29258 466.5
2007 33176 622.9 30630 477.9
2008 33008 601.9 30882 470.3
2009 33323 589.1 32199 479.3
2010 37516 647.5 35729 519.5
2011 38949 654 36720 523.1
2012 37891 615.7 37360 520.3
2013 37673 595.4 38374 521.7
2014 37855 581.2 39085 521.2
2015 39545 591.4 39877 521.8
2016 40154 583.3 40448 518.4
2017 42752 602.3 41784 522.3
2018 42630 582 42186 516.8
2019 45170 598.2 43396 520
2020 46685 601.3 44340 520.4
2021 48069 604.6 45155 520.7
2022 49221 603.6 46104 521.4

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.
  2. Observed incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward. Direct comparisons with rates for 2010 onward and prior years should generally not be made. The years before 2010 are shown to highlight the impact on new cases and rates from the change in counting standards for multiple primary cancers.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March 2021), Ontario Health (Cancer Care Ontario)

The numbers are lower for females, with 46,104 cases diagnosed and an age-standardized incidence rate of 521.4 per 100,000 (Figure 1.2). The incidence rate has been higher for males than females every year since 1984. This sex difference has been observed in many other jurisdictions.[5,6] Higher rates of cancer among males have been attributed to differences in their behaviour [7,8], immunity[9], hormones [10] and exposures (e.g., workplace carcinogens).[11,12]

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Incidence by Cancer Type

ln 2022, the most commonly diagnosed cancer is expected to be female breast cancer (12,531 cases or 13.1% of all new cases), followed by lung cancer (10,639 cases or 11.2%) and prostate cancer (10,578 cases or 11.1%) (Table 1.1). These 3 cancers are projected to account for 35% of all new cancers diagnosed in 2022.

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Among males, the most commonly diagnosed cancer is expected to be prostate cancer, with an age-standardized incidence rate of 124.2 per 100,000. Breast cancer (with an age-standardized incidence rate of 147.0 per 100,000) is projected to be the most commonly diagnosed cancer among females.

The age-standardized incidence rate is expected to be higher in males than females for all cancer types listed in Table 1.1, except thyroid cancer. A higher prevalence of certain risk factors are suspected reasons for the mostly higher cancer incidence in males. These risk factors include:

  • greater obesity, alcohol and tobacco use
  • more occupational exposure to carcinogens
  • less use of medical services
  • different influence of sex hormones

The number of new thyroid cancer cases in females will outnumber male cases by more than double. This cancer has an age-standardized incidence rate of 31.8 per 100,000 in females and 13.2 per 100,000 in males. Possible reasons for the higher incidence of this cancer in females include:

  • increased likelihood of diagnostic investigation for thyroid cancer [13]
  • a greater tendency in general to seek medical attention [14]
  • biological and hormonal factors, such as levels of thyroid stimulated hormone, levels of sex steroids, menstrual periods, use of birth control, pregnancies, breastfeeding and menopause [15-17]

The incidence of less aggressive types of thyroid cancer (e.g., papillary thyroid cancer) has been higher in females than males in a number of jurisdictions. However, the incidence of more aggressive types (e.g., anaplastic and medullary) is generally similar for males and females.[13,18] As a result, thyroid mortality rates have been fairly equal for males and females (see Chapter 5: Cancer Mortality).

Table 1.1 Projected incidence counts and age-standardized rates by cancer type and sex, Ontario, 2022
Cancer type Males and females combined –
new cases		 Males and females combined –
ASIR		 Males –
new cases		 Males – ASIR Females – new cases Females – ASIR
All cancers 95,325 556.3 49,221 603.6 46,104 521.4
Bladder 4,445 24.7 3,411 41.7 1,034 10.7
Brain 1,216 7.5 704 9.1 512 6.0
Breast (female) n/a n/a n/a n/a 12,531 147.0
Cervix n/a n/a n/a n/a 583 7.6
Colorectal 9,118 52.6 5,098 63.4 4,020 43.2
Esophagus 833 4.7 602 7.3 231 2.4
Hodgkin lymphoma 443 2.9 234 3.1 209 2.7
Kidney 3,198 19.2 2,148 27.3 1,050 11.9
Larynx 401 2.3 345 4.2 56 0.6
Leukemia 2,806 16.5 1,617 20.3 1,189 13.1
Liver 1,731 9.8 1,198 14.5 533 5.6
Lung 10,639 58.9 5,077 61.2 5,562 57.5
Melanoma 4,724 27.9 2,738 34.4 1,986 22.8
Myeloma 1,777 10.1 1,066 13.1 711 7.5
Non-Hodgkin lymphoma 5,284 30.7 3,039 38.0 2,245 24.5
Oral cavity and pharynx 2,111 12.6 1,493 18.8 618 6.9
Ovary n/a n/a n/a n/a 1,350 15.7
Pancreas 2,643 14.8 1,425 17.5 1,218 12.6
Prostate n/a n/a 10,578 124.2 n/a n/a
Stomach 1,809 10.4 1,181 14.7 628 6.8
Testis n/a n/a 541 7.1 n/a n/a
Thyroid 3,461 22.6 1,004 13.2 2,457 31.8
Uterus n/a n/a n/a n/a 3,400 39.1

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 Standard population.
  2. Projected incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward.
  3. Projections are based on malignant cases only.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March 2021), Ontario Health (Cancer Care Ontario)

Incidence by Age

The greatest number of new cancer cases is expected in people ages 60 to 79. An estimated 56% of all cases in 2022 are projected to be diagnosed in this age group (Table 1.2). The age group with the second highest number of new cancer cases will be people ages 40 to 59 (21%), followed by those age 80 and older (18%). Only 4.7% of cases are expected to be diagnosed in people under age 40.

The incidence rate in 2022 is projected to range from 60.2 per 100,000 in people age 39 and younger to 2,518.4 per 100,000 in people age 80 and older. The projected rates for 2022 increase with advancing age for most cancers, except:

  • cervical cancer, which increases with advancing age, but peaks in people ages 40 to 59
  • oral and pharynx, prostate, thyroid and uterine cancers, which increase with advancing age, but peak in people ages 60 to 79
  • testicular cancer, which decreases with advancing age
  • Hodgkin lymphoma, which is highest in people age 39 and younger and in people age 80 and older

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The incidence rates of the 23 cancers reported in Table 1.2 are projected to be very low in people under age 40. The exceptions are breast cancer at 16.7 per 100,000, testicular cancer at 10.0 per 100,000 and thyroid cancer at 8.9 per 100,000.

Table 1.2 Projected incidence counts and age-specific rates by cancer type and age group, Ontario, 2022
Cancer type Ages 0 to 39 - New cases Ages 0 to 39 - Age-specific rate Ages 40 to 59 - New cases Ages 40 to 59 - Age-specific rate Ages 60 to 79 -New cases Ages 60 to 79 - Age-specific rate Age 80 and older - New cases Age 80 and older - Age-specific rate
All cancers 4,504 60.2 19,887 514.1 53,530 1,733.1 17,404 2,518.4
Bladder 32 0.4 484 12.5 2,619 84.8 1,310 189.6
Brain 248 3.3 286 7.4 531 17.2 151 21.9
Breast (female) 609 16.7 4,104 208.1 6,189 383.3 1,629 397.1
Cervix 160 4.4 248 12.6 148 9.2 27 6.6
Colorectal 178 2.4 1,739 45 4,986 161.4 2,215 320.5
Esophagus 7 0.1 128 3.3 515 16.7 183 26.5
Hodgkin lymphoma 234 3.1 95 2.5 90 2.9 24 3.5
Kidney 136 1.8 892 23.1 1,764 56.5 424 61.4
Larynx ** ** 67 1.7 262 8.5 67 9.7
Leukemia 331 4.4 482 12.5 1,430 46.3 563 81.5
Liver 26 0.3 247 6.4 1,111 36.0 347 50.2
Lung 48 0.6 1,109 28.7 6,867 222.3 2,615 378.4
Melanoma 318 4.3 1,032 26.7 2,373 76.8 1,001 144.8
Myeloma 13 0.2 272 7.0 1,042 33.7 450 65.1
Non-Hodgkin lymphoma 332 4.4 974 25.2 2,827 91.5 1,151 166.6
Oral cavity and pharynx 53 0.7 578 14.9 1,212 39.2 268 38.8
Ovary 95 2.6 403 20.4 656 40.6 196 47.8
Pancreas 25 0.3 343 8.9 1,525 49.4 750 108.5
Prostate ** ** 1,365 72.0 8,123 551.0 1,089 387.8
Stomach 39 0.5 340 8.8 994 32.2 436 63.1
Testis 381 10.0 125 6.6 31 2.1 ** **
Thyroid 666 8.9 1,486 38.4 1,190 38.5 119 17.2
Uterus 74 2.0 1,017 51.6 1,982 122.8 327 79.7

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

Notes:

  1. Rates are per 100,000.
  2. Projected incidence rates are based on the National Cancer lnstitute’s Surveillance, Epidemiology and End Results standards for counting multiple primary cancers, which were adopted by the Ontario Cancer Registry for cases diagnosed from 2010 onward.
  3. Projections are based on malignant cases only.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (March, 2021), Ontario Health (Cancer Care Ontario)

Female breast cancer will account for the largest proportion of all cases among people ages 40 to 59 (20.6%). ln people ages 60 to 79, breast (11.6%), lung (12.8%) and prostate (15.2%) will be the most common cancers diagnosed. Among people age 80 and older, lung will be the most commonly diagnosed cancer (15.0%), followed by colorectal cancer (12.7%).

For more information on cancer incidence in Ontario, including data on more cancer types and trends over time, see Chapter 4: Cancer Incidence.

 

References

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