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Statistical Reports

Ch 5: Cancer Mortality [2022]

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Ontario Cancer Statistics 2022 Ch 5: Cancer Mortality

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 2018, which is the latest available year.

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Cancer as a Leading Cause of Death

In 2018, cancer caused 27.7% of all deaths in Ontario, making it the province’s leading cause of death (Figure 5.1).[1] Cancer caused almost as many deaths as the next 3 leading causes of death combined: diseases of the heart, accidents and cerebrovascular diseases.

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, Ontario Health (Cancer Care Ontario)
Data source: Statistics Canada. Table 13-10-0801-01 Leading causes of death, total population (age standardization using 2011 population)

Figure 5.1 Leading causes of death, Ontario, 2018
Cause of death Number of deaths
All other causes 39.7% 42451
Cancer (malignant neoplasms) 27.7% 29585
Diseases of heart 18.5% 19786
Accidents (unintentional injuries) 5.2% 5593
Cerebrovascular diseases 4.6% 4970
Chronic lower respiratory diseases 4.3% 4606

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, Ontario Health (Cancer Care Ontario)
Data source: 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)
  • availability and uptake of effective screening tests
  • 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 25.1% of people, will die from cancer (Table 5.1). Males have a greater chance of dying from cancer at slightly more than 1 in 4 (27.4%), compared with females at 1 in 4 (23.2%).

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 males), prostate (1 in 29) and colorectal (1 in 32) cancers.
  • Among females, the probability is highest for lung (1 in 19 females) breast (1 in 31) and colorectal (1 in 38) cancers.
Table 5.1 Lifetime probability of dying of cancer, by cancer type and sex, Ontario, 2014 to 2018
Cancer type Males and females combined
%
Males and females combined
1 in
Males
%
Males
1 in
Females
%
Females
1 in
All cancers 25.1% 4 27.4% 4 23.2% 4
Bladder 0.9% 116 1.3% 77 0.5% 210
Brain 0.6% 170 0.7% 152 0.5% 192
Breast (female) n/a n/a n/a n/a 3.2% 31
Cervix n/a n/a n/a n/a 0.2% 467
Colorectal 2.9% 35 3.1% 32 2.7% 38
Esophagus 0.6% 162 0.9% 106 0.3% 317
Hodgkin lymphoma 0.0% 2,845 0.0% 2,373 0.0% 3,512
Kidney 0.5% 192 0.7% 150 0.4% 261
Larynx 0.1% 923 0.2% 537 0.0% 2,750
Leukemia 1.0% 104 1.1% 88 0.8% 123
Liver 0.9% 107 1.2% 84 0.7% 146
Lung 5.7% 17 6.3% 16 5.3% 19
Melanoma 0.4% 242 0.6% 180 0.3% 351
Myeloma 0.5% 195 0.6% 170 0.4% 225
Non-Hodgkin lymphoma 1.0% 101 1.1% 90 0.9% 114
Oral cavity and pharynx 0.4% 247 0.5% 182 0.3% 376
Ovary n/a n/a n/a n/a 1.1% 95
Pancreas 1.6% 64 1.6% 63 1.5% 66
Prostate n/a n/a 3.5% 29 n/a n/a
Stomach 0.6% 157 0.8% 122 0.5% 212
Testis n/a n/a 0.0% 6,011 n/a n/a
Thyroid 0.1% 1,267 0.1% 1,410 0.1% 1,164
Uterus n/a n/a n/a n/a 0.7% 137

Abbreviation: n/a means not applicable.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Mortality by Sex and Cancer Type

In 2018, 29,712 people died from cancer in Ontario, for an age-standardized mortality rate of 185.2 per 100,000 (Table 5.2).

Table 5.2 Mortality counts and rates, by cancer type and sex, Ontario, 2018
Cancer type Males and females combined
Deaths
Males and females combined
% of deaths
Males and females combined
ASMR
Males and females combined
ASMR 95% CI
Males
Deaths
Males
% of deaths
Males
ASMR
Males
ASMR 95% CI
Females
Deaths
Females
% of deaths
Females
ASMR
Females
ASMR 95% CI
All cancers 29,712 100.0% 185.2 183.0-187.3 15,706 100.0% 220.2 216.7-223.7 14,006 100.0% 159.4 156.7-162.1
Bladder 854 2.9% 5.2 4.9-5.6 612 3.9% 8.9 8.2-9.6 242 1.7% 2.6 2.3-2.9
Brain 844 2.8% 5.4 5.1-5.8 470 3.0% 6.5 5.9-7.1 374 2.7% 4.5 4.0-5.0
Breast (female) n/a n/a n/a n/a n/a n/a n/a n/a 2,003 14.3% 23.6 22.5-24.6
Cervix n/a n/a n/a n/a n/a n/a n/a n/a 145 1.0% 1.9 1.6-2.2
Colorectal 3,099 10.4% 19.3 18.6-20.0 1,680 10.7% 23.8 22.7-25.0 1,419 10.1% 15.7 14.9-16.5
Esophagus 847 2.9% 5.3 4.9-5.7 635 4.0% 8.7 8.1-9.4 212 1.5% 2.4 2.1-2.8
Hodgkin lymphoma 35 0.1% 0.2 0.2-0.3 19 0.1% 0.3 0.2-0.4 16 0.1% 0.2 0.1-0.3
Kidney 575 1.9% 3.6 3.3-3.9 368 2.3% 5.1 4.6-5.7 207 1.5% 2.3 2.0-2.6
Larynx 148 0.5% 0.9 0.8-1.1 133 0.8% 1.8 1.5-2.2 15 0.1% 0.2 0.1-0.3
Leukemia 1,077 3.6% 6.7 6.3-7.1 609 3.9% 8.6 7.9-9.3 468 3.3% 5.2 4.7-5.7
Liver 1,210 4.1% 7.5 7.1-8.0 798 5.1% 10.9 10.2-11.7 412 2.9% 4.7 4.2-5.1
Lung 6,971 23.5% 43.1 42.1-44.2 3,712 23.6% 51.1 49.5-52.8 3,259 23.3% 37.1 35.8-38.4
Melanoma 487 1.6% 3.1 2.8-3.4 307 2.0% 4.4 3.9-4.9 180 1.3% 2.1 1.8-2.4
Myeloma 586 2.0% 3.6 3.3-3.9 329 2.1% 4.6 4.2-5.2 257 1.8% 2.8 2.5-3.2
Non-Hodgkin lymphoma 1,137 3.8% 7.1 6.7-7.5 644 4.1% 9.1 8.4-9.8 493 3.5% 5.5 5.1-6.1
Oral cavity and pharynx 565 1.9% 3.6 3.3-3.9 388 2.5% 5.3 4.8-5.9 177 1.3% 2.0 1.7-2.3
Ovary n/a n/a n/a n/a n/a n/a n/a n/a 677 4.8% 7.9 7.4-8.6
Pancreas 1,900 6.4% 11.8 11.2-12.3 984 6.3% 13.6 12.7-14.5 916 6.5% 10.2 9.5-10.9
Prostate n/a n/a n/a n/a 1,657 10.6% 24.2 23.0-25.4 n/a n/a n/a n/a
Stomach 799 2.7% 5.0 4.7-5.4 502 3.2% 7.0 6.4-7.6 297 2.1% 3.4 3.0-3.9
Testis n/a n/a n/a n/a 22 0.1% 0.3 0.2-0.5 n/a n/a n/a n/a
Thyroid 102 0.3% 0.6 0.5-0.8 51 0.3% 0.7 0.5-0.9 51 0.4% 0.6 0.4-0.8
Uterus n/a n/a n/a n/a n/a n/a n/a n/a 495 3.5% 5.7 5.2-6.2

Abbreviations: ASMR means age-standardized mortality rate; CI means confidence interval; n/a means not applicable.
Note: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

The 4 most commonly diagnosed cancers (breast, colorectal, lung and prostate) were responsible for 46% of all cancer deaths in 2018. Lung, colorectal and prostate cancers accounted for 45% of all male cancer deaths, while lung, breast and colorectal cancers accounted for 48% of all female cancer deaths (Figure 5.2).

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Figure 5.2 Proportion of cancer deaths by sex and cancer type, Ontario, 2018
Cancer Type Males Females
Lung 23.6 23.3
Breast (female) 0 14.3
Colorectal 10.7 10.1
Prostate 10.6 0
Pancreas 6.3 6.5
Liver 5.1 2.9
Ovary 0 4.8
Uterus 0 3.5
Leukemia 3.9 3.3
Bladder 3.9 1.7
Esophagus 4 1.5
Non-Hodgkin lymphoma 4.1 3.5
Stomach 3.2 2.1
Brain 3 2.7
Oral cavity & pharynx 2.5 1.3
Kidney 2.3 1.5
Melanoma 2 1.3
Myeloma 2.1 1.8
Cervix 0 1
Larynx 0.8 0.1
Thyroid 0.3 0.4
Hodgkin lymphoma 0.1 0.1
Testis 0.1 0
All other types 11.4 12.1

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

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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 6.4% of all cancer deaths in 2018, making it the third highest contributor to cancer deaths after lung and colorectal cancers (Table 5.2). By contrast, pancreatic cancer accounted for only 2.4% of new cases in the same year (see Chapter 4: Cancer Incidence).

The highest age-standardized mortality rates for cancers occurring in males and females combined were for lung (43.1 per 100,000), colorectal (19.3 per 100,000) and pancreas (11.8 per 100,000).

The age-standardized mortality rate for all cancers combined was significantly higher for males (220.2 per 100,000) than females (159.4 per 100,000). Among males, the highest age-standardized mortality rate was for lung (51.1 per 100,000), followed by colorectal (23.8 per 100,000) and prostate (24.2 per 100,000) cancers. For females, the highest age-standardized mortality rate was for lung (37.1 per 100,000), followed by breast (23.6 per 100,000) and colorectal (15.7 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 similar for males and females.

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

  • laryngeal cancer, which had a male rate that was 9 times higher than the female rate
  • esophageal cancer, which had a male rate that was close to 4 times higher than the female rate
  • bladder cancer, which had a male rate that was over 3 times higher than the female rate
  • oral cavity and pharynx cancer, which had a male rate that was close to 3 times higher than the female rate

Tobacco use is a major risk factor for these 4 cancer types. The higher mortality rates in males likely result from their historically higher rates of tobacco use.[2]

Mortality by Age

From 2016 to 2018, the median age at death for all cancers was 74 for males and 75 for females (Table 5.3). The median age at death varied by cancer type. Cancers with the lowest median age at death were testicular and cervical. The median age for most other cancer types was over 70.

Table 5.3 Median age at death, by cancer type and sex, Ontario, 2016 to 2018
Cancer type Age (years)
Males and females combined
Age (years)
Males
Age (years)
Females
All cancers 74 74 75
Bladder 81 81 82
Brain 67 65 68
Breast (female) n/a n/a 71
Cervix n/a n/a 61
Colorectal 77 75 80
Esophagus 71 70 75
Hodgkin lymphoma 73 70 78
Kidney 74 72 78
Larynx 72 72 77
Leukemia 77 76 78
Liver 72 70 75
Lung 74 74 74
Melanoma 73 73 74
Myeloma 77 76 78
Non-Hodgkin lymphoma 76 75 77
Oral cavity and pharynx 69 68 75
Ovary n/a n/a 71
Pancreas 74 72 75
Prostate n/a 82 n/a
Stomach 73 72 74
Testis n/a 43 n/a
Thyroid 73 69 79
Uterus n/a n/a 72

Abbreviation: n/a means not applicable.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

In 2018, 86% of all people in Ontario who died of cancer were age 60 or older (Table 5.4). Mortality was distributed differently by age group.

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Ages 0 to 39

People younger than age 40 made up 1.4% of all cancer deaths (compared with 5.1% of all new cases), with brain and breast cancers being the leading causes.

In 2018, 0.2% of all cancer deaths occurred in children with cancer (ages 0 to 14). From 1991 to 2019, the majority of deaths in children with cancer occurred in those with:

  • central nervous system and miscellaneous intracranial and intraspinal neoplasms (36.5%)
  • leukemias, myeloproliferative diseases and myelodysplastic diseases (25.9%)

For more information, please read the Pediatric Oncology Group of Ontario Surveillance Report.

Ages 40 to 59

People ages 40 to 59 made up 12.5% of all cancer deaths (compared with 22.7% of all new cases), with lung and breast cancers being the leading causes.

Ages 60 to 79

People ages 60 to 79 made up 50.3% of all cancer deaths (compared with 53.9% of all new cases).

This age group represented the greatest proportion of cancer deaths for 19 of the 23 types of cancer examined in this report. The greatest proportions of cancer deaths were from lung (27.8%) and colorectal (8.9%) cancers.

Ages 80 and older

People age 80 and older made up 35.8% of all cancer deaths (compared with 18.3% 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 age 80 and older. The higher mortality rate in males age 80 and older reflects 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 1,702.4 per 100,000 in people age 80 or older (Table 5.4). Mortality varied by cancer type:

  • There were significant increases in mortality with age for cancers of the bladder, breast, colorectum, kidney, stomach and thyroid, as well as leukemia, melanoma, Hodgkin lymphoma and non-Hodgkin lymphoma.
  • There were non-significant increases in mortality with age for cancers of the brain, cervix, esophagus, larynx, liver, lung, oral cavity and pharynx, ovary, pancreas, prostate and uterus.
  • Testicular cancer mortality was highest in people under age 60.
Table 5.4 Mortality counts and rates, by cancer type and age group, Ontario, 2018
Cancer type Ages 0 to 39
Deaths
Ages 0 to 39
Age-specific rate
Ages 0 to 39
95% CI
Ages 40 to 59
Deaths
Ages 40 to 59
Age-specific rate
Ages 40 to 59
95% CI
Ages 60 to 79
Deaths
Ages 60 to 79
Age-specific rate
Ages 60 to 79
95% CI
80 years or older
Deaths
80 years or older
Age-specific rate
80 years or older
95% CI
All cancers* 429 6.1 5.5-6.7 3,709 94.5 91.5-97.6 14,941 550.9 542.1-559.8 10,633 1702.4 1,670.2-1,735.1
Bladder* ** ** ** 50 1.3 0.9-1.7 340 12.5 11.2-13.9 465 74.5 67.8-81.5
Brain 68 1 0.7-1.2 210 5.3 4.7-6.1 424 15.6 14.2-17.2 142 22.7 19.1-26.8
Breast (female)* 58 1.7 1.3-2.2 447 22.4 20.4-24.6 858 60.4 56.4-64.6 640 170.3 157.3-184.0
Cervix 11 0.3 0.2-0.6 60 3.0 2.3-3.9 45 3.2 2.3-4.2 29 7.7 5.2-11.1
Colorectal* 38 0.5 0.4-0.7 387 9.9 8.9-10.9 1,327 48.9 46.3-51.6 1,347 215.7 204.3-227.5
Esophagus ** ** ** 130 3.3 2.8-3.9 482 17.8 16.2-19.4 231 37.0 32.4-42.1
Hodgkin lymphoma* ** ** ** ** ** ** 19 0.7 0.4-1.1 7 1.1 0.5-2.3
Kidney* ** ** ** 80 2.0 1.6-2.5 286 10.5 9.4-11.8 207 33.1 28.8-38.0
Larynx ** ** ** 20 0.5 0.3-0.8 82 3.0 2.4-3.8 43 6.9 5.0-9.3
Leukemia* 51 0.7 0.5-1.0 107 2.7 2.2-3.3 473 17.4 15.9-19.1 446 71.4 64.9-78.4
Liver 10 0.1 0.1-0.3 153 3.9 3.3-4.6 704 26.0 24.1-27.9 343 54.9 49.3-61.0
Lung 17 0.2 0.1-0.4 704 17.9 16.6-19.3 4,155 153.2 148.6-157.9 2,095 335.4 321.2-350.1
Melanoma* 17 0.2 0.1-0.4 83 2.1 1.7-2.6 216 8.0 6.9-9.1 171 27.4 23.4-31.8
Myeloma ** ** ** 50 1.3 0.9-1.7 283 10.4 9.3-11.7 256 41.0 36.1-46.3
Non-Hodgkin lymphoma* 15 0.2 0.1-0.4 114 2.9 2.4-3.5 547 20.2 18.5-21.9 461 73.8 67.2-80.9
Oral cavity and pharynx 8 0.1 0.0-0.2 110 2.8 2.3-3.3 317 11.7 10.4-13.0 127 20.3 17.0-24.2
Ovary 15 0.4 0.2-0.7 137 6.9 5.8-8.1 351 24.7 22.2-27.4 174 46.3 39.7-53.7
Pancreas 7 0.1 0.0-0.2 212 5.4 4.7-6.2 1,052 38.8 36.5-41.2 629 100.7 93.0-108.9
Prostate ** ** ** 50 2.6 1.9-3.4 644 49.9 46.1-53.9 962 386.8 362.8-412.1
Stomach* 13 0.2 0.1-0.3 122 3.1 2.6-3.7 421 15.5 14.1-17.1 243 38.9 34.2-44.1
Testis 12 0.3 0.2-0.6 6 0.3 0.1-0.7 ** ** ** ** ** **
Thyroid* ** ** ** 20 0.5 0.3-0.8 53 2.0 1.5-2.6 33 5.3 3.6-7.4
Uterus ** ** ** 70 3.5 3.4-5.2 293 20.6 18.3-23.1 135 35.9 30.1-42.5

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; the 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, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

This section describes annual percent changes in the age-standardized mortality rates, which are used to examine short-term changes in the trend in rates over time (Table 5.5).

The age-standardized mortality rate for all cancers combined in Ontario has been decreasing over the past few decades, with the drop in mortality accelerating in recent years. From 1984 to 2001, the age-standardized mortality rate decreased by 0.5% per year and fell a further 1.5% per year from 2001 to 2018.

The decrease in mortality was greater for males than females. For males, the mortality rate decreased by 1.0% per year from 1988 to 2001 and then by 1.7% per year from 2001 to 2018. For females, the rate decreased by 0.3% per year from 1984 to 2001 and then decreased by 1.3% per year from 2001 to 2018. This section examines some of the reasons for these changes in mortality trends.

Recent mortality trends for the 4 most common cancers

PROSTATE CANCER

The prostate cancer age-standardized mortality rate decreased by 2.9% per year from 1994 to 2014 and then stabilized from 2014 to 2018 (Table 5.5). This decrease was likely due to early detection and improved treatments, which have increased prostate cancer survival.[3]

BREAST CANCER

The age-standardized mortality rate for breast cancer decreased by 2.5% per year from 1994 to 2013 and was stable from 2013 to 2018 (Table 5.5). This decrease was likely due to:

  • greater regular participation in mammography screening, especially after the introduction of Ontario’s organized breast screening program [4,5]
  • improved treatment [6,7]
  • the use of more effective systemic therapies following breast cancer surgery [6,7]

COLORECTAL CANCER

The colorectal cancer age-standardized mortality rate consistently decreased in males and females combined from 1984 to 2018, with the greatest decrease being in recent years (Table 5.5). The mortality rate decreased 3.1% per year from 2005 to 2018 among males and by 2.7% per year from 2004 to 2018 among females.

Reasons for this decrease in mortality may be changes in risk and protective factors, including earlier diagnosis due to greater uptake of screening and improvements in treatment.[8]

LUNG CANCER

In males, the age-standardized mortality rate for lung cancer decreased by 2.2% per year from 1989 to 2011, followed by a steeper decrease of 3.1% from 2011 to 2018 (Table 5.5). Among females, the mortality rate was stable from 1999 to 2010 and then began a decrease of 1.8% per year from 2010 to 2018.

The drop in lung cancer mortality is largely due to less tobacco use, which began to decrease in the late 1950s for males and in the mid-1970s for females.[2,9] This approximate 15-year gap in male and female peak smoking rates corresponds to the sex-based gap in the stabilization of lung cancer mortality rates.

Notable changes in trend for other cancers

LIVER CANCER

The liver cancer age-standardized mortality rate increased in all people from 1984 to 2018. The male rate increased by 2.2% per year from 1994 to 2018, following a previous rapid upward trend in the mortality rate (Table 5.5). The female mortality rate experienced a rapid increase from 2008 to 2013 before stabilizing from 2013 to 2018. This increase in mortality was probably at least partially due to a rise in incidence rate over the same period.

OVARIAN CANCER

The age-standardized mortality rate for ovarian cancer decreased significantly by 4.6% per year from 2003 to 2007 and then by 1.0% per year from 2007 to 2018 (Table 5.5). This pattern paralleled the decrease in the ovarian cancer incidence rate from 2002 to 2018.

Drops in ovarian cancer incidence and mortality likely resulted from changes in exposure to risk and protective factors, including the increasing use of oral contraceptives.[10] Drops in mortality may also reflect increasing survival due to improvements in treatment for this cancer.[11]

STOMACH CANCER

The stomach cancer age-standardized mortality rate decreased by 4.0% per year until 1993 and then by 2.2% per year from 1993 to 2018 (Table 5.5).

Reasons for this decrease include less exposure to Helicobacter pylori infection, improvements in food preservation and refrigeration, lifestyle changes and better treatment for this cancer.[12]

Table 5.5 Annual percent change in age-standardized mortality rates, by cancer type and sex, Ontario, 1984 to 2018
Cancer type Males and females combined
Period
Males and females combined
APC (%)
Males
Period
Males
APC (%)
Females
Period
Females
APC (%)
All cancers 1984-2001 -0.5* 1984-1988 0.5 1984-2001 -0.3*
  2001-2018 -1.5* 1988-2001 -1* 2001-2018 -1.3*
      2001-2018 -1.7*    
Bladder 1984-2018 -0.5* 1984-2018 -0.7* 1984-1997 -1.5*
          1997-2004 2.2
          2004-2018 -1.7*
Brain 1984-2006 -1.1* 1984-1995 -1.9* 1984-2006 -1.4*
  2006-2010 4.8 1995-2018 0.4 2006-2011 4.6
  2010-2018 -1     2011-2018 -1.3
Breast (female) n/a n/a n/a n/a 1984-1994 -0.8*
  n/a n/a n/a n/a 1994-2013 -2.5*
  n/a n/a n/a n/a 2013-2018 -0.7
Cervix n/a n/a n/a n/a 1984-2018 -2.6*
Colorectal 1984-2005 -1.6* 1984-2005 -1.5* 1984-2004 -1.8*
  2005-2018 -2.9* 2005-2018 -3.1* 2004-2018 -2.7*
Esophagus 1984-2000 0.5 1984-2001 0.8* 1984-2018 -0.9*
  2000-2018 -0.6* 2001-2018 -0.7*    
Hodgkin lymphoma 1984-2018 -3.4* 1984-2018 -3.5* 1984-2018 -3.3*
Kidney 1984-2008 -0.1 1984-2014 -0.3* 1984-2010 -0.3
  2008-2018 -1.9* 2014-2018 -4.8* 2010-2018 -2.9*
Larynx 1984-1988 3.2 1984-2001 -2* 1984-2018 -3.2*
  1988-2001 -2.5* 2001-2018 -4.5*    
  2001-2018 -4.2*        
Leukemia 1984-2018 -0.9* 1984-2018 -1* 1984-2018 -1*
Liver 1984-1994 4.7* 1984-1995 4.6* 1984-1991 6.3*
  1994-2008 1.8* 1995-2018 2.2* 1991-2008 1.4*
  2008-2012 5.6     2008-2013 6.6*
  2012-2018 0.5     2013-2018 -0.4
Lung 1984-1993 0.1 1984-1989 -0.3 1984-1999 2*
  1993-2010 -1* 1989-2011 -2.2* 1999-2010 -0.1
  2010-2018 -2.4* 2011-2018 -3.1* 2010-2018 -1.8*
Melanoma 1984-2014 1* 1984-2014 1.3* 1984-1995 2.1*
  2014-2018 -4 2014-2018 -4.7 1995-2018 -0.2
Myeloma 1984-1998 0.4 1984-2018 -0.7* 1984-1999 0.4
  1998-2018 -1.2*     1999-2018 -1.6*
Non-Hodgkin lymphoma 1984-1998 2.2* 1984-1999 2* 1984-1997 2.5*
  1998-2018 -1.8* 1999-2018 -1.7* 1997-2018 -2*
Oral cavity and pharynx 1984-2009 -1.9* 1984-2007 -2.3* 1984-2012 -1.6*
  2009-2018 1.7* 2007-2018 1.2* 2012-2018 2.8
Ovary n/a n/a n/a n/a 1984-1999 -0.9*
  n/a n/a n/a n/a 1999-2003 2.2
  n/a n/a n/a n/a 2003-2007 -4.6*
  n/a n/a n/a n/a 2007-2018 -1*
Pancreas 1984-2002 -0.8* 1984-2005 -1.2* 1984-2018 -0.1
  2002-2018 0.4* 2005-2018 1*    
Prostate n/a n/a 1984-1994 1.5* n/a n/a
  n/a n/a 1994-2014 -2.9*    
  n/a n/a 2014-2018 -1 n/a n/a
Stomach 1984-1993 -4* 1984-1993 -4.1* 1984-1997 -3.5*
  1993-2018 -2.2* 1993-2018 -2.5* 1997-2018 -1.8*
Testis n/a n/a 1984-2018 -2.3* n/a n/a
Thyroid 1984-2018 -0.1 1984-2018 0.9* 1984-2018 -0.7*
Uterus n/a n/a n/a n/a 1984-1993 -1.7
  n/a n/a n/a n/a 1993-2018 1.2*

Abbreviations: APC means annual percent change; n/a means not applicable.

Symbol: *Statistically significant trend.

Note: Rates are standardized to the 2011 Canadian Standard population

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Thirty-five year trend in mortality by cancer type

The age-standardized mortality rate from 1984 to 2018 for breast, colorectal, lung, oral cavity and pharynx, pancreatic, prostate and uterus cancers are shown in Figure 5.3. These cancers represent the 4 most common cancers, plus those with an increasing trend in mortality in recent years.

 

Note: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Figure 5.3A Age-standardized mortality rates by cancer type and sex, for the 4 most common cancers, Ontario, 1984 to 2018
Year of death Breast (female) Colorectal Prostate Lung
1984 43.6 38.8 37.5 61.9
1985 43.5 39.5 39.2 61.7
1986 44.5 38.3 38.8 60.5
1987 43.6 37.1 41.9 61.4
1988 42.6 38.1 42.9 64.2
1989 43.9 36.5 40.9 62.5
1990 41.3 34.9 41.2 62.2
1991 41 34.6 42.1 62.1
1992 40.8 34.3 44.3 61
1993 40.5 32.9 44.4 62.9
1994 41.5 32.9 44.1 62.1
1995 40.8 34.3 44 59.5
1996 39.5 32.8 41.9 59.8
1997 37.9 31.9 40.9 57.8
1998 34.4 30.9 40.4 58.8
1999 34.4 31.1 37.9 60.1
2000 35.7 31.1 37.2 57.7
2001 34.1 29.6 37.5 58.9
2002 33.4 30.4 36.4 57.6
2003 32.8 28.8 34.9 55.7
2004 32.3 28.5 34.4 55
2005 32 28.8 31.3 55
2006 29.2 26.4 31.8 55.9
2007 29.9 26.4 29.7 53
2008 28.2 26 29.9 52.7
2009 27.3 25.1 28.9 52.1
2010 26.9 23.6 29.2 52.7
2011 26.7 24.1 27.6 50.2
2012 25.7 22.7 26 50
2013 24.5 21.5 26.4 48.3
2014 25.1 21.9 25 47.6
2015 24.5 21 24.1 46.4
2016 25.2 20.6 24.8 44.8
2017 24.9 19.7 24.4 43.8
2018 23.6 19.3 24.2 43.1
Figure 5.3B Age-standardized mortality rates by cancer type and sex, for selected cancers, Ontario, 1984 to 2018
Year of death Pancreas Uterus Oral cavity and pharynx
1984 12.9 5.2 4.8
1985 13.5 5 5.4
1986 13.4 4.6 4.7
1987 13 5 5.1
1988 12.6 4.1 4.9
1989 12.7 4.7 4.9
1990 12 4.9 4.4
1991 12.1 4.2 4.3
1992 12.5 4.5 4.2
1993 12.5 4.2 3.9
1994 12.9 4.7 4
1995 11.5 4.2 4.5
1996 11.9 4.7 3.8
1997 11.7 4.4 4.1
1998 11.4 4.4 3.9
1999 11.4 4.7 3.8
2000 11.6 4.5 3.3
2001 11.9 4.7 3.6
2002 11.4 4.8 3.8
2003 11.8 5.1 3.2
2004 11.8 5 3.6
2005 11.3 5 3.5
2006 10.8 4.5 3.2
2007 11.8 5.2 3.4
2008 11.5 4.6 3.2
2009 11.8 5.4 3
2010 11 5.1 3.2
2011 11.8 5 3.3
2012 12.1 5.5 2.9
2013 12.3 5.7 3.6
2014 12.1 5.1 3.4
2015 12 5.8 3.4
2016 12.4 6 3.6
2017 12.1 5.5 3.5
2018 11.8 5.7 3.6

Note: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

From 1984 to 2018, the average annual percent change in the age-standardized mortality rate for males (Figure 5.4):

  • decreased for most types of cancer, including Hodgkin lymphoma (3.5% per year), laryngeal cancer (3.2%) and stomach cancer (2.9%)
  • increased for liver cancer (2.9% per year) and thyroid cancer (0.9% per year)
  • was stable for brain and esophageal cancers, as well as melanoma and non-Hodgkin lymphoma

Over the same period, the average annual percent change in the age-standardized mortality rate for females:

  • decreased for most types of cancer, including Hodgkin lymphoma (3.3% per year), and cervical (2.6%) and laryngeal (3.2%) cancers
  • increased for liver (2.9% per year) and lung (0.5%) cancers
  • was stable for bladder, brain, oral cavity and pharynx, pancreatic and uterine cancers, as well as non-Hodgkin lymphoma and melanoma

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

Notes:

  1. Rates are standardized to the age distribution of the 2011 Canadian Standard population.
  2. The average annual percent change for the following cancer types was not statistically significant among males: brain, esophagus, melanoma and non-Hodgkin lymphoma.
  3. The average annual percent change for the following cancer types was not statistically significant among females: bladder, brain, melanoma, non-Hodgkin lymphoma, oral cavity and pharynx, pancreas and uterus.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Figure 5.4 Average annual percent change in age-standardized mortality rates by cancer type and sex, Ontario, 1984 to 2018
Year of death Male Female
Liver 2.9 2.9
Melanoma 0.6 0.6
Thyroid 0.9 -0.7
Uterus   0.4
Non-Hodgkin lymphoma -0.1 -0.3
Esophagus 0.1 -0.9
Myeloma -0.7 -0.7
Kidney -0.9 -0.9
Brain -0.4 -0.5
Pancreas -0.4 -0.1
Bladder -0.7 -0.8
Leukemia -1 -1
Ovary   -1
All cancers -1.2 -0.8
Prostate -1.4  
Oral cavity & pharynx -1.2 -0.8
Breast (female)   -1.8
Lung -2.1 0.5
Colorectal -2.1 -2.2
Cervix   -2.6
Stomach -2.9 -2.4
Testis -2.3  
Larynx -3.2 -3.2
Hodgkin lymphoma -3.5 -3.3

Notes:

  1. Rates are standardized to the age distribution of the 2011 Canadian Standard population.
  2. The average annual percent change for the following cancer types was not statistically significant among males: brain, esophagus, melanoma and non-Hodgkin lymphoma.
  3. The average annual percent change for the following cancer types was not statistically significant among females: bladder, brain, melanoma, non-Hodgkin lymphoma, oral cavity and pharynx, pancreas and uterus.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Mortality rates across all age groups have been decreasing in recent decades. In younger people, they have decreased fairly equally for males and females. However, among people age 60 and older, the decreases in mortality have been greater among males (Figure 5.5).

Both Sexes APCs (Annual percentage change (%))

Ages 0 to 39
Period APC
1984-2006 -1.9*
2006-2018 -0.6
Ages 40 to 59
Period APC
1984-1989 -0.8
1989-2018 -2.1*
Ages 60 to 79
Period APC
1984-1988 0.7
1988-2001 -0.7*
2001-2018 -1.9*
Age 80 or older
Period APC
1984-2001 0.5*
2001-2018 -0.5*

Males APCs (Annual percentage change (%))

Ages 0 to 39
Period APC
1984-2018 -1.6*
Ages 40 to 59
Period APC
1984-2018 -2.1*
Ages 60 to 79
Period APC
1984-1988 0.7
1988-2001 -1.2*
2001-2014 -2.3*
2014-2018 -1.4*
Age 80 or older
Period APC
1984-2001 0.0
2001-2018 -1.0*

Females APCs (Annual percentage change (%))

Ages 0 to 39
Period APC
1984-2006 -1.9*
2006-2018 -0.2
Ages 40 to 59
Period APC
1984-2018 -1.9*
Ages 60 to 79
Period APC
1984-2002 -0.2
2002-2018 -1.7*
Age 80 or older
Period APC
1984-1992 -0.2
1992-2001 1.3*
2001-2018 -0.5*

Abbreviation: APC means annual percent change.
Symbol: *Statistically significant annual percent change.
Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

Figure 5.5A (Males and females combined)
Year of death AGE 80 AND OLDER AGES 60 TO 79 AGES 40 TO 59 AGES 0 TO 39
1984 1731.8 796.5 175.2 10.4
1985 1773.6 807.6 178.2 9.3
1986 1675.4 793.7 179.1 9.6
1987 1700.9 805.4 175.7 9.3
1988 1743.4 835.4 170.1 9.7
1989 1761.9 803.4 170.8 9.0
1990 1694.3 790.4 166.6 8.2
1991 1792.1 790.2 159.1 7.7
1992 1711.1 791.7 159.9 9.0
1993 1744.1 793.1 157.1 8.2
1994 1802.1 802.4 158.5 8.0
1995 1813.3 782.1 154.2 7.8
1996 1783.1 776.4 148.2 8.4
1997 1781.9 760.3 140.7 7.7
1998 1773.9 747.8 138.2 8.0
1999 1808.2 752.9 140.1 7.5
2000 1859.9 746.0 135.4 7.7
2001 1900.8 738.0 133.1 7.2
2002 1841.3 738.4 128.5 6.9
2003 1840.9 717.4 127.9 6.8
2004 1812.0 711.2 123.6 7.1
2005 1824.8 689.4 123.2 6.5
2006 1767.4 678.4 117.3 6.0
2007 1781.2 657.2 117.4 6.2
2008 1769.3 651.8 113.2 6.5
2009 1771.4 632.4 111.4 6.3
2010 1778.8 621.9 109.3 6.8
2011 1784.4 616.6 107.4 6.2
2012 1751.0 601.2 108.0 6.4
2013 1730.9 591.9 101.2 6.1
2014 1746.6 572.7 102.6 5.9
2015 1707.6 567.9 98.0 6.6
2016 1725.1 565.6 96.5 6.2
2017 1709.5 552.2 92.5 5.8
2018 1680.1 544.8 90.1 6.0
Figure 5.5B (Males)
Year of death AGE 80 AND OLDER AGES 60 TO 79 AGES 40 TO 59 AGES 0 TO 39
1984 2534.0 1054.9 180.1 9.7
1985 2662.7 1036.8 182.0 8.6
1986 2571.4 1029.1 182.6 9.5
1987 2570.2 1048.2 176.8 9.5
1988 2714.3 1097.1 173.8 9.2
1989 2683.7 1049.2 171.9 8.3
1990 2530.8 1027.8 172.9 7.5
1991 2728.6 1004.3 161.7 7.4
1992 2642.4 1011.0 160.8 8.7
1993 2601.9 996.8 160.0 7.5
1994 2706.3 1016.1 159.7 8.2
1995 2665.7 983.2 156.1 7.1
1996 2638.4 967.6 144.0 8.4
1997 2649.2 953.9 146.0 7.5
1998 2614.4 929.9 135.5 8.0
1999 2548.7 932.9 141.8 7.2
2000 2671.9 914.1 132.2 7.7
2001 2676.8 902.2 137.0 6.5
2002 2644.2 899.6 127.5 6.3
2003 2627.3 863.2 126.7 6.8
2004 2543.9 852.3 121.8 6.6
2005 2504.4 818.9 122.6 6.2
2006 2518.0 812.4 116.8 6.0
2007 2378.3 781.1 122.5 5.8
2008 2450.7 770.2 111.0 6.4
2009 2418.2 754.1 113.5 5.8
2010 2422.8 735.0 107.5 6.8
2011 2414.7 727.4 108.4 6.2
2012 2358.9 712.9 105.0 6.3
2013 2344.9 685.4 103.3 5.1
2014 2366.0 675.6 100.4 5.2
2015 2269.4 656.0 94.5 5.7
2016 2288.6 648.4 94.0 5.8
2017 2222.6 643.6 90.9 6.0
2018 2205.9 639.1 87.7 5.3
Figure 5.5C (Females)
Year of death AGE 80 AND OLDER AGES 60 TO 79 AGES 40 TO 59 AGES 0 TO 39
1984 1358.4 597.5 170.7 11.2
1985 1365 630.9 174.7 10
1986 1262.8 610.2 175.9 9.6
1987 1298.1 617.8 174.9 9
1989 1332.3 610.6 169.9 9.6
1991 1350.2 621.1 156.6 8
1992 1272.1 617.2 159 9.3
1993 1329.6 630.9 154.2 8.9
1994 1367.3 630.6 157.3 7.7
1995 1403.4 621.6 152.4 8.5
1996 1367.2 622.2 152.3 8.4
1997 1359.3 603.1 135.5 7.9
1998 1370.8 598.7 140.8 8
1999 1442.4 604.2 138.5 7.9
2000 1460.1 606.7 138.6 7.8
2001 1516.3 601.7 129.3 7.9
2002 1439.6 603.1 129.7 7.6
2003 1442.3 594.6 129.1 6.8
2004 1439.4 592.1 125.3 7.6
2005 1475.3 579.1 123.9 6.8
2006 1376.1 563.7 118 5.9
2007 1457.8 550.5 112.5 6.6
2008 1398.4 549.4 115.5 6.6
2009 1413.5 527.1 109.6 6.7
2010 1416.9 523.4 111.2 6.9
2011 1427.5 519.5 106.6 6.1
2012 1398.9 503.5 111 6.5
2013 1365.6 509.6 99.3 7.1
2014 1374 482.2 104.7 6.5
2015 1365.1 490 101.4 7.5
2016 1377.1 492.2 99 6.5
2017 1386.5 471.1 94 5.6
2018 1348.2 460.9 92.5 6.7

Abbreviation: APC means annual percent change.
Symbol: *Statistically significant annual percent change.
Notes: Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian Standard population.

Analysis by: Surveillance, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2020), Ontario Health (Cancer Care Ontario)

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 decreased by 1.6% per year from 1984 to 2018. Among females in this age group, mortality rates decreased by 1.9% per year from 1984 to 2006, and were stable from 2006 to 2018.

Age-standardized mortality rates among children with cancer (ages 0 to 14) decreased from 1991 to 2019 by an average of 1.2% per year (see Spotlight: Childhood Cancer Mortality Trend, Figure 5.S1).

Symbol: * Means significant changing APC
Abbreviation: APC means annual percent change

Notes:

  1. Rates are per 1,000,000.
  2. Includes cases diagnosed since 1986 to align with Pediatric Oncology Group of Ontario Networked Information System data capture.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario
Data source: Pediatric Oncology Group of Ontario Networked Information System (April 7, 2021), Pediatric Oncology Group of Ontario

Time Period APC (%)
1991-2019 -1.2*
Figure 5.S1: Annual percent change in age-standardized mortality rates of cancer in children, all cancers combined, ages 0 to 14, Ontario, 1991 to 2019
Year of death ASMR
1991 29.2
1992 33
1993 36.6
1994 36.3
1995 27
1996 33.7
1997 27.4
1998 29.8
1999 29.3
2000 25.3
2001 30.8
2002 27.9
2003 23.8
2004 33.4
2005 21.5
2006 25.6
2007 28.7
2008 20.3
2009 28.4
2010 26.2
2011 23
2012 23.5
2013 28.2
2014 22.5
2015 25.2
2016 22.1
2017 22.1
2018 26.9
2019 24.7

Symbol: * Means significant changing APC
Abbreviation: APC means annual percent change

Notes:

  1. Rates are per 1,000,000.
  2. Includes cases diagnosed since 1986 to align with Pediatric Oncology Group of Ontario Networked Information System data capture.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario
Data source: Pediatric Oncology Group of Ontario Networked Information System (April 7, 2021), Pediatric Oncology Group of Ontario

For more details on childhood cancer mortality trends, read the Pediatric Oncology Group of Ontario Surveillance Report.

Ages 40 to 59

For people ages 40 to 59, the mortality rate was stable until 1989, when it started to decrease by 2.1% per year until 2018. Similar trends were seen separately for males and for females.

Ages 60 to 79

Among people ages 60 to 79, the mortality rate was stable until 1988. The mortality rate then decreased by 0.7% per year from 1988 to 2001 and by 1.9% per year from 2001 to 2018. The rate of decrease in the most recent decades has been greater for males (2.3% per year from 2001 to 2014 and 1.4% per year from 2014 to 2018) than females (1.7% per year from 2002 to 2018).

Ages 80 and older

Mortality among people age 80 and older increased by 0.5% per year from 1984 to 2001 and then decreased by 0.5% per year from 2001 to 2018. The decrease in mortality was greater for males, at 1.0% per year from 2001 to 2018. Among females, the mortality rate increased by 1.3% from 1992 to 2001 and then decreased by 0.5% per year.

 

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