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Canadian
Cancer Statistics
2015
Special topic: Predictions of the future burden
of cancer in Canada
Produced by Canadian Cancer Society, Statistics Canada,
Public Health Agency of Canada, Provincial/Territorial Cancer Registries
cancer.ca/statistics
Citation
Material appearing in this publication may be reproduced or copied
without permission. However, the following citation must be used
to indicate the source: Canadian Cancer Society’s Advisory
Committee on Cancer Statistics. Canadian Cancer Statistics 2015.
Toronto, ON: Canadian Cancer Society; 2015.
[May 2015, adapted June 2015]
ISSN 0835-2976
This publication is available in English and French on the Canadian
Cancer Society’s website at cancer.ca/statistics. Please visit the
website for the most up-to-date version of this publication and
additional resources, such as individual figures from the publication
and an archive of previous editions.
The development of this publication over the years has benefited
considerably from the comments and suggestions of readers. The
Advisory Committee appreciates and welcomes such comments. To
be notified about next year’s publication or to offer ideas on how
the publication can be improved, please complete the evaluation
form or email [email protected]
Canadian Cancer Society
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Canadian Cancer Statistics 2015
2
Members of the Canadian Cancer
Statistics Advisory Committee
Gillian Bromfield, MSc (Chair)
Ryan Woods, MSc
Cancer Control Policy, Canadian Cancer Society,
Toronto, Ontario
Cancer Control Research, BC Cancer Agency,
Vancouver, British Columbia
Darlene Dale, BASc, FHA
Analytic and statistical support
Princess Margaret Cancer Registry, Princess Margaret
Cancer Centre, Toronto, Ontario
Lin Xie, MSc (Statistics), MSc (MIS)
Prithwish De, PhD
Surveillance and Cancer Registry, Cancer Care
Ontario, Toronto, Ontario
Kim Newman, MA
Health Statistics Division, Statistics Canada, Ottawa,
Ontario
Rami Rahal, BSc, MBA
Larry Ellison, MSc
Health Statistics Division, Statistics Canada, Ottawa,
Ontario
Amanda Shaw, MSc
Formerly – Centre for Chronic Disease Prevention,
Public Health Agency of Canada, Ottawa, Ontario
Division of Cancer Prevention and Control, Centers
for Disease Control and Prevention, Atlanta, Georgia
Canadian Cancer Statistics 2015
Centre for Chronic Disease Prevention, Public Health
Agency of Canada, Ottawa, Ontario
The analysts were supported by:
Hannah K. Weir, PhD
n
Alain Demers, PhD
System Performance and Surveillance, Canadian
Partnership Against Cancer, Toronto, Ontario
Centre for Chronic Disease Prevention, Public Health
Agency of Canada, Ottawa, Ontario
Canadian Cancer Society
Centre for Chronic Disease Prevention, Public Health
Agency of Canada, Ottawa, Ontario
Robert Semenciw, MSc
Review of French translation:
Jean-Marc Daigle, MSc
Institut national de santé publique du Québec, Québec,
Québec
3
Table of Contents
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
About this publication . . . . . . . . . . . . . . . . . . . . . . . . 8
Purpose and intended audience . . . . . . . . . . . . . . . .
Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis and production . . . . . . . . . . . . . . . . . . . . . .
A note on data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Actual and estimated data . . . . . . . . . . . . . . . . . . . .
8
8
8
8
9
Introduction
Cancer in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
CHAPTER 1
Incidence: How many people in Canada get
cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Probability of developing cancer . . . . . . . . . . . . . .
New cases of cancer in 2015 . . . . . . . . . . . . . . . . . .
Trends over time . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trends for selected cancers . . . . . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
Canadian Cancer Society
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Canadian Cancer Statistics 2015
16
16
16
17
18
19
22
CHAPTER 2
Incidence by sex, age and geography: Who gets
cancer in Canada? . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Incidence by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Incidence by age . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Children, adolescents and young adults . . . . . . . .
Incidence by geographic region . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
29
29
29
29
30
31
33
CHAPTER 3
Mortality: How many people in Canada
die of cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Probability of dying from cancer . . . . . . . . . . . . . .
Deaths from cancer in 2015 . . . . . . . . . . . . . . . . . .
Trends over time . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trends for selected cancers . . . . . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
38
38
38
39
40
41
44
4
Table of Contents
CHAPTER 4
Mortality by sex, age and geography:
Who dies of cancer in Canada? . . . . . . . . . . . . . . . 51
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mortality by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mortality by age . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cancer deaths among adolescents and
young adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mortality by geographic region . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
51
51
51
52
52
54
55
CHAPTER 5
Relative survival: What is the likelihood of
surviving cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Five-year relative survival . . . . . . . . . . . . . . . . . . . .
Five-year conditional relative survival . . . . . . . . .
Five-year childhood cancer (0–14 years) survival . . .
International comparison . . . . . . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
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Canadian Cancer Statistics 2015
60
60
61
63
64
64
64
CHAPTER 6
Prevalence: How many people diagnosed with
cancer are alive today? . . . . . . . . . . . . . . . . . . . . . . . 70
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tumour-based prevalence . . . . . . . . . . . . . . . . . . . .
Person-based prevalence . . . . . . . . . . . . . . . . . . . . .
What do these statistics mean? . . . . . . . . . . . . . . .
70
70
71
72
73
CHAPTER 7
Special topic: Predictions of the future burden
of cancer in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Projected trends in population . . . . . . . . . . . . . . . .
Projected trends in cancer incidence counts
and rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The influence of selected risk factors and
interventions on the burden of cancer . . . . . . . . .
Comparisons of projections to other countries . .
What do these statistics mean? . . . . . . . . . . . . . . .
78
79
80
81
90
94
95
APPENDIX I
Actual data for new cases and deaths . . . . . . . . 107
Appendix II
Data sources and methods . . . . . . . . . . . . . . . . . . 117
Data sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Data and methods issues . . . . . . . . . . . . . . . . . . . . 124
APPENDIX III
Previous special topics, abbreviations and
index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Previous special topics . . . . . . . . . . . . . . . . . . . . . 142
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Index of tables and figures . . . . . . . . . . . . . . . . . . 144
For further information . . . . . . . . . . . . . 147
Partner organizations . . . . . . . . . . . . . . . . . . . . . . 147
Canadian Council of Cancer Registries . . . . . . . 148
Canadian Cancer Society offices . . . . . . . . . . . . . 150
5
Executive summary
Canadian Cancer Statistics is an annual publication
that provides estimates of the burden of cancer in
Canada for the current year.
About 2 in 5 Canadians will develop cancer in their
lifetime, and about 1 in 4 Canadians will die of cancer.
In 2015, it is estimated that 196,900 Canadians will
develop cancer, and 78,000 will die of cancer. More
than half of new cancer cases (51%) will be lung,
breast, colorectal and prostate cancer. Lung cancer is
the leading cause of cancer death, causing more cancer
deaths among Canadians than the other three major
cancer types combined. Despite this large impact, there
has been a substantial drop in the lung cancer death
rate (especially for men) over the past 25 years, which
has driven a decline in the overall cancer death rate.
Slightly more men than women get cancer in Canada,
and the vast majority (89%) of Canadians who develop
cancer are over the age of 50. However, cancer can
occur at any age. Its impact at a younger age can be
particularly devastating. According to Statistics
Canada, in 2011, cancer was the leading cause of
disease-related death in children under the age of 15
years.
Overall, the five-year relative survival ratio for people
diagnosed with cancer is 63%, but it ranges widely by
the type of cancer. Some cancers have very high
five-year relative survival ratios, including thyroid
cancer (98%). Other cancers have consistently low
five-year relative survival ratios, such as pancreatic
cancer (8%).
Canadian Cancer Society
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Canadian Cancer Statistics 2015
810,045
Canadians were alive at
the beginning of 2009
with a cancer diagnosed
in the previous
10 years
63
%
The likelihood, in
Canada, of surviving at
least 5 years after a cancer
diagnosis compared to the
survival of comparable
people in the general
population
2 in 5
Canadians will
develop cancer in
their lifetime
196,900
Canadians will be diagnosed
with cancer in 2015
78,000
Canadians
will die of cancer
in 2015
1 in 4
Canadians will die
from cancer
6
Executive Summary
As of January 2009, 810,045 Canadians had been
diagnosed with cancer within the previous 10 years and
were still alive on that date. This means that about 2.4%
of the Canadian population was living with, or beyond,
a cancer diagnosis in the decade leading up to 2009.
This year’s publication also features the future burden
of cancer in Canada (Chapter 7: Special topic:
Predictions of the future burden of cancer in Canada).
The chapter is focused on cancer incidence up to 2032
and also considers the impact of changing risk factor
prevalence and the economic impact of selected
interventions. From 2003 to 2007 to 2028 to 2032, the
average annual Canadian population is predicted to
grow by 29%, but the proportion of Canadians (65+) is
predicted to increase significantly as well, from 13% in
2003 to 2007 to 22% in 2028 to 2032.
By 2028 to 2032, the average annual number of new
cancer cases is estimated to increase 79% compared to
2003 to 2007. The increase in the number of new
cancer cases is primarily due to the aging Canadian
population and, to a lesser extent, population growth
and changes in the risk of developing cancer. The sheer
number of expected cancer cases is yet another reason
Canadian Cancer Society
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Canadian Cancer Statistics 2015
for highlighting the importance of prevention and
planning for additional health resources for managing
the future burden of cancer in Canada. Despite the
increase in the number of new cases, the agestandardized incidence rate (a measure of cancer risk)
is expected to decline somewhat in males (from 465 to
443 per 100,000) but increase in females (from 358 to
371 per 100,000).
Measuring the cancer burden in Canada is vital for
health policy, and it helps decision-makers assess the
type and allocation of health resources needed. The
data are also essential in focusing prevention efforts, in
both primary prevention of cancer and secondary
prevention, and allowing more effective treatment of
certain cancers through earlier detection. Finally, these
statistics can be useful for prioritizing services to help
Canadians and their families who have been affected
by cancer and who may need supportive care after
their treatment has ended. We hope that our readers
think critically about what these numbers mean and
how they can be used to improve survival, develop
better overall care for those with cancer and reduce
cancer incidence in Canada.
7
About this publication
Canadian Cancer Statistics is part of an annual series
that began in 1987. It has been developed by cancer
surveillance experts on the Canadian Cancer Statistics
Advisory Committee who were brought together by
the Canadian Cancer Society, the Public Health
Agency of Canada and Statistics Canada. In addition to
these organizations, members of this committee are
from the Canadian Council of Cancer Registries,
Canadian Partnership Against Cancer and the US
Centers for Disease Control and Prevention, as well as
researchers based in universities and provincial or
territorial cancer agencies.
Purpose and intended audience
The aim of this annual publication is to provide
detailed information regarding incidence, mortality,
survival and other measures of cancer burden for the
most common types of cancer. Data are presented by
sex, age, province and territory. Trends over time are
also examined. The publication is designed to help
health professionals, policy-makers and researchers
identify and make decisions about new areas for
investigation. The media, educators and members of
the public with an interest in cancer may also find this
publication valuable.
Format
This publication is organized as follows:
• The Introduction provides an overview of cancer in
Canada by describing the health and economic
challenges posed by the disease, the potential role
prevention can play in addressing the cancer burden
and the value of surveillance in cancer control efforts
in Canada.
Canadian Cancer Society
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• Chapters 1 and 2 describe the incidence of cancer in
Canada overall by age, sex, province and over time.
• Chapters 3 and 4 examine the mortality associated with
cancer in Canada by age, sex, province and over time.
• Chapter 5 (mostly a repeat from 2014 edition) focuses
on survival for cancer relative to the survival in the
general population, in Canada by age, sex, province
over time and international comparison.
• Chapter 6 (a repeat from 2014 edition) describes the
prevalence of cancer in Canada by examining the
number of cancer cases and the number of people
diagnosed with cancer who are still alive.
• Chapter 7 is a special topic that explores the future
burden of cancer in Canada. Changes in cancer
incidence by age, sex and region are projected to
2028–2032. Changes in cancer prevalence as well as
the economic impacts of selected interventions are
also considered. In future editions, this chapter will
feature other emerging or prominent issues related to
cancer, which are selected annually based on criteria
that include data availability, recent trends and
feedback from our readers through evaluation forms.
• The appendices provide the actual (not projected)
data for new cancer cases and deaths, as well as
additional information on data sources and
projection methods. They also discuss caveats to the
analyses presented in this publication and provide a
listing of previously covered special topics, which are
available in past editions.
• The last section of this publication (For further
information) includes contact information for the
organizations leading the development of the publication
and the provincial and territorial cancer registries.
The Introduction and Chapters 1 to 7 conclude with a
list of other relevant resources, including links to
online databases for additional analyses.
Analysis and production
The Surveillance and Epidemiology Division of the
Centre for Chronic Disease Prevention (CCDP) at the
Public Health Agency of Canada conducted the data
analyses on incidence, mortality, probability and
trends presented in this publication. Provincial and
territorial cancer registries were consulted regarding
the cancer incidence and mortality estimates for their
own jurisdictions. The Health Statistics Division of
Statistics Canada conducted the analyses on survival
and prevalence presented in this publication. However,
updated survival and prevalence data were not
available for this edition, and the analyses included
here (Chapters 5 and 6) are repeated from the 2014
edition, with the exception of a section on
international comparison (Chapter 5). As such, the
analytical techniques used and the interpretation of the
results included reflect the state of knowledge at the
time of the production of the 2014 edition. It was
decided to include these chapters again to ensure a
complete publication.
The Canadian Cancer Society supports the production
of this publication with charitable funds. Ms Monika
Dixon coordinated the production process and
provided administrative support from the initial
planning through to release.
A note on data
The main sources of data for this publication are the
Canadian Cancer Registry (CCR), National Cancer
8
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
About this publication
Incidence Reporting System (NCIRS), Canadian Vital
Statistics – Death database (CVS: D) and population
life tables, censuses and forecasts.
• Provincial and territorial cancer registries collect
clinical and demographic data on newly diagnosed
cancer cases for people residing in the province or
territory. These data are reported annually to
Statistics Canada and added to the CCR.
• Provincial and territorial registrars of vital statistics
collect demographic and cause-of-death information
for people who die in their province or territory.
These data are reported annually to Statistics Canada
and added to the CVS: D.
• Cancer cases included in the analysis include only
invasive primary cancers (with the exception of
in situ bladder, which is considered invasive for
surveillance reporting) and are defined according to
ICD-O-3(1) and ICD-10(2) classifications, unless
otherwise noted.
• Non-melanoma skin cancers (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous)
are not included because most provincial and territorial
cancer registries do not collect incidence data on this
type of cancer. Canada-wide non-melanoma skin
cancer estimates are based on data from four provinces
only and are shown in select tables.
• This publication examines approximately 20 cancer
types, which represent the vast majority of cancers
that occur in Canada. Information on cancer types
not covered here may be found through reports and
Canadian Cancer Society
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Canadian Cancer Statistics 2015
databases from Statistics Canada and the Public
Health Agency of Canada.
Actual and estimated data
This publication strives to provide the most up-to-date
data. However, because time is required for reporting,
collating, verifying, analyzing and publishing
surveillance data, the most recent information available
is several years behind the current year. Actual cancer
incidence data reported in this publication are for the
period 1986 to 2010. Data for 1992 to 2010 were
obtained from the CCR, except for Quebec data from
2008 to 2010, which were received in a summary format
from the Quebec Cancer Registry. Actual cancer
mortality data are for the period 1986 to 2010 for all
provinces and territories obtained from the CVS: D.
Short-term statistical projections provide an estimate of
cancer incidence and mortality for recent years (see
Appendix II: Data sources and methods). Incidence and
mortality are projected for each year from 2011–2015
for all provinces and territories.
Tables A1 and A2 list a larger number of cancer types
than other tables in the publication. In addition, Tables
A3 to A6 provide actual incidence and mortality
counts and age-standardized rates for selected cancers
by province and territory. Because of the small
populations of the territories, only five-year averages
(2006 to 2010 for both incidence and mortality) are
provided.
For information on how to access the most recent
available data, refer to the additional sources of
information listed at the end of each chapter or contact
the respective cancer registries (see a list of Canadian
Cancer Registries).
References
1. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin D, et al., eds. International
Classification of Diseases for Oncology. Third Edition. Geneva, Switzerland: World Health
Organization; 2000.
2. World Health Organization. International Statistical Classification of Diseases and Related
Health Problems, Tenth Revision. Volumes 1 to 3. Geneva, Switzerland: World Health
Organization; 1992.
Because the CCR is a dynamic database, estimates may
be updated as new data become available. Projected
data are derived using statistical models; therefore,
they should be considered as estimates only and
viewed with caution. Moreover, models can produce
estimates that vary considerably from year to year. For
this reason, using the estimates to track year-to-year
changes (such as comparing estimates to those from
prior editions of this publication) can be misleading
and is discouraged.
9
Introduction
Cancer in Canada
Almost half of all Canadians will develop cancer in
their lifetime, and a quarter of all Canadians are
expected to die of the disease. Cancer is the leading
cause of death in Canada (Figure A), responsible for
nearly 30% of all deaths, followed by cardiovascular
diseases (heart disease and cerebrovascular diseases)
and chronic lower respiratory diseases.(1)
Cancer is also the leading cause of premature death, as
measured by potential years of life lost (PYLL). PYLL
provides an alternative measure to death rates by
taking into account average life expectancy and giving
more weight to deaths that occur among younger
people. In 2010, cancer represented approximately 40%
of the PYLL compared to other leading causes of
premature death in Canada (Figure B). Generally,
PYLL is higher for cancers that are more common,
have an earlier age of onset and more quickly lead to
death. In both sexes combined, lung cancer was
responsible for 27% of the premature deaths caused by
cancer (see online Table W1). With regard to the most
common cancers in women and men, the PYLL from
female breast cancer (94,000) far exceeded that from
prostate cancer (35,500), reflecting the relatively
younger age at which women die from breast cancer.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
FIGURE A Proportion of deaths due to cancer and other causes, Canada, 2011
Other
25.0%
Cancer
29.9%
Kidney disease 1.4%
Suicide 1.5%
Influenza and pneumonia 2.4%
Alzheimer’s disease 2.6%
Heart disease
19.7%
Diabetes 3.0%
Accidents 4.4%
Chronic lower
respiratory diseases
4.6%
Cerebrovascular
diseases
5.5%
Note: The total of all deaths in 2011 in Canada was 242,074.
Adapted from: Statistics Canada. Leading Causes of Death in Canada, 2011, CANSIM Table 102-0522
10
Introduction
Although many individuals who survive a cancer
diagnosis continue to live productive and rewarding
lives, the cancer experience presents many physical,
emotional and spiritual challenges that can persist long
after the disease is treated. In addition to being
personally costly, cancer has major economic
ramifications on Canadian society at large. It is difficult
to obtain reliable measures of the true cost of cancer.
Several analyses attempt to quantify this for Canada
and have produced a wide range of estimates.
According to one such analysis by the Public Health
Agency of Canada, in 2008, cancer was the 7th most
costly illness or injury in Canada accounting for
$4.4 billion in economic costs. This includes
$3.8 billion in direct healthcare costs (includes
hospital, drug and physician costs) and $586 million in
indirect costs from lost productivity due to illness or
premature death. Cancer is the costliest illness in terms
of lost productivity due to death; the value of lost
productivity due to cancer death was estimated to be
$166 million, representing 36.6% of the overall value of
lost productivity due to death for all illnesses and
injuries included in this analysis.(2) As described in
Chapter 7: Predictions of the future burden of cancer in
Canada, there will be an increasing number of cancers
related to the growing and aging population,
highlighting the importance of disease prevention
measures and planning for additional health resources.
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Canadian Cancer Statistics 2015
FIGURE B Selected causes of death and their associated potential years of life lost (PYLL), Canada, 2010
Cancer
Males
Heart disease
Non-motor vehicle accidents
Respiratory disease
Females
Suicide
Motor vehicle accidents
Cerebrovascular disease
Perinatal causes
Diabetes
Cirrhosis
Congenital anomalies
HIV
Note: Figures are displayed in
decreasing order of total PYLL for
both males and females combined
and are calculated based on life
expectancy based on 2008–2010
all-cause mortality rates.
600 500 400 300 200 100 0 100 200 300 400 500 600
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
11
Introduction
Despite these ongoing challenges, much progress has
been made in the fight against cancer. Today, more is
known about what causes cancer, how it develops and
how best to treat it. More is also known about how we
can improve the quality of life of people living with
cancer and cancer survivors, as well as the lives of their
families and caregivers. One example of progress is
seen in the drop in the cancer mortality rate. It is
estimated that since 1988 when the cancer mortality
rate peaked in Canada, over 143,000 deaths have been
avoided (Figure C) as a result of cancer prevention and
control efforts. Many of the avoided deaths were
related to lung and breast cancers. Over 23,000 deaths
were avoided (mainly in men) since the lung cancer
death rate peaked in 1988, largely reflecting the control
of tobacco use among Canadians. Over 26,000 deaths
have been avoided since the female breast cancer death
rate peaked in 1986, reflecting, in part, the role of
breast cancer screening in women and advances in
breast cancer treatment (see Chapter 3 for further
details).
Cancer surveillance can help inform cancer prevention
and control. Canada is one of the few nations in the
world with a national population-based cancer registry
that covers the entire population. The information
gained from the national and provincial cancer
registries is valuable for monitoring cancer patterns
and serves as a source of data for cancer control
planning, healthcare resource allocation and research.
Surveillance data are also essential to help focus both
primary prevention efforts (through reducing risk
factors and promoting protective factors) and
secondary prevention efforts (which have the goal of
improving survival through the earlier detection of
cancers and treatment of cancer precursors). To this
end, the annual Canadian Cancer Statistics publication
aims to provide the most current summary of key
cancer surveillance indicators.
FIGURE C Number of cancer deaths avoided* since the cancer mortality rate peaked in Canada for all cancers combined, lung and female breast cancers
100
All cancers, 1989–2010
25
Lung cancer, 1989–2010
8
90
70
Deaths (in thousands)
Deaths (in thousands)
20
60
50
40
30
7
23,164 lung cancer deaths avoided
15
10
4
3
1
10
0
1980
5
2
5
20
26,448 breast cancer deaths avoided
6
Deaths (in thousands)
143,424 cancer deaths avoided
80
Female breast cancer, 1987–2010
1985
1990
1995
2000
2005
2010
Year of death
0
1980
1985
1990
1995
2000
Year of death
2005
2010
0
1980
1985
1990
1995
2000
2005
2010
* For overall and lung cancer
deaths, the orange line represents
the number of deaths that would
have occurred if the death rate had
remained the same as in 1989. For
breast cancer deaths, the orange
line represents the number of
deaths that would have occurred if
the death rate had remained the
same as in 1987.
Year of death
Observed deaths
Observed deaths
Observed deaths
Expected deaths
Expected deaths
Expected deaths
Analysis by: Canadian Cancer Society
Data source: Canadian Vital Statistics Death database at Statistics Canada
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12
Introduction
Data from the Canadian Cancer Statistics show that
Canada compares favourably to other countries on
several measures, such as relative survival and
mortality rates. Comparable cancer indicators for
different countries can be found through various
international resources, including the GLOBOCAN
database,(3) the Cancer Incidence in Five Continents
publication,(4) the International Cancer Benchmarking
Partnership(5) and the CONCORD studies on cancer
survival.(6)
The World Health Organization suggests that prevention
offers the most cost-effective, long-term strategy for
controlling cancer and other non-communicable
diseases.(7) Reducing the risk of cancer can be achieved
through the following approaches, among other
measures:
• Avoiding smoking – Tobacco is responsible for
nearly one-quarter of cancer deaths worldwide,
making it the single greatest avoidable risk factor for
cancer.(7)
• Following a healthy lifestyle – Eating a diet high in
vegetables, fruit and fibre and low in red and
processed meat, maintaining a healthy body weight
and being physically active can prevent about
one-third of the 12 major cancers worldwide,
according to the American Institute for Cancer
Research and the World Cancer Research Fund.(8,9)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
• Reducing alcohol consumption – Alcohol is a risk
factor for many different types of cancer, and the risk
of cancer increases with the amount of alcohol
consumed.(7)
• Avoiding overexposure to sunlight and not using
tanning beds or sun lamps – Limiting time in
midday sun, wearing protective clothing, seeking
shade and using sunscreen can help reduce the risk
of skin cancer, while still allowing people to receive
the health benefits of sun exposure.(7) Indoor tanning
does not provide a safe alternative to the sun and
should be avoided.
• Avoid infections, environmental and occupational
carcinogens – Certain vaccines, testing and
awareness can help reduce, respectively, the risk of
some infections associated with cancer (e.g., human
papillomavirus and hepatitis B and C), environmental
causes of cancer (e.g., radon) and occupational
carcinogens (e.g., industrial chemicals).(7)
Increases in the number of new cancer cases in Canada
over the past 30 years can largely be attributed to the
aging and growing population. In Figure D, the lowest
solid line represents the total number of new cancer
cases or cancer deaths that would have occurred each
year if the population size and age structure remained
the same as they were in 1986. Thus, this line measures
the effect of changes in cancer risk and cancer control
practices. There is very little change in cancer
incidence as a result of changes in cancer risk or in
cancer control practices. The uppermost line
represents the number of new cases or deaths that
actually occurred once the impact of population
growth and aging are taken into account. According to
Statistics Canada, the average annual Canadian
population is projected to increase from 32.3 million
in 2003 to 2007 to almost 42 million people by 2028 to
2032 (in a medium-growth scenario). The average
annual number of Canadians aged 65+ is expected to
more than double, from 4.2 million in 2003 to 2007 to
9.4 million in 2028 to 2032 (for population calculation
method, see Appendix II: Data sources and methods).
With such population factors expected to continue into
the foreseeable future, the Canadian healthcare system
is expected to face greater demand for cancer
screening as well as diagnostic and treatment services.
13
Introduction
FIGURE D Trends in new cases and deaths for all cancers and ages, attributed to changes in cancer risk and cancer control practices, population growth and aging of the population, both sexes, Canada, 1986–2015
Incidence
110
110
45
100
100
40
90
90
80
80
Aging population
70
60
70
Population growth
50
(1986 cancer count)
Changes in cancer risk
and cancer control practices
30
25
20
20
10
20
10
0
0
1986
1990
1995
2000
2005
2010
30
25
Population growth
(1986 cancer death)
20
Changes in cancer risk
and cancer control practices
10
5
15
10
5
0
0
1986
Incidence
New cases (in thousands)
35
Aging population
15
2015
1990
1995
2000
2005
2010
2015
Mortality
Deaths (in thousands)
110
110
45
45
100
100
40
40
90
90
35
35
70
60
70
Population growth
(1986 cancer count)
Changes in cancer risk
and cancer control practices
30
20
10
1986
1990
1995
2000
2005
2010
25
50
20
30
20
0
2015
30
60
40
Estimated
50
40
80
Aging
population
Females
30
Aging population
25
Population growth
20
(1986 cancer death)
15
Changes in cancer risk
and cancer control practices
10
10
5
0
0
15
Estimated
80
Males
40
30
50
30
45
35
60
40
Estimated
40
Mortality
Deaths (in thousands)
Estimated
New cases (in thousands)
10
5
0
1986
1990
1995
2000
2005
2010
2015
Note: New cases exclude
non-melanoma skin cancer
(neoplasms, NOS; epithelial
neoplasms, NOS; and basal and
squamous). Actual incidence and
mortality data were available up to
the year 2010. The range of scales
differs between the figures.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System, Canadian Vital Statistics Death databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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14
Introduction
For more information
References
• North American Association of Central Cancer Registries.
Cancer in North America: 2007–2011. Available at:
http://www.naaccr.org/DataandPublications/CINAPubs.aspx
(accessed Jan. 16, 2015).
1. Statistics Canada. Leading Causes of Death in Canada, 2011. Ottawa: Statistics Canada;
2014.
2. Public Health Agency of Canada 2014. Economic Burden of Illness in Canada,
2005–2008. Ottawa. Available at: http://www.phac-aspc.gc.ca/ebic-femc/index-eng.php
(accessed, Dec. 22, 2014).
3. International Agency for Research on Cancer. GLOBOCAN 2012. Available at:
http://globocan.iarc.fr/ (accessed Dec. 22, 2014).
4. Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, SteliarovaFoucher E, Swaminathan R and Ferlay J, eds (2013). Cancer Incidence in Five Continents,
Vol. X (electronic version) Lyon, IARC. Available at: http://ci5.iarc.fr/ (accessed Dec. 22, 2014).
5. International Cancer Benchmarking Partnership. Available at: http://www.
cancerresearchuk.org/cancer-info/spotcancerearly/ICBP/ (accessed Dec. 22, 2014).
6. Global Surveillance of Cancer Survival: The CONCORD Programme. Available at:
http://www.lshtm.ac.uk/eph/ncde/cancersurvival/research/concord/concord_2.html
(accessed Dec. 22, 2014).
7. World Health Organization. Cancer Prevention. Available at: http://www.who.int/cancer/
prevention/en/index.html (accessed Dec. 22, 2014).
8. World Cancer Research Fund/American Institute for Cancer Research (AICR). Continuous
Update Project Interim Report Summary. Food, Nutrition, Physical Activity and the
Prevention of Colorectal Cancer. Washington, DC: AICR; 2011.
9. World Cancer Research Fund/American Institute for Cancer Research (AICR). Policy and
Action for Cancer Prevention: Food, Nutrition, and Physical Activity. Washington, DC:
AICR; 2009.
• Canadian Partnership Against Cancer (2014). The 2014 Cancer
System Performance Report. Toronto: Canadian Partnership
Against Cancer. Available at: http://www.cancerview.ca/idc/
groups/public/documents/webcontent/sp_report_2014.pdf
(accessed Jan. 16, 2015)
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15
CHAPTER 1
Incidence: How many people in Canada get cancer?
Highlights
Introduction
• It is expected that 2 in 5 Canadians will develop
cancer in their lifetimes. Males have a 45% lifetime
probability (or a 1 in 2.2 chance) of developing
cancer. Females have a 42% lifetime probability (or a
1 in 2.4 chance) of developing cancer.
• An estimated 196,900 new cases of cancer are
expected to be diagnosed in Canada in 2015. More
than half of these cases (51%) will be lung, breast,
colorectal and prostate cancers.
• From 2001 to 2010, the overall age-standardized
incidence rate rose by 0.5% per year for females and
decreased by 0.7% per year for males.
• Some of the overall increase in the incidence rate is
related to increased detection, while decreases
correspond in part to previous declines in major risk
factors, such as tobacco use.
• Since 2006, lung cancer incidence in females is no
longer increasing.
• Increases in the number of new cases over the past
30 years can largely be attributed to a growing and
aging population, rather than to an increase in
cancer risk. Given current population trends,
increases in cancer incidence are expected to
continue. Increases in incidence have implications
for screening, diagnostic and treatment services.
Each hour, an estimated 22 people will be diagnosed
with cancer in Canada in 2015. The number of new
cases of cancer each year (the incidence) is an
important measure of cancer burden on the Canadian
population and healthcare system. Trends in incidence
rates can be used to predict the future burden of
cancer. This information is essential in ensuring
adequate screening, diagnostic and treatment services,
as well as directing future cancer prevention, control
and research programs.
Probability of developing cancer
of people in Canada and does not take into account
individual behaviours and risk factors.
The Canadian population is aging.(1) Like many other
developed countries, Canada now has a greater
proportion of people who are over 65 years of age.
Seniors represent the fastest-growing age group in
Canada. As a result, it is expected that a growing
number of people will be diagnosed with diseases
related to aging, such as cancer.
In Canada, 1 in 2.2 males and 1 in 2.4 females
(approximately 2 in 5 Canadians) are expected to
develop cancer in their lifetime (Figure 1.1).
The probability of developing a specific type of cancer
depends on many factors, including the population
characteristics (e.g., demographics), prevalence of risk
factors (e.g., smoking, obesity), life expectancy and
others. This probability reflects the average experience
FIGURE 1.1 Lifetime probability of developing cancer, Canada, 2010
Males
Females
45%
(1 in 2.2)
42%
(1 in 2.4)
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, Vital Statistics Death databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
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CHAPTER 1
n
Incidence: How many people in Canada get cancer?
New cases of cancer in 2015
Probability
The chance a person has of developing cancer
measured over a period of time. The data here are
presented over a lifetime, but probability can also
be calculated as the chance of developing cancer at
a specific point in time, such as by age 30 or over
the next 10 years. The probability of developing
cancer is expressed as a percentage or as a chance
(e.g., a 1 in 5 chance).
The probability of developing cancer varies by cancer
type for males and females.
• As shown in Table 1.1, Canadian males are most
likely to develop prostate cancer, with 1 in 8 males
expected to be diagnosed with prostate cancer in
their lifetime. After prostate cancer, males have the
highest probability of developing lung cancer, with 1
in 12 males expected to be diagnosed in their
lifetime, followed by colorectal cancer, with 1 in 14
males expected to develop colorectal cancer in their
lifetime.
• Canadian females are most likely to develop breast
cancer, with 1 in 9 females expected to develop
breast cancer in their lifetime. One in 15 females is
likely to be diagnosed with lung cancer, and 1 in 16
females is likely to be diagnosed with colorectal
cancer during their lifetime.
FIGURE 1.2 Percent distribution of estimated new cancer cases, by sex,
An estimated 196,900 new cases of cancer, as well as an Canada, 2015
estimated 78,300 new cases of non-melanoma skin
cancers (neoplasms, neoplasms of the skin (NOS);
epithelial neoplasms, NOS; and basal and squamous),
are expected to be diagnosed in 2015 (Table 1.2).
Males
Males
• Four cancers – prostate, breast, lung and colorectal –100,500 100,500
New cases
New cases
together are expected to account for more than half
(51%) of all cancers diagnosed in Canada in 2015.
Prostate23.9%
Colorectal13.9%
• As shown in Figure 1.2, the leading cancers are
Lung13.5%
prostate cancer for males (24,000 expected new
Bladder6.1%
cases, or 24% of all new male cases) and breast
Non-Hodgkin lymphoma 4.5%
Kidney3.9%
cancer for females (25,000 expected new cases, or
Melanoma3.6%
26% of all new female cases).
Leukemia3.5%
• In males, colorectal cancer is now the second most
Oral2.9%
common cancer followed by lung cancer, each
Pancreas2.4%
Stomach2.1%
accounting for approximately 14% of all new male
Brain/CNS1.7%
cases. In females, lung cancer is the second most
Esophagus1.7%
common cancer, representing 14% of all new female
Liver1.7%
cases followed by colorectal cancer representing
Multiple myeloma
1.5%
Thyroid1.4%
approximately 12% of all new female cases.
Testis1.0%
Larynx0.9%
Hodgkin lymphoma
0.5%
Breast0.2%
All other cancers
9.0%
Females
Females
New cases
New cases
96,400 96,400
Breast25.9%
Lung13.5%
Colorectal11.5%
Body of uterus
6.5%
Thyroid5.0%
Non-Hodgkin lymphoma 3.8%
Melanoma3.2%
Ovary2.9%
Leukemia2.8%
Pancreas2.5%
Kidney2.4%
Bladder2.1%
Cervix1.5%
Oral1.5%
Brain/CNS1.3%
Stomach1.3%
Multiple myeloma
1.2%
Liver0.6%
Esophagus0.5%
0.5%
Hodgkin lymphoma
Larynx0.2%
All other cancers
9.3%
CNS=central nervous system
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer
Registry (2008–2010)
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CHAPTER 1
n
Incidence: How many people in Canada get cancer?
Trends over time
FIGURE 1.3 New cases and age-standardized incidence rates (ASIR) for all cancers, Canada, 1986–2015
Between 1986 and 2015, the number of new cancer
cases rose steadily (Figure 1.3). However, agestandardized incidence rates (ASIR) have decreased for
males and increased slightly for females.
• In males, brief peaks in the number of new cancer
cases in the early 1990s and early 2000s reflect the
underlying trend in the prostate cancer incidence
rate, which is the leading type of cancer in Canadian
men.
• Among females, the recent slight increase in the
overall cancer incidence rate primarily reflects the
steady rise in melanoma, thyroid and uterine cancer
incidence rates.
ASIR (per 100,000)
New cases (in thousands)
600
110
100
Males
ASIR
New cases
90
500
80
70
400
60
50
300
40
Estimated
200
30
20
10
Age-standardized incidence rate (ASIR)
The number of new cases of cancer per 100,000
people, standardized to the age structure of the
1991 Canadian population to account for changes
in age distribution over time.
Annual percent change (APC)
100
1986
1990
1995
2000
2005
ASIR (per 100,000)
2010
110
100
Incidence
300
80
70
60
50
40
The number of new cases of cancer in a given year.
Estimated
200
n
Canadian Cancer Statistics 2015
30
20
10
100
1986
1990
1995
2000
2005
2010
2015
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer
Registry (2008–2010)
Canadian Cancer Society
Females
ASIR
New cases
90
500
400
Refers to a number or a relationship that is unlikely
to occur simply by chance; in other words, a statistic
that is reliable.
0
New cases (in thousands)
600
The estimated change in the rate of new cases
(incidence) from one year to the next over a defined
period of time, reported as a percentage. Along with
the changepoint (the year in which the APC
changed), the APC is useful for examining trends.
Statistical significance
2015
0
Note: “All cancers” exclude
non-melanoma skin cancer
(neoplasms, NOS; epithelial
neoplasms, NOS; and basal and
squamous). Rates are
age-standardized to the 1991
Canadian population. Actual
incidence data were available to
2010. For further details, see
Appendix II: Data sources
and methods.
View data
18
Incidence: How many people in Canada get cancer?
Trends for selected cancers
Tables 1.3 and 1.4 show the ASIR for selected cancers
in males and females over 30 years. Table 1.5 shows the
annual percent change (APC).
Figures 1.4 and 1.5 show, among males and females,
the five most common cancers and those with the
largest statistically significant increases or decreases in
APC (of at least 2% per year). These cancers are
discussed below.
Bladder cancer
Bladder cancer predominantly affects Canadians over
the age of 70 years and occurs more commonly in the
Atlantic provinces. Between 2001 and 2010, little or no
change has been seen for the incidence rates for
bladder cancer in males or females. The incidence of
bladder cancer has decreased in most Western
countries but increased in some eastern European and
developing countries.(2) These patterns may in part
reflect tobacco use,(2,3) which is estimated to account
for between 34%–50% of all bladder cancers.(4,5)
Occupational exposure to certain chemicals is the
second most important risk factor for bladder cancer.
Exposure to aromatic amines (especially
betanaphthylamine, benzidine, 4-aminobiphenyl and
4-o-toluidine), polyaromatic hydrocarbons (PAHs)
and diesel engine exhaust is also found to increase the
risk for bladder cancer.(6)
FIGURE 1.4 Age-standardized incidence rates (ASIR) for selected* cancers, males, Canada, 1986–2015
ASIR (per 100,000)
160
160
Estimated
n
140
120
140
120
100
100
80
80
60
60
40
40
20
20
0
1986
1990
1995
2000
2005
2010
2015
30
25
25
20
20
15
15
10
10
5
5
0
1986
1990
1995
2000
2005
2010
2015
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer
Registry (2008–2010)
Canadian Cancer Society
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Males
Prostate
Lung
Colorectal
Bladder
View data
ASIR (per 100,000)
30
Estimated
CHAPTER 1
0
Males
Stomach
Melanoma
Larynx
Liver
Thyroid
* Five most frequent cancers (both
sexes combined) and cancers with a
statistically significant change in
incidence rate of at least 2% per
year (see Table 1.5).
Note: Rates are age-standardized
to the 1991 Canadian population.
See Table 1.3 for data points. Actual
data for incidence were available to
2010. The range of scales differs
widely between the figures. The
complete definition of the specific
cancers listed here can be found in
Table A10.
19
Incidence: How many people in Canada get cancer?
Body of uterus (uterine cancer)
The majority of cancers of the uterus occur in the
endometrium or lining of the uterus. Incidence rates of
uterine cancer have increased by 2.6% per year among
women since 2004. This is consistent with recent
reports from the United States.(7) Exposure to estrogen
appears to increase risk for uterine cancer. Risk factors
include exposure to unopposed estrogen therapies.
Reduced risk appears associated with a lower
cumulative exposure to estrogen and/or higher
exposure to progesterone, such as increasing number
of full term pregnancies and shorter menstrual
lifespan.(8) Other risk factors include being overweight
or obese, a genetic predisposition, diabetes,
endometrial hyperplasia, chronic anovulation,
previous pelvic radiation, estrogen-secreting ovarian
tumours and hereditary non-polyposis colon cancer.
FIGURE 1.5 Age-standardized incidence rates (ASIR) for selected* cancers, females, Canada, 1986–2015
ASIR (per 100,000)
160
140
120
Canadian Cancer Society
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140
Females
Breast
Colorectal
Lung
120
100
100
80
80
60
60
40
40
20
20
View data
0
1986
Breast cancer
The breast cancer incidence rate rose through the early
1990s. This increase in the incidence rate is due in part
to increased opportunistic mammography screening
that was done before organized provincial screening
programs were implemented from 1988 onward. Since
1988, the rates have fluctuated. The reasons for these
fluctuations are unclear, but they likely have to do with
continued participation in mammography screening
and long-term changes in hormonal factors, such as
early age at menarche, breastfeeding, late age at
menopause, oral contraceptive use and late age at
full-term pregnancy.(9) Diabetes may also increase risk
of breast cancer.(10) The recent decrease in incidence
that occurred around 2002 may reflect the reduced use
of hormone replacement therapy (HRT) among
postmenopausal women.(11,12) Since 2004, breast cancer
incidence rates have stabilized. This is consistent with
recent reports from the United States.(13)
160
Estimated
n
1990
1995
2000
2005
2010
2015
ASIR (per 100,000)
30
30
25
25
20
20
Estimated
CHAPTER 1
15
15
10
10
5
5
0
1986
1990
1995
2000
2005
2010
Females
Body of Uterus
Melanoma
Bladder
Thyroid
Larynx
Liver
2015
Analysis by: Surveillance and Epidemiology Division, CCDPC, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer
Registry (2008–2010)
0
* Five most frequent cancers (both
sexes combined) and cancers with a
statistically significant change in
incidence rate of at least 2% per
year (see Table 1.5).
Note: Rates are age-standardized
to the 1991 Canadian population.
See Table 1.4 for data points. Actual
data for incidence were available to
2010. The range of scales differs
widely between the figures. The
complete definition of the specific
cancers listed here can be found in
Table A10.
20
CHAPTER 1
n
Incidence: How many people in Canada get cancer?
Colorectal cancer
Lung cancer
Prostate cancer
Starting from the mid-1980s, overall incidence rates
for colorectal cancer declined for both sexes until the
mid-1990s (although this decline was more prominent
for females).(14) Incidence rates then rose through 2000,
only to decline slightly thereafter, most likely due to
increased use of colorectal cancer screening, which can
identify and remove precancerous polyps, which can in
turn reduce incidence. The decline in colorectal cancer
incidence rates appears confined to older adults as rates
are increasing among young adults under the age of
50 years in Canada and in the United States.(15-17)
Diabetes may also increase risk for colorectal cancer.(10)
In males, the incidence rate of lung cancer began to
level off in the mid-1980s and has since been declining
(almost 2.0% per year in recent years, Table 1.5).
Among females, the incidence rate for lung cancer is
no longer increasing since 2006. The incidence rate of
lung cancer remains higher among males (58 per
100,000) than females (48 per 100,000), although rates
among younger adults appear to be converging.(27)
The prostate-specific antigen (PSA) test is not currently
recommended in Canada as a population-based
screening test.(29) Despite uncertainty about the benefits
and risks of prostate cancer testing, use of the PSA test
is widespread.(30,31) In Canada, the incidence rate of
prostate cancer peaked in 1993 and 2001. Each of these
peaks was followed by a decline. These peaks are
compatible with two waves of intensified screening
activity using the PSA test. Since at least 2001, the
age-standardized incidence rate has been declining
(1.6% per year).
As of 2014, nine provinces had organized screening
programs available, and the remaining province has
announced the intention to implement one.(18,19)
Participation rates vary within and between the existing
organized programs and do not meet the target of 60%.(18)
Colorectal cancer is linked to several modifiable risk
factors including obesity, physical inactivity, consumption
of red and processed meat and smoking.(20,21)
Larynx cancer
Incidence rates of larynx cancer decreased significantly
from 2001 to 2010 for both males (2.9% per year) and
females (3.5% per year). As cancer of the larynx is most
strongly associated with smoking(22) and alcohol,(23)
declines in incidence rates most likely reflect decreasing
trends in these risk factors.(24,25)
Liver cancer
The incidence rate of liver cancer increased significantly
for males (2.3% per year) and females (2.4% per year).
These increases may be at least partially explained by
rising immigration from regions of the world where
risk factors for liver cancer, such as hepatitis B and C
infection and exposure to aflatoxin, are more common.(26)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
The differences in lung cancer incidence rates among
males and females reflect past differences in tobacco
use. According to the 2013 Canadian Tobacco, Alcohol
and Drugs Survey, the smoking prevalence for
Canadians age 15 and over is 15% in both sexes
combined.(24) In males, a drop in smoking began in the
mid-1960s, preceding the drop in lung cancer
incidence by about 20 years. In females, tobacco
consumption began to drop in the mid-1980s,
suggesting that lung cancer incidence rates in women
should also begin to decrease in the next two decades.
Melanoma
Incidence rates of melanoma have increased in both
men and women over the past several decades, with
recent increases of 2.3% per year in men between 2001
and 2010, and 2.9% per year among women between
2001 and 2010. Exposure to ultraviolet (UV) radiation
through exposure to sunlight, tanning beds and sun lamps
appears to be a major risk factor for melanoma.(28)
Other risk factors include number and type of moles,
having a fair complexion, personal and family history
of skin cancer, a weakened immune system and a
history of severe blistering sunburn.
Stomach cancer
Incidence rates of stomach cancer continue to decline
in both males (2.2% per year) and females (1.3% per
year). Current rates are about half of what they were in
1985. This decline may be due to long-term improvements
in diets(32) and decreases in smoking and heavy alcohol
use.(33) The declining incidence rates of stomach cancer
may also be related to the more recent recognition and
treatment of infection with the bacterium Helicobacter
pylori, an important risk factor for stomach cancer.(34)
Thyroid cancer
The incidence rate of thyroid cancer is the most rapidly
increasing incidence rate among all major cancers not
only in Canada but worldwide.(35) In Canada, there was
a 6.3% per year increase in males since 2001 and a
4.4% per year increase in females between 2005 and
2010. The rise may be due to several reasons, including
overdiagnoses. More frequent use of diagnostic testing,
including ultrasound, computed tomography (CT)
scanning and magnetic resonance imaging (MRI), may
mean that more earlier stage, asymptomatic thyroid
cancers are being diagnosed.(36) Exposure to diagnostic
ionizing radiation has likely increased over time, and
this could promote the initiation of new tumours.(37)
21
What do these statistics mean?
Generally, the incidence rate for all cancers combined
in males has been stable over the past two decades. In
contrast, the incidence rate for all cancers combined in
females has continued to increase. This increase is in
part driven by the rise in melanoma, thyroid, uterine
and liver cancer incidence. While the incidence rates
for individual cancer types can be better explained by
changes in risk factors and prevention efforts, the
overall trend reflects the cumulative impact of the
changes seen for each type of cancer.
Given that so much of the increase in cancer incidence
over the past 30 years is due to an aging and growing
population, this increase can be expected to continue
as the population continues to age (see Chapter 7 for
more details). With the rising incidence of cancer,
there will be a commensurate increase in the need for
diagnostic, treatment and support services, including
palliative care in the healthcare system. It will also be
important to promptly develop strategies to address
the cancers that are now showing significant increase
in incidence, such as liver and thyroid cancers.
Prevention efforts should be improved to reduce the
impact of risk factors, such as tobacco use and obesity.
In addition, a sustained focus on screening for breast,
colorectal and cervical cancers will help catch and
more effectively treat these cancers earlier in their
course.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
For more information
Publications
• Kachuri L, De P, Ellison LF, Semenciw R. Cancer incidence,
mortality and survival trends in Canada, 1970–2007. Chronic
Diseases and Injuries in Canada. 2013;33(2):69–80.
• Navaneelan T, Janz T. Cancer in Canada: Focus on lung,
colorectal, breast and prostate. Health at a Glance, Statistics
Canada. (Catalogue no. 82-624-X), 2011.
• Marrett LD, De P, Airia P, Dryer D. Cancer in Canada in 2008.
CMAJ. 2008;179(11):1163–70.
• Statistics Canada. Cancer Incidence in Canada. (Catalogue
no. 82-231-X). Ottawa, 2011.
Databases
• Statistics Canada. Table 103-0550 – New cases for ICD-O-3
primary sites of cancer (based on the July 2011 CCR
tabulation file), by age group and sex, Canada, provinces
and territories, annual, CANSIM (database).
• Statistics Canada. Table 103-0553 – New cases and
age-standardized rate for ICD-O-3 primary sites of cancer
(based on the July 2011 CCR tabulation file), by sex, Canada,
provinces and territories, annual, CANSIM (database).
• Public Health Agency of Canada. Chronic Disease Infobase
Cubes. Ottawa, Canada.
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bladder cancer incidence and mortality. Eur Urol. 2014;66(1):59–73.
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13.Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H,
Anderson RN, Kohler BA, Eheman CR, Ward EM. Annual Report to the Nation on the
status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival
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Health Rep. 2001;12(2):41–55.
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20.World Cancer Research Fund / American Institute for Cancer Research. Continuous
Update Project Interim Report Summary. Food, Nutrition, Physical Activity and the
Prevention of Colorectal Cancer. Washington, DC: AICR; 2011.
21.Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention:
A meta-analysis. Br J Cancer. 2009;100(4):611–6.
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ON: Health Canada; 2012.
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27.Jemal A, Travis WD, Tarone RE, Travis L, Devesa SS. Lung cancer rates convergence in
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32.Howson CP, Hiyama T, Wynder EL. The decline in gastric cancer: Epidemiology of an
unplanned triumph. Epidemiologic Reviews. 1986;8:1–27.
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systematic review and meta-analysis. Cancer Causes Control. 2011;22(3):375–387.
35.Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence
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37.How J, Tabah R. Explaining the increasing incidence of differentiated thyroid cancer.
CMAJ. 2007;177(11):1383–4.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
23
CHAPTER 1
n
Incidence: How many people in Canada get cancer?
TABLE 1.1 Lifetime probability of developing cancer overall and by age group, Canada, 2010
Lifetime probability of
developing cancer
%
One in:
Males
All cancers*
Prostate
Lung
Colorectal
Bladder
Non-Hodgkin lymphoma
Leukemia
Kidney
Melanoma
Oral
Pancreas
Stomach
Esophagus
Multiple myeloma
Brain/CNS
Liver
Larynx
Thyroid
Testis
Hodgkin lymphoma
Females
All cancers*
Breast
Lung
Colorectal
Body of uterus
Non-Hodgkin lymphoma
Thyroid
Ovary
Leukemia
Melanoma
Pancreas
Bladder
Kidney
Oral
Stomach
Multiple myeloma
Cervix
Brain/CNS
Esophagus
Liver
Hodgkin lymphoma
Larynx
Lifetime probability (%) of developing cancer in next 10 years by age group
30–39
40–49
50–59
60–69
70–79
80–89
44.7
12.8
8.4
7.2
3.8
2.3
1.9
1.8
1.7
1.5
1.3
1.2
0.9
0.8
0.8
0.8
0.6
0.5
0.4
0.2
2.2
8
12
14
27
43
53
56
57
68
78
81
116
118
125
133
173
188
245
432
0.7
—
—
0.1
—
0.1
—
—
0.1
—
—
—
—
—
—
—
—
0.1
0.1
—
1.7
0.2
0.1
0.2
0.1
0.1
0.1
0.1
0.1
0.1
—
—
—
—
0.1
—
—
0.1
0.1
—
5.8
1.6
0.7
0.7
0.3
0.3
0.2
0.3
0.2
0.3
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
—
—
14.0
4.8
2.2
1.9
0.8
0.6
0.4
0.5
0.4
0.4
0.3
0.3
0.2
0.2
0.2
0.2
0.2
0.1
—
—
20.6
5.6
4.0
3.1
1.6
0.9
0.7
0.6
0.6
0.5
0.5
0.5
0.3
0.4
0.2
0.3
0.2
0.1
—
—
20.4
4.1
3.7
3.2
2.0
0.9
0.8
0.5
0.6
0.4
0.6
0.6
0.4
0.4
0.2
0.3
0.2
0.1
—
—
41.5
11.7
6.9
6.3
2.8
2.0
1.8
1.4
1.4
1.3
1.3
1.2
1.1
0.8
0.7
0.7
0.7
0.7
0.3
0.3
0.2
0.1
2.4
9
15
16
36
50
56
71
72
74
75
84
90
133
135
143
152
153
348
373
498
959
1.4
0.4
—
0.1
0.1
—
0.3
—
—
0.1
—
—
—
—
—
—
0.1
—
—
—
—
—
3.3
1.4
0.2
0.2
0.2
0.1
0.4
0.1
0.1
0.2
—
—
0.1
—
—
—
0.2
—
—
—
—
—
6.4
2.2
0.7
0.6
0.6
0.2
0.4
0.2
0.1
0.2
0.1
0.1
0.2
0.1
0.1
0.1
0.1
0.1
—
—
—
—
10.7
3.2
1.8
1.2
1.0
0.5
0.3
0.3
0.2
0.3
0.2
0.2
0.2
0.2
0.1
0.1
0.1
0.1
0.1
0.1
—
—
14.5
3.3
2.9
2.2
0.8
0.7
0.3
0.4
0.4
0.3
0.5
0.4
0.4
0.2
0.2
0.3
0.1
0.2
0.1
0.1
—
—
14.6
2.6
2.2
2.7
0.5
0.7
0.1
0.4
0.6
0.3
0.6
0.5
0.3
0.2
0.4
0.3
0.1
0.2
0.1
0.1
—
—
CNS=central nervous system
— Value less than 0.05
* “All cancers” include in situ bladder cancer except for Ontario and
exclude non-melanoma skin cancer (neoplasms, NOS; epithelial
neoplasms, NOS; and basal and squamous). The complete definition
of the specific cancers listed here can be found in Table A10.
Note: The probability of developing cancer is calculated based on
age- and sex-specific cancer incidence and mortality rates for Canada
in 2010 and on life tables based on 2008–2010 all-cause mortality
rates. For further details, see Appendix II: Data sources and methods.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, Canadian Vital Statistics Death databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
24
CHAPTER 1
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Incidence: How many people in Canada get cancer?
TABLE 1.2 Estimated new cases and age-standardized incidence rates (ASIR) for cancers by sex, Canada, 2015
New cases (2015 estimates)
All cancers
Lung
Breast
Colorectal
Prostate
Bladder†
Non-Hodgkin lymphoma
Melanoma
Body of uterus
Thyroid
Kidney
Leukemia
Pancreas
Oral
Stomach
Brain/CNS
Ovary
Multiple myeloma
Esophagus
Liver
Cervix
Larynx
Testis
Hodgkins lymphoma
All other cancers
Non-melanoma skin
Cases per 100,000
Total*
Males
Females
Total
Males
Females
196,900
26,600
25,200
25,100
24,000
8,300
8,200
6,800
6,300
6,300
6,200
6,200
4,800
4,400
3,400
3,000
2,800
2,700
2,200
2,200
1,500
1,050
1,050
1,000
18,000
78,300
100,500
13,600
220
14,000
24,000
6,200
4,500
3,700
—
1,450
3,900
3,500
2,400
2,900
2,100
1,750
—
1,500
1,700
1,650
—
880
1,050
540
9,000
44,400
96,400
13,000
25,000
11,100
—
2,100
3,700
3,100
6,300
4,800
2,300
2,700
2,400
1,450
1,250
1,250
2,800
1,150
500
550
1,500
170
—
460
8,900
34,000
398.0
51.9
52.1
49.0
99.3
15.8
16.8
14.4
23.9
14.9
12.7
12.9
9.3
8.8
6.6
6.9
10.8
5.1
4.2
4.4
7.5
2.1
6.4
2.8
35.6
—
431.3
57.6
0.9
59.5
99.3
26.2
19.8
16.1
—
6.7
16.7
15.7
10.3
12.4
9.1
8.2
—
6.3
7.0
7.0
—
3.7
6.4
3.0
39.3
—
374.3
47.5
99.7
39.7
—
7.3
14.2
13.2
23.9
23.1
9.0
10.5
8.4
5.6
4.5
5.7
10.8
4.1
1.8
2.0
7.5
0.6
—
2.5
32.7
—
— Not applicable; CNS=central nervous system
* Column totals may not sum to row totals due to rounding.
At the time the data were received, Ontario did not report in situ bladder
cancer; this should be considered when making comparisons across
provinces.
†
Note: “All cancers” excludes the estimated new cases of non-melanoma
skin cancer (neoplasms, NOS; epithelial neoplasms, NOS; and basal and
squamous). The complete definition of the specific cancers listed here can
be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
25
CHAPTER 1
n
Incidence: How many people in Canada get cancer?
TABLE 1.3 Age-standardized incidence rates (ASIR) for selected* cancers, males, Canada, 1986–2015†
Cases per 100,000
Year
All cancers
Prostate
Colorectal
Lung
Stomach
Liver
Thyroid
Larynx
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011†
2012†
453.9
458.5
460.9
453.8
460.2
472.4
490.5
503.2
491.5
467.1
458.3
461.3
461.3
472.1
476.6
482.6
466.7
462.6
466.5
465.5
465.0
469.3
457.6
452.6
440.4
443.7
440.5
86.1
89.5
90.4
91.8
99.8
112.5
125.8
140.8
129.9
111.9
110.1
115.7
115.1
119.6
124.9
133.3
123.9
120.5
122.7
122.1
126.2
126.1
115.5
113.1
108.4
107.9
105.6
63.5
63.4
63.4
62.0
61.9
61.8
63.4
61.0
62.1
60.6
59.5
59.2
61.4
62.2
64.2
63.2
62.6
60.4
61.6
61.5
60.5
61.0
61.6
60.1
57.0
59.8
59.8
96.1
94.8
95.1
93.3
92.4
90.5
90.6
91.6
86.9
84.8
82.3
79.4
80.7
79.6
77.1
77.0
74.5
72.4
72.4
71.2
69.1
69.3
67.0
65.9
63.2
62.5
61.3
Bladder Melanoma
32.5
33.2
32.9
30.3
29.9
30.5
30.2
30.4
30.3
29.6
28.6
29.7
28.4
30.0
28.9
28.0
28.1
28.6
28.7
27.6
27.7
27.1
27.9
27.6
27.5
27.0
26.8
9.0
9.6
10.4
9.3
10.1
9.1
10.4
10.3
10.8
11.2
11.0
11.4
11.1
12.8
12.6
12.8
12.2
12.9
12.7
12.7
13.6
13.8
14.6
15.0
14.8
15.3
15.5
18.0
17.4
17.0
16.7
15.8
15.6
14.6
14.3
14.2
13.3
13.6
13.1
12.6
12.6
12.3
12.0
11.0
11.7
11.4
11.1
10.8
10.6
10.3
10.1
9.4
9.6
9.5
3.3
3.1
3.0
3.2
3.4
3.6
3.5
3.8
4.3
4.2
4.2
4.5
4.4
4.6
4.7
5.3
5.4
5.1
5.4
5.8
5.8
6.4
6.1
6.4
6.1
6.5
6.6
2.0
2.2
2.1
2.1
2.2
2.4
2.0
2.5
2.7
2.6
2.6
2.6
2.7
3.2
3.5
3.6
4.0
3.7
4.0
4.7
5.0
5.2
5.6
5.8
5.9
6.0
6.2
8.8
8.8
8.6
8.1
7.7
8.4
8.1
7.4
7.5
7.4
6.9
6.6
6.7
6.6
5.9
6.1
5.8
5.4
5.3
5.2
4.7
4.8
4.9
4.7
4.7
4.2
4.1
2013†
2014†
2015†
437.5
434.3
431.3
103.5
101.4
99.3
59.7
59.6
59.5
60.0
58.8
57.6
26.6
26.4
26.2
15.8
16.0
16.1
9.3
9.2
9.1
6.7
6.9
7.0
6.4
6.5
6.7
3.9
3.8
3.7
* Five most frequent cancers (both sexes combined) and cancers with a
statistically significant change in incidence rate of at least 2% per year
(see Table 1.5).
†
Rates for these years are estimated based on all provinces and
territories. Actual data were available to 2010. These estimates are
based on long-term trends and may not reflect recent changes in trends.
Note: “All cancers” excludes non-melanoma skin cancer (neoplasms,
NOS; epithelial neoplasms, NOS; and basal and squamous). Rates are
age-standardized to the 1991 Canadian population. The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
26
CHAPTER 1
n
Incidence: How many people in Canada get cancer?
TABLE 1.4 Age-standardized incidence rates (ASIR) for selected* cancers, females, Canada, 1986–2015†
Cases per 100,000
Year
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011 †
2012†
2013†
2014†
2015†
All cancers
Breast
Lung
Colorectal
Body of
uterus
325.4
331.6
336.8
330.6
333.6
338.0
344.2
343.6
344.1
342.2
340.5
344.7
352.5
353.3
355.1
352.8
358.7
351.6
354.4
361.0
360.9
365.2
363.0
368.7
368.9
369.3
370.5
371.7
373.1
374.3
88.6
91.1
97.8
96.4
96.0
100.2
102.2
99.3
99.3
99.0
99.0
102.5
103.6
105.6
101.9
100.5
102.5
97.0
97.4
98.6
98.5
99.0
96.9
99.2
101.2
99.2
99.3
99.4
99.6
99.7
31.5
33.2
34.6
34.9
36.3
37.5
39.7
40.6
39.8
40.8
42.0
42.0
43.7
43.5
45.1
45.1
45.7
45.6
46.3
47.6
48.0
47.9
48.5
48.3
46.8
48.0
48.0
48.0
47.8
47.5
47.1
46.7
45.0
44.3
44.5
43.2
43.3
43.2
42.6
41.5
40.2
40.5
42.9
42.0
43.0
42.4
42.1
41.2
41.7
41.5
40.3
41.0
40.8
40.5
39.9
40.1
40.0
39.9
39.8
39.7
19.5
20.5
20.1
18.7
19.0
18.9
18.9
19.7
19.5
18.6
18.5
19.0
19.4
19.2
19.4
18.9
19.7
19.5
19.4
19.5
20.1
20.9
20.8
21.4
22.8
22.5
22.8
23.2
23.6
23.9
Thyroid Melanoma
5.2
5.2
5.1
5.6
5.8
5.9
6.8
7.1
7.6
7.6
7.8
7.8
8.2
9.5
10.4
11.2
13.3
13.6
15.1
16.7
16.8
18.0
19.1
19.8
20.6
20.7
21.3
21.8
22.5
23.1
8.3
9.3
9.2
8.6
8.5
8.8
8.7
9.0
9.1
9.4
9.6
9.6
9.6
10.0
10.3
10.2
10.0
10.1
10.4
10.7
11.0
11.3
11.7
12.3
12.0
12.4
12.6
12.8
13.0
13.2
Bladder
7.9
8.6
9.0
7.8
7.9
7.9
7.6
8.2
7.8
7.9
7.4
7.7
8.1
7.8
7.4
7.5
7.5
7.8
7.7
7.8
7.6
7.9
7.2
7.7
7.2
7.4
7.4
7.3
7.3
7.3
Liver
Larynx
0.9
1.1
1.1
1.2
1.0
1.0
1.3
1.3
1.3
1.3
1.4
1.3
1.6
1.2
1.6
1.5
1.5
1.6
1.5
1.6
1.8
1.8
1.9
1.7
1.8
1.9
1.9
2.0
2.0
2.0
1.4
1.5
1.5
1.6
1.4
1.6
1.3
1.3
1.4
1.4
1.3
1.3
1.2
1.2
1.1
1.1
1.1
1.1
1.0
0.9
0.8
1.0
0.9
0.9
0.8
0.8
0.7
0.7
0.7
0.6
* Five most frequent cancers (both sexes combined) and cancers with a
statistically significant change in incidence rate of at least 2% per year
(see Table 1.5).
†
Rates for these years are estimated based on all provinces and
territories. Actual data were available to 2010. These estimates are
based on long-term trends and may not reflect recent changes in trends.
Note: “All cancers” excludes non-melanoma skin cancer (neoplasms,
NOS; epithelial neoplasms, NOS; and basal and squamous). Rates are
age-standardized to the 1991 Canadian population. The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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27
CHAPTER 1
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Incidence: How many people in Canada get cancer?
TABLE 1.5 Annual percent change (APC) in age-standardized incidence rates for selected cancers, by sex, Canada, 2001–2010
Males
APC
†
All cancers
Lung
Breast
Colorectal
Prostate
Bladder
Non-Hodgkin lymphoma
Melanoma
Kidney
Thyroid
Body of uterus
Leukemia
Pancreas
Oral
Stomach
Brain/CNS
Ovary
Multiple myeloma
Liver
Esophagus
Cervix
Larynx
Testis
Hodgkin lymphoma
–0.7**
–1.9**
—
–0.7**
–1.6**
–0.3
0.3
2.3**
1.3**
6.3**
—
0.3
–0.3
1.2
–2.2**
–0.1
—
0.6
2.3**
1.5**
—
–2.9**
1.7**
–0.1
Females
Changepoint
‡
2006
APC
†
0.5**
–0.4
0.5
–0.6**
—
–0.4
0.4
2.9**
1.1
4.4**
2.6**
1.1**
–0.1
0.5
–1.3**
–0.2
–1.0**
0.3
2.4**
0.2
0.7
–3.5**
—
0.2
Changepoint‡
2006
2004
2004
2005
2004
CNS=central nervous system
— Not applicable or small number of cancer cases
* Significant increase or decrease in APC, p<0.05.
** Significant increase or decrease in APC, p<0.01.
2005
†
APC is calculated assuming a piecewise log linear model. The model
was fitted to the rates in 1986–2010. “All cancers” includes cancers
not found in the table but excludes non-melanoma skin cancer
(neoplasms, NOS; epithelial neoplasms, NOS; and basal and squamous).
When there is no changepoint in the most recent 10 years, the APC
was obtained. If there is a changepoint, the APC was taken from the
last segment. For further details, see Appendix II: Data sources and
methods.
‡
Changepoint indicates the baseline year for the APC shown, if the
slope of the trend changed after 2001.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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CHAPTER 2
Incidence by sex, age and geography: Who gets cancer in Canada?
Highlights
Trends over time
Incidence by age
• In general, cancer rates increase with age and are
more common in males than females. Cancer
incidence rates are slowly declining over time in
males and slowly increasing in females.
• In 2015, it is estimated that 89% of all cancers will be
diagnosed in Canadians over the age of 50, while
43% will occur in Canadians 70 years of age and
older. Females have higher rates of cancer than males
between the ages of 20 and 59, primarily due to
breast and thyroid cancer. Cancer rates are higher in
males in all other age groups.
• Cancer incidence rates generally increase from west
to east across the country.
Figure 2.1 shows that the incidence rates for both
males and females changed between 1986 and 2015.
• The overall cancer incidence rate for males rose until
the early 1990s. Since 1993, there has been a decline
in cancer incidence rate in males, primarily due to
the decline in lung cancer.
• Among females, the overall cancer incidence rate has
been increasing slowly since the early 1990s. This
increase primarily reflects the rise in lung cancer, but
it also represents an increase in thyroid and uterine
cancers, as well as melanoma.
Cancer primarily affects Canadians over the age of 50:
89% of all new cases are diagnosed in people in this
age group. For both males and females, the median age
of cancer diagnosis is between 65 and 69 years of age.
As shown in Table 2.1, it is estimated that in 2015:
• 43% of all new cases will occur in people aged 70
years or older.
• 28% of all new cases will occur in people aged 60–69
years.
• 18% of all new cases will occur in people aged 50–59
years.
FIGURE 2.1 Age-standardized incidence and mortality rates for all cancers combined, by sex, Canada, 1986–2015
Introduction
Cancer strikes males and females, young and old, and
those in different regions across Canada on a decidedly
uneven basis. This chapter examines incidence by sex,
age and geographic region to see how cancer affects
people in Canada.
Incidence by sex
Rate (per 100,000)
600
600
500
500
400
400
Incidence
Mortality
Females
Prostate and breast cancer are the most frequently
diagnosed cancers for males and females respectively,
followed by lung and colorectal cancers. Overall, more
males are diagnosed with cancer than females: 51% of
all new cases are diagnosed in males; 49% of all new
cases are diagnosed in females (Table 2.1).
300
300
200
200
100
100
0
1986
1990
1995
2000
2005
2010
2015
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting system, Canadian Vital Statistics Death databases at Statistics
Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
Males
n
Canadian Cancer Statistics 2015
0
Incidence
Mortality
Note: Rates are agestandardized to the 1991
Canadian population. Actual
incidence and mortality data
were available to 2010. Dashed
lines represent estimated rates.
View data
29
CHAPTER 2
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Incidence by sex, age and geography: Who gets cancer in Canada?
• Less than 1% of all new cases will occur in children
and youth aged 0–19 years. Although this represents
a small percentage of new cancer cases, a cancer
diagnosis in this age group has a significant impact
on both children and their families.
The largest proportion of new cases of lung, breast,
prostate and colorectal cancers occurs in older adults
(Table 2.2).
• Just over half of all newly diagnosed cases of lung
and colorectal cancer will occur among people aged
70 years or older.
• The majority of breast cancers occur in females
50–69 years of age (52%). Approximately 30% of
breast cancers are diagnosed in females aged 70 and
over, while 18% occur in females under age 50.
• Prostate cancer is most common in males aged
60–69 years (40%).
Figure 2.2 shows that the distribution of new cancer
cases varies between age groups:
• Between 2006 and 2010, the most commonly
diagnosed cancer in children aged 0–14 was
leukemia (32%), followed by cancers of the central
nervous system (CNS) and lymphomas (19% and
11% respectively).
FIGURE 2.2 Distribution of new cancer cases for selected cancers by age group, Canada, 2006–2010
100
Canadian Cancer Society
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Canadian Cancer Statistics 2015
N=4,600
N=12,300
Thyroid
(16%)
90
Leukemia
(32%)
80
% of cases
60
Hodgkin
lymphoma
(12%)
CNS
(19%)
50
40
N=90,500
Breast
(25%)
Testis
(13%)
70
Children, adolescents and young adults
Cancers in children (0–14 years of age, see Table A7)
differ from those occurring in adults in both their site
of origin and their behaviour. Generally, tumours in
children have shorter latency periods and are more
aggressive and invasive than tumours in adults.
Childhood tumours are more likely to be embryonic or
hematopoietic in origin, most commonly leukemia,
lymphoma and central nervous system (CNA) cancers.
To account for these differences, a separate classification
scheme of diagnostic groupings has been created.(1)
Adolescents and young adults (15–29 years of age, see
Table A8) represent a transitional phase where some
tumours still closely resemble those found in
childhood, while others have characteristics more
common in adults. Consequently, diagnosis and
treatment within this age group can be challenging and
there have been limited advancements in overall
survival in this age group in recent years.
• New cancer cases among older adolescents and
young adults aged 15–29 years old account for
approximately 1.5% of all new cancer cases. The
most commonly diagnosed cancers in this age group
are thyroid (16%), testicular (13%), Hodgkin
lymphoma (12%) and melanoma (8%).
• Among middle age and older adults, the distribution
of cancers resembles patterns noted in previously
Lymphoma
(11%)
Neuroblastoma
and other PNC (8%)
30
Melanoma
(8%)
Brain/CNS
(7%)
Leukemia
(6%)
Thyroid
(10%)
Colorectal (8%)
N=366,500
N=360,800
Prostate
(17%)
Lung
(17%)
Breast
(15%)
Colorectal
(15%)
Lung
(14%)
Prostate
(13%)
Melanoma (6%)
Lung (5%)
Colorectal
(11%)
Non-Hodgkin
lymphoma (5%)
Breast
(9%)
Bladder
(6%)
Non-Hodgkin
lymphoma (4%)
Non-Hodgkin
lymphoma (6%)
Breast (4%)
Soft tissue (6%)
20
Renal tumours (5%)
Other malignant
epithelial (5%)
10
Other
(28%)
Other
(41%)
Other
(43%)
30–49
50–69
Other
(36%)
Malignant bone (4%)
Other
(9%)
0
0–14
15–29
Age group (years)
N is the total number of cases
over 5 years (2006–2010) for each
age group; CNS=central nervous
system; PNC=peripheral nervous
cell tumours.
Note: Cancers in children
(ages 0–14 years) are classified
according to ICCC-3.(1) The
complete definition of the specific
cancers listed here can be found in
Table A10.
70+
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
30
CHAPTER 2
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Incidence by sex, age and geography: Who gets cancer in Canada?
• Incidence rates in males have been stable or slowly
increasing in all age groups under the age of 70.
• Incidence rates in males over 70 have been
decreasing over time primarily due to the declining
rate of lung cancer from decreased tobacco use in
past decades.(2)
published reports. For both sexes combined, the
most common cancers for ages 30–49, 50–69 and
70+ were breast (25%), prostate (17%) and lung
(17%), respectively. After age 50, breast, colorectal,
lung and prostate account for over 50% of all new
cancer cases.
Trends over time
Incidence by geographic region
Trends in incidence rates over time vary by sex and age
group (Figure 2.3).
• Incidence rates are higher in females between the
ages of 20 and 59 primarily due to breast and thyroid
cancers. Incidence rates are higher in males
compared to females in all other age groups.
• Incidence rates in females have been stable or slowly
increasing in every age category over time.
The estimated number of new cases for all cancers
combined by province and territory for 2015 are
shown in Figure 2.4, with data in Table 2.3. The
age-standardized incidence rate (ASIR) shows a
declining trend moving from east to west across
Canada, with the highest incidence rates in the
Atlantic provinces and Quebec and the lowest rates in
Alberta and British Columbia.
Age-standardized incidence rate (ASIR)
The number of new cases of cancer per 100,000
people, standardized to the age structure of the
1991 Canadian population to account for changes
in age distribution over time.
In this section, age standardization is used to adjust for
differences in age distributions among the provinces
and territories, which allows for more accurate comparisons.
Province or territory
Refers to the province or territory of a person’s
permanent residence at the time of cancer diagnosis.
The most recent actual data for provinces and territories
are available to 2010 (see Tables A3 and A4 in
Appendix I: Actual data for new cases and deaths).
FIGURE 2.3 Age-standardized incidence rates (ASIR) for all cancers, by age group, Canada, 1986–2015
100
140
1,800
1,800
1,600
1,600
120
1,400
100
80
80
60
60
40
40
20
20
0
1986 1990
1995
2000
Females (0–19)
Females (20–29)
Females (30–39)
2005
2010
0
2015
1,200
1,000
1,200
1,000
800
600
600
400
400
200
200
1986 1990
Males (0–19)
Males (20–29)
Males (30–39)
1995
2000
Females (40–49)
Females (50–59)
Females (60–69)
2005
2010
0
2015
Age groups 70–80+
4,000
3,500
1,400
800
0
4,000
2,000
Estimated
ASIR per 100,000
120
2,000
ASIR per 100,000
Estimated
140
Age groups 40–69
160
Estimated
Age groups 0–39
ASIR per 100,000
160
3,000
3,500
3,000
2,500
2,500
2,000
2,000
1,500
1,500
1,000
Males (40–49)
Males (50–59)
Males (60–69)
1986 1990
1995
2000
Females (70–79)
Females (80+)
2005
2010
Males (70–79)
Males (80+)
2015
1,000
Note: The range of rate scales
differs widely between the age
groups. Incidence rates exclude
non-melanoma skin cancer
(neoplasms, NOS; epithelial
neoplasms, NOS; and basal and
squamous). Actual incidence data
were available up to 2010.
View data
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System databases at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
31
CHAPTER 2
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Incidence by sex, age and geography: Who gets cancer in Canada?
Estimated new cases (Table 2.4) and ASIR (Table 2.5)
for specific cancer types by sex and province show that
there are geographic differences in rates for males and
females across Canada.
• Prostate cancer incidence rates vary greatly among
the provinces, possibly due to variations in PSA
testing across the country.
• Among males and females, lung cancer incidence
rates are estimated to be highest in Quebec and
lowest in British Columbia. This difference in
incidence rates is linked in large part to the
prevalence of smoking in each province.
• Colorectal cancer incidence rates for both males and
females are highest in Newfoundland and Labrador.
For females, high rates are also seen in Nova Scotia,
Prince Edward Island and Manitoba. The lowest rates
for both sexes are in British Columbia.
• Apart from Newfoundland and Labrador, breast
cancer incidence rates appear to be fairly consistent
across the country, with no discernible geographic
pattern. The lower rate in Newfoundland and
Labrador may be related to incomplete registration
of all breast cancers.
Geographic variations in incidence rates may be due to
differences in modifiable risk factors, such as
unhealthy diet, smoking, obesity and physical
inactivity. Differences in incidence rates may also be
related to different provincial or territorial programs or
procedures for the diagnosis and early detection of
cancer, such as approved screening programs and the
availability of diagnostic services.
Other factors may impact the interpretation of
variations in projected rates among the provinces,
including the following:
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
FIGURE 2.4 Geographic distribution of estimated new cancer cases and age-standardized incidence rates (ASIR) by province and territory,
both sexes, Canada, 2015
340.1 per 100,000
(140 new cases)
372.9 per 100,000
(160 new cases)
381.1 per 100,000
(80 new cases)
367.6 per 100,000
(25,400 new cases)
435.8 per 100,000
(3,500 new cases)
365.7 per 100,000
(17,000 new cases)
394.7 per 100,000
(6,700 new cases)
376.3 per 100,000
(5,500 new cases)
404.2 per 100,000
(76,000 new cases)
412.6 per 100,000
(50,100 new cases)
426.6 per 100,000
(5,100 new cases)
402.6 per 100,000
(910 new cases)
420.6 per 100,000
(6,300 new cases)
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
32
CHAPTER 2
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Incidence by sex, age and geography: Who gets cancer in Canada?
• Cancer frequency – When a cancer is rare or the
population is small, the estimated number of new
cases of a cancer type may be subject to greater
statistical variation.
• Cancer registration method – While the registration
of new cancer cases is generally very good across the
country, there are exceptions. Incomplete
registration is mainly linked to the unavailability and
inaccuracy of death certificate data and specific
diagnostic information in some provinces.
• Method of projection – The selected method of
projection (Nordpred Power5 regression model or
five-year average) for provincial data can vary across
provinces and across cancer types (see Tables A12
and A13 in Appendix II: Data sources and methods).
• Availability of in situ cases – The large variation seen
in bladder cancer incidence rates among the
provinces is likely due to differences in reporting of
in situ cases, especially in Ontario, where such cases
were not collected until recently and were not
available in the data analyzed for this publication.
thyroid. The priorities of people with cancer and their
needs for services can be expected to vary at different
points in the age continuum.
What do these statistics mean?
• De P, Ellison LF, Barr RD, et al. Canadian adolescents and
young adults with cancer: Opportunity to improve
coordination and level of care. CMAJ. 2011;183:E187–E194.
This chapter shows a distinct picture of cancer
distribution in Canada by presenting incidence
estimates by sex, age and geographic region. These data
can support informed decision-making to ensure that
healthcare services meet the needs of a specific
population and identify opportunities to target
prevention and cancer control initiatives. For example,
nearly half of all people diagnosed with cancer will be
over the age of 70, and it must be recognized that
evidence-based treatment guidelines may vary by age.
The data indicate that females are more likely than
males to be diagnosed with cancer in the prime of their
lives (between the ages of 20 and 59 years), which
reflects patterns for specific cancers, such as breast and
Canadian Cancer Society
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Canadian Cancer Statistics 2015
Finally, cancer incidence rates across the country vary,
with higher rates in the east and lower rates in the west.
To better target prevention efforts, these data can be
correlated with data on risk factors such as tobacco and
alcohol consumption, physical inactivity or obesity rates.
For further information
Publications
• Kachuri L, De P, Ellison LF, Semenciw R. Cancer incidence,
mortality and survival trends in Canada, 1970–2007. CDIC
2013 Mar;33(2):69–80.
Databases
• Statistics Canada. Table 103-0550 — New cases for ICD-O-3
primary sites of cancer (based on the July 2011 CCR
tabulation file), by age group and sex, Canada, provinces
and territories, annual, CANSIM (database).
• Statistics Canada. Table 103-0553 — New cases and
age-standardized rate for ICD-O-3 primary sites of cancer
(based on the July 2011 CCR tabulation file), by sex, Canada,
provinces and territories, annual, CANSIM (database).
References
1. Steliarova-Foucher E, Stiller CA, Lacour B, Kaatsch P. International classification of
childhood cancer. 3rd ed. Cancer. 2005;103:1457–1467.
2. Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS). Ottawa; 2012.
• Mitra D, Shaw AK, Hutchings K. Trends in incidence of
childhood cancer in Canada, 1992–2006. Chronic Diseases
and Injuries in Canada. 2012;32(3):131–9.
• Furlong W, Rae C, Greenberg ML, Barr RD. Surveillance and
survival among adolescents and young adults with cancer in
Ontario, Canada. International Journal of Cancer.
2012;131(11):2660–7.
• Navaneelan T, Janz T. Cancer in Canada: Focus on lung,
colorectal, breast and prostate. Health at a Glance, Statistics
Canada (Catalogue no. 82-624-X), 2011.
• Ellison LF, De P, Mery LS, Grundy PE. Canadian cancer
statistics at a glance: Cancer in children. CMAJ.
2009:180(4):422–4.
• Greenberg ML, Barnett H, Williams J, editors. Atlas of
Childhood Cancer in Ontario. Toronto: Pediatric Oncology
Group of Ontario; 2015: http://www.pogo.ca/wp-content/
uploads/2015/02/POGO_CC-Atlas-1985-2004_Full-Report_
Feb-2015.pdf
33
CHAPTER 2
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Incidence by sex, age and geography: Who gets cancer in Canada?
TABLE 2.1 Estimated population and new cases for all cancers by age group and sex, Canada, 2015
Population (in thousands)
New cases (2015 estimates)
Age
Total*
Males
Females
Total*
Males
Females
All ages
0–19
20–29
30–39
40–49
50–59
60–69
70–79
80+
36,104
7,991
4,938
4,950
4,846
5,383
4,132
2,350
1,516
17,913
4,102
2,512
2,480
2,436
2,688
2,012
1,100
583
18,191
3,889
2,426
2,470
2,409
2,695
2,120
1,250
933
196,900
1,500
2,200
5,400
12,800
34,700
54,900
48,000
37,400
100,500
810
1,050
1,800
4,400
16,500
30,700
27,000
18,300
96,400
690
1,200
3,600
8,400
18,200
24,200
21,000
19,100
* Column totals may not sum to row totals due to rounding.
Note: “New cases” excludes non-melanoma skin cancer (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous).
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database, Census and Demographics Branch at Statistics Canada and Quebec Cancer Registry (2008–2010)
TABLE 2.2 Estimated new cases for the most common cancers by age group and sex, Canada, 2015
Lung
Colorectal
Prostate
Breast
Age
Total*
Males
Females
Total*
Males
Females
Males
Females
All ages
0–19
20–29
30–39
40–49
50–59
60–69
70–79
80+
26,600
10
25
90
640
3,700
7,900
8,400
5,900
13,600
5
10
30
270
1,700
4,100
4,500
3,000
13,000
5
15
60
370
1,950
3,800
3,900
2,900
25,100
10
80
310
1,100
3,700
6,700
7,000
6,200
14,000
5
40
160
570
2,100
4,100
4,100
2,900
11,100
5
40
150
520
1,550
2,600
2,900
3,300
24,000
—
—
5
460
4,400
9,600
6,400
3,100
25,000
5
120
1,050
3,300
6,200
6,800
4,500
3,100
— Fewer than 3 cases.
* Column totals may not sum to row totals due to rounding.
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
This table was adapted in June 2015.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
34
CHAPTER 2
n
Incidence by sex, age and geography: Who gets cancer in Canada?
TABLE 2.3 Estimated population and new cases for all cancers by sex and geographic region, Canada, 2015
Population (in thousands)
CANADA
British Columbia (BC)
Alberta (AB)
Saskatchewan (SK)
Manitoba (MB)
Ontario (ON)†
Quebec (QC)‡
New Brunswick (NB)
Nova Scotia (NS)
Prince Edward Island (PE)
Newfoundland and Labrador (NL)‡
Yukon (YT)
Northwest Territories (NT)
Nunavut (NU)
New cases (2015 estimates)
Total*
Males
Females
Total*
Males
Females
36,104
4,888
3,996
1,068
1,300
14,128
8,214
769
967
149
510
35
45
34
17,913
2,423
2,032
532
649
6,970
4,078
378
471
73
249
18
23
18
18,191
2,465
1,964
536
652
7,158
4,136
391
496
76
261
17
22
17
196,900
25,400
17,000
5,500
6,700
76,000
50,100
5,100
6,300
910
3,500
140
160
80
100,500
13,400
9,000
2,800
3,400
38,300
24,900
2,800
3,300
510
1,950
70
80
40
96,400
12,000
8,000
2,700
3,300
37,700
25,200
2,300
3,000
400
1,550
70
80
40
* Column totals may not sum to row totals due to rounding.
†
At the time the data were received, Ontario did not report in situ bladder
cancer; this should be considered when making comparisons across
provinces.
†
The number of cases for some cancers used to calculate the overall 2015
incidence estimates for this province was underestimated.
Note: New cases excludes non-melanoma skin cancer (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous).
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database, Census and Demographics Branch at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
35
CHAPTER 2
n
Incidence by sex, age and geography: Who gets cancer in Canada?
TABLE 2.4 Estimated new cases for selected cancers by sex and province, Canada, 2015
Males
All cancers
Prostate
Colorectal
Lung
Bladder
Non-Hodgkin lymphoma
Kidney
Melanoma
Leukemia
Oral
Pancreas
Stomach
Brain/CNS
Esophagus
Liver
Multiple myeloma
Thyroid
Testis
Females
All cancers
Breast
Lung
Colorectal
Body of uterus
Thyroid
Non-Hodgkin lymphoma
Melanoma
Ovary
Leukemia
Pancreas
Kidney
Bladder
Cervix
Oral
Stomach
Brain/CNS
Multiple myeloma
Liver
Esophagus
Canada*
BC
AB
SK
MB
100,500
24,000
14,000
13,600
6,200
4,500
3,900
3,700
3,500
2,900
2,400
2,100
1,750
1,700
1,650
1,500
1,450
1,050
96,400
25,000
13,000
11,100
6,300
4,800
3,700
3,100
2,800
2,700
2,400
2,300
2,100
1,500
1,450
1,250
1,250
1,150
550
500
ON†
QC‡
13,400
3,800
1,750
1,550
890
640
350
550
490
380
330
270
200
210
250
190
120
150
9,000
2,200
1,250
1,100
610
440
360
320
350
260
220
200
150
200
150
140
130
110
2,800
690
430
360
200
140
120
75
120
65
70
65
45
40
25
40
20
30
12,000
3,400
1,600
1,400
870
300
510
460
310
340
310
200
290
180
180
140
150
140
85
75
8,000
2,300
1,050
910
540
370
360
260
190
260
220
220
180
170
110
85
110
110
55
50
2,700
710
410
340
170
50
110
65
80
85
75
75
70
45
35
35
35
35
10
15
NB
NS
3,400
740
540
430
220
150
160
110
140
120
85
90
50
50
40
45
35
40
38,300
9,700
5,100
4,600
1,650
1,750
1,500
1,750
1,450
1,200
910
780
740
700
700
600
680
410
3,300
860
460
430
250
100
140
80
100
80
80
80
70
50
55
40
40
35
15
15
37,700
9,800
4,400
4,100
2,600
2,500
1,450
1,500
1,200
1,200
860
950
510
640
610
510
490
480
190
200
PE
NL‡
24,900
4,600
3,700
4,300
2,000
1,000
1,000
510
730
680
650
540
440
350
410
370
360
230
2,800
780
370
430
180
110
140
95
85
65
65
55
35
45
20
35
35
20
3,300
710
510
480
230
140
150
160
80
90
65
65
50
55
40
45
30
25
510
140
65
75
30
15
20
25
15
15
10
10
5
10
5
5
5
5
1,950
540
330
280
100
85
75
50
35
45
30
55
25
20
15
20
15
10
25,200
6,100
4,000
2,900
1,450
1,200
810
440
700
540
660
580
750
290
350
330
360
270
160
110
2,300
570
380
260
140
110
95
90
65
50
70
80
65
30
30
35
30
30
5
10
3,000
780
480
410
160
90
120
140
65
60
80
100
75
45
40
40
40
30
10
20
400
110
60
55
25
10
15
15
10
10
10
15
10
10
10
5
5
5
—
—
1,550
360
190
230
95
40
70
35
30
20
25
50
35
30
15
30
20
15
5
5
— Fewer than 3 cases.
CNS=central nervous system
* Column totals may not sum to row totals due to rounding. Canada totals
include provincial and territorial estimates. Territories are not listed due to
small numbers.
At the time the data were received, Ontario did not report in situ bladder
cancer; this should be considered when making comparisons across
provinces.
†
‡
The number of cases for some cancers used to calculate the overall 2015
estimates for this province was underestimated.
Note: “All cancers” excludes non-melanoma skin cancer (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous). The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
36
CHAPTER 2
n
Incidence by sex, age and geography: Who gets cancer in Canada?
TABLE 2.5 Estimated age-standardized incidence rates (ASIR) for selected cancers by sex and province, Canada, 2015
Cases per 100,000
Canada*
Males
All cancers
Prostate
Colorectal
Lung
Bladder
Non-Hodgkin lymphoma
Kidney
Melanoma
Leukemia
Oral
Pancreas
Stomach
Brain/CNS
Esophagus
Thyroid
Liver
Testis
Multiple myeloma
Females
All cancers
Breast
Lung
Colorectal
Body of uterus
Thyroid
Non-Hodgkin lymphoma
Melanoma
Ovary
Leukemia
Kidney
Pancreas
Cervix
Bladder
Oral
Brain/CNS
Stomach
Multiple myeloma
Liver
Esophagus
BC
AB
SK
MB
ON†
QC‡
NB
NS
PE
NL‡
431
99
60
58
26
20
17
16
16
12
10
9
8
7
7
7
6
6
405
111
51
46
26
20
11
17
16
11
10
8
7
6
4
7
7
6
407
96
57
50
28
20
16
14
16
11
10
9
7
9
6
6
6
6
402
98
62
51
28
21
18
11
18
9
10
9
7
6
4
4
7
6
428
91
67
54
28
19
20
14
18
14
11
11
7
6
5
5
7
6
432
107
57
51
18
20
17
20
17
13
10
9
9
8
8
8
6
7
444
79
65
75
36
18
18
10
14
12
11
10
9
6
7
7
7
7
491
130
65
74
32
20
24
17
16
11
11
10
7
8
7
3
6
6
465
95
71
67
33
20
22
23
12
13
9
9
8
8
5
5
6
6
484
126
60
71
30
16
20
24
14
14
12
8
7
8
6
4
7
7
507
133
85
70
26
23
19
14
10
12
7
14
8
5
5
3
5
5
374
100
48
40
24
23
14
13
11
11
9
8
7
7
6
6
5
4
2
2
337
100
41
36
24
11
14
14
9
10
5
8
6
7
5
5
4
4
2
2
333
96
44
37
22
17
15
11
8
11
9
9
8
7
4
5
3
4
2
2
357
96
51
42
22
9
15
9
10
11
10
9
9
9
5
5
4
5
1
2
371
100
49
44
28
15
15
10
12
9
9
8
7
7
6
5
4
3
2
1
385
101
42
39
26
31
15
16
13
13
10
8
8
5
6
6
5
4
2
2
396
101
60
41
22
25
13
8
11
9
9
9
6
11
6
7
5
4
2
1
373
93
56
39
21
22
15
16
11
9
13
10
7
10
5
6
5
4
1
2
387
102
56
49
20
16
16
20
8
8
13
9
8
9
5
6
5
4
1
2
338
95
45
44
19
10
13
16
10
8
11
8
10
7
7
5
4
4
—
—
375
86
42
53
23
13
16
9
8
6
12
5
10
8
4
5
8
3
1
1
CNS=central nervous system
* Canada totals include provincial and territorial estimates. Territories are
not listed due to small numbers.
At the time the data were received, Ontario did not report in situ bladder
cancer; this should be considered when making comparisons across
provinces.
†
‡
The number of cases for some cancers that were used to calculate the
overall 2015 estimates for this province was underestimated.
Note: “All cancers” excludes non-melanoma skin cancer (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous). Rates are
age-standardized to the 1991 Canadian population. The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
37
CHAPTER 3
Mortality: How many people in Canada die of cancer?
Highlights
Probability of dying from cancer
• An estimated 78,000 Canadians are expected to die
of cancer in 2015.
• It is expected that 1 in 4 Canadians will die of cancer.
Males have a 29% lifetime probability (approximately
a 1 in 3.5 chance) of dying from cancer. Females have
a 24% lifetime probability (approximately a 1 in 4.1
chance) of dying from cancer.
• Between 2001 and 2010, overall age-standardized
mortality rates declined by 1.8% per year for males.
A similar decline of 1.2% per year for females was
seen between 2002 and 2010. On average, mortality
rates declined by at least 2% per year for the
following: colorectal, lung and oral cancers in males;
breast and cervical cancers in females; and larynx,
non-Hodgkin lymphoma and stomach cancers in
both sexes.
• Between 2001 and 2010, liver cancer mortality rates
increased in both males and females.
• Between 2005 and 2010, uterine cancer mortality
rates increased by 2.8%.
In Canada, approximately 1 in 4 Canadians are expected
to die from cancer (data not shown). The chance of
dying from cancer differs slightly by sex (see Figure 3.1).
As shown in Table 3.1, males have a 29% chance (or 1
in 3.5 chance) of dying from cancer. Lung cancer is the
most likely cause of cancer death, with a 1 in 13
chance. Prostate cancer is the next most likely cause of
cancer death, with a 1 in 27 chance. Colorectal cancer
is the third most likely cause of cancer death, with a 1
in 29 chance.
Table 3.1 also shows that females in Canada have a
24% chance (or a 1 in 4.1 chance) of dying from
cancer. Lung cancer is the most likely cause of cancer
death in females, with a 1 in 17 chance. Females have a
1 in 30 chance of dying from breast cancer, followed by
a 1 in 32 chance of dying from colorectal cancer.
FIGURE 3.1 Lifetime probability of dying from cancer, Canada, 2010
Males
Females
29%
(1 in 3.5)
24%
(1 in 4.1)
Introduction
Each hour, an estimated nine people will die of cancer
in Canada, in 2015. Monitoring cancer deaths over
time allows us to measure progress in reducing cancer
deaths and contemplate the implications of changing
patterns on the Canadian healthcare system.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
38
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
Deaths from cancer in 2015
FIGURE 3.2 Percent distribution of estimated cancer deaths, by sex,
Canada, 2015
An estimated 78,000 Canadians are expected to die
from cancer in 2015 (Table 3.2).
• Lung, colorectal, breast and prostate cancers account
for approximately 50% of all cancer deaths combined
Males
Males
in each sex (Figure 3.2). Although it is much less
41,000
41,000
commonly diagnosed than many other cancers,
Deaths
Deaths
pancreatic cancer is the fourth leading cause of
Lung26.6%
cancer death in both sexes because of its low survival
Colorectal12.4%
rate.
Prostate10.1%
Pancreas5.6%
• Lung cancer is the leading cause of cancer death for
Bladder4.0%
both sexes. It is responsible for approximately equal
Esophagus3.9%
proportions of all cancer deaths in both males and
Leukemia3.8%
Non-Hodgkin lymphoma 3.5%
females.
Stomach3.1%
• Colorectal cancer is the second most common cause
Brain/CNS3.0%
of cancer death for males and the third most
Kidney2.7%
Liver2.1%
common cause of cancer death for females.
Oral2.0%
• Breast cancer is the second most common cause of
Melanoma1.8%
cancer death in females.
Multiple myeloma
1.8%
Larynx0.8%
• Prostate cancer is the third most common cause of
Breast0.1%
cancer death in males.
All other cancers
12.5%
Age-standardized mortality rate (ASMR)
Females
Females
Deaths
Deaths
37,000 37,000
Lung27.0%
Breast13.6%
Colorectal11.5%
Pancreas6.2%
Ovary4.7%
Non-Hodgkin lymphoma 3.3%
Leukemia3.1%
Body of uterus
2.8%
Brain/CNS2.3%
Stomach2.1%
Bladder1.8%
Kidney1.8%
Multiple myeloma
1.7%
Esophagus1.2%
Melanoma1.1%
Oral1.1%
Cervix1.0%
Liver0.7%
Larynx0.2%
All other cancers
12.8%
The number of cancer deaths per 100,000 people,
standardized to the age structure of the 1991
Canadian population to account for changes in age
distribution over time.
Annual percent change (APC)
The estimated change in the rate of cancer deaths
(mortality) from one year to the next over a defined
period of time, reported as a percentage. Along with
the changepoint (the year in which the APC
changed), the APC is useful for examining trends.
Mortality
The number of deaths due to cancer in a given year.
Probability
The chance a person has of dying from cancer
measured over a period of time. The probability of
dying from cancer is expressed as a percentage or as
a chance (e.g., a 1 in 5 chance).
Statistical significance
Refers to a number or a relationship that is unlikely
to occur simply by chance; in other words, a statistic
that is reliable.
CNS=central nervous system
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
39
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
Trends over time
FIGURE 3.3 Deaths and age-standardized mortality rates (ASMR) for all cancers, Canada, 1986–2015
Over the past several decades, the number of cancer
deaths per year continues to increase in both sexes.
During this period, age-standardized mortality rates
(ASMR) for some cancers have varied between the
sexes (Figures 3.3–3.5).
• For males, the mortality rate for all cancers has been
decreasing after it reached a peak in 1988. This is
largely due to decreases in mortality rates for lung
cancer and, to a lesser extent, decreases in deaths
from colorectal and prostate cancers.
• For females, the cancer mortality rate for all cancers
has also declined, but to a lesser degree than for
males. The ASMR for females has dropped since the
mid-1990s as a result of declines in the mortality
rates for breast and colorectal cancers.
• Since the early 2000s, the mortality rate for nonHodgkin lymphoma has declined for both sexes.
• Cancer mortality rates continue to increase for liver
cancer in both sexes.
ASMR (per 100,000)
Deaths (in thousands)
80
600
70
Males
ASMR
Deaths
500
60
50
400
40
300
30
Estimated
20
200
10
100
1986
1990
1995
2000
2005
ASMR (per 100,000)
2010
2015
0
Deaths (in thousands)
80
600
70
Females
ASMR
Deaths
500
60
50
400
40
300
30
Estimated
20
200
10
100
1986
1990
1995
2000
2005
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
2010
2015
0
Note: Rates are agestandardized to the 1991
Canadian population.
Actual mortality data were
available to 2010.
View data
40
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
Trends for selected cancers
Tables 3.3 and 3.4 show the ASMR from 1986 to 2015
for selected cancers in males and females. Table 3.5
shows the annual percent change (APC). Figures 3.4
and 3.5 show, among males and females, the five most
common cancers and those with the largest statistically
significant decreases or increases in APC (of at least
2% per year). These cancers are discussed below.
Body of uterus (uterine cancer)
The mortality rate for uterine cancer among females
increased by 2.8% per year between 2005 and 2010.
The increase in the mortality rate has followed the
increase in the incidence rate of uterine cancer over
the same period of time.
FIGURE 3.4 Age-standardized mortality rates (ASMR) for selected* cancers, males, Canada, 1986–2015
ASMR (per 100,000)
90
90
Estimated
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
Breast cancer
The female breast cancer death rate has been declining
since the mid-1980s. After its peak in 1986, the
age-standardized mortality rate has fallen 44%, from
32.0 deaths per 100,000 in 1986 to a projected rate of
17.9 deaths per 100,000 in 2015. The downward trend
has accelerated to 2.5% per year since 2001, which is
likely due to a combination of increased
mammography screening(1) and the use of more
effective therapies following breast cancer surgery.(2,3)
Mammographic screening between ages 40 through 79
reduced subsequent mortality rates from breast cancer.(4)
However, most provincial screening programs target
women >50 ages, reflecting the uncertainty about the
role of mammography in the reduction in breast
cancer mortality in younger women. One Canadian
study found no benefit to mammography in women
between 40–50 years of age(5) while other studies report
a benefit.(6,7) Both pre-diagnosis and post-diagnosis
physical activity was associated with reduced breast
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
80
1986
1990
1995
2000
2005
2010
2015
0
Males
Lung
Colorectal
Prostate
View data
ASMR (per 100,000)
20
20
Estimated
15
15
10
10
5
5
0
1986
1990
1995
2000
2005
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
2010
2015
0
Males
Stomach
Pancreas
Non-Hodgkin lymphoma
Larynx
Oral
Liver
* Five most frequent causes of
cancer death (both sexes
combined) and cancers with a
statistically significant change in
mortality rate of at least 2% per
year (see Table 3.5).
Note: Rates are age-standardized
to the 1991 Canadian population.
See Table 3.3 for data points.
Actual data for mortality were
available to 2010. The range of
scales differs widely between the
figures. The complete definition of
the specific cancers listed here can
be found in Table A10.
41
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
mortality,(8,9) while high body mass index was associated
with a poor prognosis in women of all ages.(10) The
breast cancer mortality rate in Canada is the lowest it
has been since 1950, with similar declines observed in
the United States, United Kingdom and Australia.(11)
Cervical cancer
The mortality rate for cervical cancer decreased by
2.3% per year between 2001 and 2010. The decrease in
mortality rate has followed the reduction in the
cervical cancer incidence rate over the same period of
time. The latter is largely the result of Pap test
screening,(12) which has helped detect precancerous
and malignant lesions at an earlier stage when
treatment is more effective. Screening appears to play
more of a role in reducing cervical cancer mortality
among women over the age of 30 years.(13,14)
FIGURE 3.5 Age-standardized mortality rates (ASMR) for selected* cancers, females, Canada, 1986–2015
ASMR (per 100,000)
50
Estimated
40
40
30
30
20
20
10
10
0
Colorectal cancer
The death rate from colorectal cancer continues to
decline for both males (2.5% per year since 2004) and
females (1.8% per year since 2001). The declines in
colorectal cancer death rates are consistent with a
relatively large contribution from screening and with a
smaller impact of risk factor reductions and improved
treatments.(15) In Canada, higher colorectal cancer
death rates have been seen in areas of lower income
despite universal access to healthcare.(16) Physical
activity is associated with a reduction in colorectal
cancer mortality.(9,17)
50
1986
1990
1995
2000
2005
Canadian Cancer Statistics 2015
0
View data
ASMR (per 100,000)
15
Estimated
10
10
Females
Pancreas
Stomach
Non-Hodgkin lymphoma
Body of Uterus
Cervix
Liver
Larynx
5
5
1986
1990
1995
2000
2005
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health of Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
n
2015
15
0
Canadian Cancer Society
2010
Females
Breast
Lung
Colorectal
2010
2015
0
* Five most frequent causes of
cancer death (both sexes
combined) and cancers with a
statistically significant change in
mortality rate of at least 2% per
year (see Table 3.5).
Note: Rates are age-standardized
to the 1991 Canadian population.
See Table 3.4 for data points.
Actual data for mortality were
available to 2010. The range of
scales differs widely between the
figures. The complete definition of
the specific cancers listed here can
be found in Table A10.
42
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
Larynx cancer
Deaths due to larynx cancer have been declining by
more than 4% per year in both males and females since
2001. The trend in mortality rates has followed the
reduction in the larynx cancer incidence rate during
the same time period. Sustained reductions in tobacco
use following the release of the first US Surgeon
General’s Report in 1964 has had a major impact on
the morality rates of tobacco-related cancers, including
those of the larynx.
Liver cancer
Between 2001 and 2010, the mortality rate of liver
cancer has increased significantly for both males (3.1%
per year) and females (2.2% per year). The upward
trend in mortality rates has followed the increase in
liver cancer incidence rates.
Lung cancer
In males, the mortality rate of lung cancer began to
level off in the late 1980s and has been declining ever
since. The mortality rate for females shows a slight but
statistically significant increase (0.4% per year between
2001 and 2010). However, the death rate in females is
expected to begin to decline in the future, similar to
the trend in the female lung cancer death rate seen in
the United States.(18) Despite the converging trends,
males are projected to continue to have a higher
mortality rate of lung cancer (46.3 per 100,000) than
females (35.6 per 100,000) in 2015. Sustained
reductions in tobacco use following the release of the
first US Surgeon General’s Report in 1964 have had a
major impact on lung cancer death rates in North
America. However, tobacco control efforts are still
needed to further reduce the burden of lung cancer(19)
as approximately 15% of the Canadian population
continues to smoke.(20)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
While smoking remains the most important risk factor
for lung cancer, asthma may be a risk factor for lung
cancer mortality among nonsmokers.(21) And areas
with higher residential measurement of radon appear
to have higher lung cancer mortality rates.(22)
Non-Hodgkin lymphoma (NHL)
Mortality rates for NHL have declined by more than
2% per year for both males and female since 2001.
Declines in mortality may reflect recent improvements
in treatment, such as immunotherapy (e.g., rituximab).
In addition, the introduction of highly active
antiretroviral therapy (HAART) in the late 1990s(23) for
HIV infection has resulted in a decline of aggressive
forms of non-Hodgkin lymphoma attributable to HIV
infection.
Oral cancer
Mortality rates for cancers of oral cavity and pharynx
have declined by 2.4% per year for males between 2001
and 2010. The age-standardized mortality rate has
fallen 45%, from 6.2 deaths per 100,000 in 1986 to a
projected rate of 3.4 deaths per 100,000 in 2015.
Mortality rates in females are stable between 2001 and
2010. These rates likely reflect patterns of smoking
prevalence.(24)
Pancreatic cancer
Although it is much less commonly diagnosed than
many other cancers, pancreatic cancer is the fourth
leading cause of cancer death in both sexes because of
its low survival rate. Mortality rates for pancreatic
cancer have been stable in males and females. The
mortality rates for pancreatic cancer closely reflect the
incidence rates for this cancer due to the low survival.(25)
In other countries, trends in pancreatic cancer
mortality rates have shown wide variation in the past
decade. For example, the United Kingdom experienced
decreases,(26) while the United States showed increases
of pancreatic cancer mortality rates.(27)
Prostate cancer
The mortality rate for prostate cancer rose slowly from
1986 to the mid-1990s, when it began to decline. Since
2006, the decline in mortality rate for prostate cancer
has slowed. Nevertheless, the decline likely reflects
improved treatment following the introduction of
hormonal therapy for early and advanced-stage
disease(28,29) and advances in radiation therapy.(30) The
role that screening with the prostate-specific antigen
(PSA) test played in the reduced mortality rate remains
unclear. In 2009, two large randomized trials in the
United States and Europe that studied the use of PSA
testing in males over the age of 55 reported conflicting
results.(31,32) The ongoing follow-up of the men in these
studies may help clarify the role of PSA testing in
reducing deaths from prostate cancer. Diabetes(33,34)
and increasing body mass index(35) may increase risk of
death among men diagnosed with prostate cancer.
Stomach cancer
Between 2001 and 2010, mortality rates for stomach
cancer declined for both males (3.0% per year) and
females (2.3% per year). Mortality rates for both males
and females are less than half of what they were in
1986. The trend in mortality rates has followed the
reduction in the stomach cancer incidence rate during
the same time period and may reflect a reduction in
tobacco use.(36)
43
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
What do these statistics mean?
While the overall incidence rate of cancer has been
slightly increasing in Canada, the overall cancer
mortality rate has been decreasing. A decrease in the
mortality rate for a specific cancer can result from a
decrease in the incidence rate or improvement in the
survival rate. For example, the relatively large
reduction in mortality rates from lung, oral and larynx
cancers reflect the reduction in smoking rates that led
to a large reduction in cancer incidence rates,
particularly among males. The decrease in the
mortality rate for a specific cancer can also reflect the
availability of better treatment options leading to
improved or longer survival, particularly for cancers
that are detected at an early stage of disease when they
are most amenable to treatments. Although the ASMR
for cancer mortality continues to decline, the actual
number of cancer deaths continues to increase due to
the growth and aging of the population. This has
implications for health policy and resource planning.
For further information
Publications
• Kachuri L, De P, Ellison LF, Semenciw R. Cancer incidence,
mortality and survival trends in Canada, 1970–2007. Chronic
Diseases and Injuries in Canada. 2013;33(2):69–80.
• Navaneelan T, Janz T. Cancer in Canada: Focus on lung,
colorectal, breast and prostate. Health at a Glance, Statistics
Canada (Catalogue no. 82-624-X); 2011.
• Marrett LD, De P, Airia P, Dryer D. Cancer in Canada in 2008.
CMAJ. 2008;179(11):1163–70.
Databases
• Statistics Canada. Table 102-0522 – Deaths, by cause,
Chapter II: Neoplasms (C00 to D48), age group and sex,
Canada, annual (number), CANSIM (database).
• Statistics Canada. Table 102-4309 – Mortality and potential
years of life lost, by selected causes of death and sex,
three-year average, Canada, provinces, territories, health
regions and peer groups, occasional (number unless
otherwise noted), CANSIM (database).
• Statistics Canada, Table 102-0551 – Deaths and mortality
rate, by selected grouped causes, age group and sex,
Canada, CANSIM (database).
• Public Health Agency of Canada. Chronic Disease Infobase
Cubes. Ottawa, Canada.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
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27.American Cancer Society. Cancer Facts & Figures 2013. Atlanta: American Cancer Society;
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28.Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR. National practice patterns and time
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45
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
TABLE 3.1 Lifetime probability of dying from cancer overall and by age group, Canada, 2010
Lifetime probability of
dying from cancer
%
One in:
Males
All cancers
Lung
Colorectal
Prostate
Pancreas
Brain/CNS
Esophagus
Non-Hodgkin lymphoma
Leukemia
Stomach
Kidney
Bladder
Oral
Liver
Melanoma
Multiple myeloma
Larynx
Females
All cancers
Lung
Breast
Colorectal
Pancreas
Ovary
Brain/CNS
Non-Hodgkin lymphoma
Leukemia
Body of uterus
Stomach
Cervix
Kidney
Multiple myeloma
Bladder
Esophagus
Oral
Melanoma
Liver
Thyroid
Lifetime probability (%) of dying from cancer in next 10 years by age group
30–39
40–49
50–59
60–69
70–79
80–89
28.6
7.7
3.5
3.7
1.4
0.7
0.9
1.0
1.0
0.8
0.7
1.2
0.5
0.4
0.4
0.5
0.2
3.5
13
29
27
72
153
106
99
96
118
139
82
200
224
227
195
412
0.1
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
0.4
0.1
0.1
—
—
—
—
—
—
—
—
—
—
—
—
—
—
1.8
0.5
0.2
—
0.1
0.1
0.1
0.1
—
0.1
0.1
—
0.1
0.1
—
—
—
5.3
1.8
0.6
0.3
0.3
0.2
0.2
0.2
0.2
0.2
0.1
0.1
0.1
0.1
0.1
0.1
0.1
11.2
3.5
1.4
1.1
0.6
0.3
0.4
0.4
0.4
0.3
0.3
0.4
0.2
0.2
0.2
0.2
0.1
16.5
3.9
2.1
2.9
0.7
0.2
0.4
0.6
0.7
0.5
0.4
0.8
0.2
0.2
0.2
0.3
0.1
24.3
5.9
3.3
3.1
1.4
1.1
0.5
0.8
0.8
0.6
0.5
0.2
0.4
0.4
0.5
0.3
0.3
0.2
0.1
0.1
4.1
17
30
32
70
91
197
118
132
156
182
475
234
239
210
324
346
456
684
1,068
0.2
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
0.6
0.1
0.2
0.1
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
1.8
0.5
0.4
0.2
0.1
0.1
0.1
—
—
0.1
—
—
—
—
—
—
—
—
—
—
4.1
1.3
0.6
0.3
0.2
0.2
0.1
0.1
0.1
0.1
0.1
—
0.1
0.1
—
0.1
—
—
—
—
7.7
2.4
0.9
0.8
0.5
0.4
0.1
0.3
0.2
0.2
0.2
0.1
0.1
0.2
0.1
0.1
0.1
0.1
0.1
—
11.0
2.3
1.3
1.6
0.7
0.4
0.2
0.5
0.4
0.3
0.3
0.1
0.2
0.2
0.3
0.2
0.1
0.1
0.1
0.1
CNS=central nervous system
— Value less than 0.05
Note: The probability of dying from cancer represents the proportion
of Canadians who die of cancer in a cohort based on age- and
sex-specific cancer mortality rates for Canada in 2010 and on life
tables based on 2008–2010 all-cause mortality rates. For further
details, see Appendix II: Data sources and methods. The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
46
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
TABLE 3.2 Estimated deaths and age-standardized mortality rates (ASMR) for cancers by sex, Canada, 2015
Deaths (2015 estimates)
All cancers
Lung
Colorectal
Breast
Pancreas
Prostate
Leukemia
Non-Hodgkin lymphoma
Bladder
Brain/CNS
Esophagus
Stomach
Kidney
Ovary
Multiple myeloma
Oral
Melanoma
Liver
Body of uterus
Larynx
Cervix
All other cancers
Deaths per 100,000
Total*
Males
Females
Total
Males
Females
78,000
20,900
9,300
5,100
4,600
4,100
2,700
2,700
2,300
2,100
2,100
2,000
1,800
1,750
1,400
1,200
1,150
1,100
1,050
380
380
9,900
41,000
10,900
5,100
60
2,300
4,100
1,550
1,450
1,600
1,250
1,600
1,300
1,150
—
740
810
750
860
—
310
—
5,100
37,000
10,000
4,200
5,000
2,300
—
1,150
1,200
680
860
460
760
660
1,750
640
390
420
270
1,050
75
380
4,700
148.0
40.2
17.4
9.7
8.7
17.4
5.2
5.1
4.1
4.4
3.9
3.9
3.4
6.2
2.6
2.3
2.3
2.2
3.7
0.7
1.6
18.3
174.2
46.3
21.6
0.2
9.7
17.4
6.8
6.2
6.8
5.5
6.7
5.5
4.7
—
3.1
3.4
3.2
3.6
—
1.3
—
22.0
128.2
35.6
13.8
17.9
7.8
—
3.9
4.2
2.1
3.4
1.5
2.6
2.3
6.2
2.2
1.4
1.5
0.9
3.7
0.3
1.6
15.4
CNS=central nervous system
— Not applicable
* Column totals may not sum to row totals due to rounding.
Note: “All other cancers” includes 500 deaths from non-melanoma skin
cancer. The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
47
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
TABLE 3.3 Age-standardized mortality rates (ASMR) for selected* cancers, males, Canada, 1986–2015
Deaths per 100,000
Year
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011 †
2012†
2013†
2014†
2015†
All
cancers
Lung
Colorectal
Prostate
Pancreas
Non-Hodgkin
lymphoma
Stomach
Liver
Oral
Larynx
249.0
248.1
254.6
249.4
246.4
247.5
245.2
243.2
242.3
239.3
236.6
232.3
230.7
229.8
225.8
224.3
220.3
215.4
212.1
207.7
201.5
201.7
198.4
194.3
188.8
186.1
183.0
180.0
177.0
174.2
78.8
78.5
81.2
81.0
79.4
78.7
77.6
77.9
75.6
73.3
72.9
70.5
70.2
70.4
64.3
64.7
64.5
62.7
60.6
59.8
57.5
57.3
55.0
54.7
52.8
51.1
49.8
48.6
47.4
46.3
31.9
31.9
32.3
31.9
30.8
30.3
31.0
29.6
30.2
30.0
29.4
28.8
28.8
28.4
28.4
27.0
27.6
26.7
26.7
26.4
24.8
24.6
24.7
23.6
22.8
22.9
22.5
22.2
21.8
21.5
29.4
29.4
30.7
29.7
30.1
31.2
31.1
31.1
30.8
31.1
29.0
28.8
28.1
26.9
26.9
26.7
25.1
24.0
23.4
21.9
20.8
20.8
20.5
19.9
19.7
18.9
18.5
18.1
17.7
17.4
12.8
12.6
11.8
11.5
11.3
11.0
11.2
11.1
11.0
10.7
10.9
10.0
10.4
10.6
10.1
10.3
9.8
10.3
10.4
9.8
9.8
10.3
10.0
10.2
9.5
9.9
9.8
9.8
9.8
9.7
7.7
7.1
7.8
7.7
7.9
8.1
8.1
7.7
8.4
8.4
8.4
8.7
8.9
9.2
9.0
9.1
8.5
8.5
8.3
7.9
7.5
7.9
7.4
7.4
6.9
6.9
6.7
6.5
6.4
6.2
13.1
12.9
12.8
12.3
11.3
10.3
10.7
9.7
9.8
9.6
9.5
9.0
8.6
8.4
8.1
7.6
7.3
7.4
7.0
6.8
7.0
6.5
6.2
6.1
5.7
5.9
5.8
5.6
5.6
5.5
2.3
2.3
2.6
2.4
2.0
1.9
2.2
2.3
2.5
2.1
2.2
2.4
2.7
2.7
2.4
2.6
2.6
2.7
2.6
3.0
3.0
3.1
3.0
3.3
3.4
3.4
3.4
3.5
3.5
3.6
6.2
5.8
5.8
5.9
5.6
6.0
5.4
5.6
5.3
5.2
5.0
5.0
4.7
4.7
3.9
4.6
4.7
4.1
4.1
4.0
3.9
4.1
3.9
3.6
3.7
3.6
3.5
3.5
3.4
3.4
3.5
3.6
3.7
3.2
3.6
3.5
3.3
3.2
3.2
3.1
2.9
2.8
2.7
2.6
2.8
2.7
2.5
2.3
2.2
2.1
2.0
1.8
2.0
1.9
1.7
1.6
1.5
1.4
1.4
1.3
* Five most frequent causes of cancer death (both sexes combined)
and cancers with a statistically significant change in mortality rate of
at least 2% per year (see Table 3.5).
†
Rates for these years are estimated based on all provinces and
territories. Actual mortality data were available to 2010. These
estimates are based on long-term trends and may not reflect recent
changes in trends. The complete definition of the specific cancers
listed here can be found in Table A10.
Note: Rates are age-standardized to the 1991 Canadian population.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
48
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
TABLE 3.4 Age-standardized mortality rates (ASMR) for selected* cancers, females, Canada, 1986–2015
Deaths per 100,000
Year
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011†
2012†
2013†
2014†
2015†
All
cancers
Lung
Breast
Colorectal
Pancreas
Non-Hodgkin
lymphoma
Body of
uterus
Stomach
Cervix
Liver
Larynx
154.4
154.0
155.3
153.0
152.9
153.7
153.1
154.9
155.2
152.0
155.2
150.4
151.3
149.8
149.8
148.2
149.2
148.1
147.0
143.7
141.5
141.6
140.5
137.5
136.2
134.3
132.8
131.3
129.7
128.2
23.9
25.3
26.9
26.9
27.5
29.5
29.6
31.7
31.9
31.3
33.6
32.6
34.5
34.9
34.4
34.4
35.2
35.3
36.1
35.9
36.8
36.2
36.2
36.1
36.1
36.1
36.1
36.1
35.8
35.6
32.0
31.3
31.4
31.2
31.3
30.1
30.4
29.4
30.0
28.7
28.9
27.8
26.4
25.2
25.0
25.0
24.4
24.1
23.1
22.6
21.5
21.8
21.0
20.5
19.9
19.5
19.0
18.6
18.2
17.9
23.3
22.8
22.6
21.2
21.2
20.6
20.1
20.2
19.8
19.7
19.6
18.7
19.1
18.5
18.1
17.6
17.5
16.9
17.1
16.7
15.7
16.4
15.8
15.2
14.9
14.8
14.5
14.3
14.0
13.8
8.5
8.7
8.1
7.8
8.2
8.0
8.0
8.3
8.4
7.9
8.3
8.0
8.0
7.8
7.9
7.8
7.8
8.1
8.2
7.8
8.0
7.9
7.9
8.0
7.6
7.8
7.8
7.8
7.8
7.8
5.1
5.2
5.0
5.5
5.5
5.7
5.5
5.5
5.7
5.9
5.8
5.8
6.0
5.7
6.1
5.7
5.7
5.5
5.8
5.0
4.9
5.2
4.8
4.7
4.4
4.5
4.4
4.3
4.2
4.2
3.6
4.1
3.6
3.7
3.9
3.5
3.5
3.4
3.2
3.6
3.4
3.4
3.4
3.3
3.2
3.3
3.3
3.5
3.4
3.0
3.2
3.5
3.4
3.6
3.7
3.5
3.6
3.6
3.6
3.7
6.1
5.7
5.1
5.5
5.0
4.9
4.9
4.5
4.6
4.6
4.4
3.9
3.8
4.0
3.9
3.4
3.6
3.5
3.3
3.5
3.2
2.9
3.2
2.9
2.9
2.8
2.8
2.8
2.7
2.7
3.2
3.0
3.0
2.9
3.0
2.9
2.4
2.6
2.7
2.4
2.6
2.5
2.3
2.4
2.2
2.1
1.9
1.9
2.0
1.8
1.8
1.9
1.7
1.7
1.7
1.7
1.6
1.6
1.6
1.6
0.9
0.9
0.9
1.0
0.8
0.7
0.7
0.7
0.6
0.6
0.7
0.6
0.7
0.8
0.7
0.7
0.8
0.7
0.7
0.7
0.8
0.8
0.8
0.8
0.9
0.9
0.9
0.9
0.9
0.9
0.6
0.6
0.6
0.5
0.5
0.7
0.4
0.5
0.6
0.6
0.4
0.5
0.4
0.5
0.5
0.4
0.4
0.4
0.4
0.4
0.3
0.4
0.4
0.3
0.3
0.3
0.3
0.3
0.3
0.3
* Five most frequent causes of cancer death (both sexes combined)
and cancers with a statistically significant change in mortality rate of
at least 2% per year (see Table 3.5).
†
Rates for these years are estimated based on all provinces and
territories. Actual data were available to 2010. These estimates are
based on long-term trends and may not reflect recent changes in
trends. The complete definition of the specific cancers listed here can
be found in Table A10.
Note: Rates are age-standardized to the 1991 Canadian population.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
49
CHAPTER 3
n
Mortality: How many people in Canada die of cancer?
TABLE 3.5 Annual percent change (APC) in age-standardized mortality rates (ASMR) for selected cancers, by sex, Canada, 2001–2010
Males
APC
†
All cancers
Lung
Colorectal
Breast
Pancreas
Prostate
Leukemia
Non-Hodgkin lymphoma
Bladder
Stomach
Esophagus
Brain/CNS
Kidney
Ovary
Multiple myeloma
Oral
Liver
Melanoma
Body of uterus
Larynx
Cervix
–1.8**
–2.3**
–2.5**
—
–0.4
–1.6**
–1.5**
–2.6**
–0.1
–3.0**
0.3
0.6
–0.7
—
–1.7*
–2.4**
3.1**
1.8*
—
–4.6**
—
Females
Changepoint
‡
2004
2006
APC
†
–1.2**
0.4*
–1.8**
–2.5**
–0.2
—
–0.6
–2.8**
0.5
–2.3**
–0.8
0.0
–0.8
–1.9**
–1.9**
–0.9
2.2**
0.5
2.8*
–4.1*
–2.3**
Changepoint‡
2002
CNS=central nervous system
— Not applicable or small number of deaths
* Significant increase or decrease in APC, p<0.05
2004
** Significant increase or decrease in APC, p<0.01
APC is calculated assuming a piecewise log linear model. The model
was fitted to the rates in 1986–2010. When there is no changepoint in
the most recent 10 years, the APC was obtained by running a separate
changepoint analysis on the most recent 10 years. If there is a
changepoint, the APC was taken from the last segment. For further
details, see Appendix II: Data sources and methods. The complete
definition of the specific cancers listed here can be found in Table A10.
†
2005
‡
Changepoint indicates the baseline year for the APC shown, if the
slope of the trend changed after 2001.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
50
CHAPTER 4
Mortality by sex, age and geography: Who dies of cancer in Canada?
Highlights
Mortality by sex
Trends over time
• Overall, mortality rates in both sexes have been
decreasing since 1988.
• In 2015, it is estimated that 53% of all cancer deaths
will occur among males and 47% among females.
The mortality rate has been decreasing to varying
degrees for all age groups in males and for the under
70 age groups in females.
• In 2015, almost all cancer deaths in Canada (96%)
will occur in people over the age of 50 years. Most of
these cancer deaths (62%) will occur in people aged
70 years and over.
• Mortality rates generally increase from west to east
across the country.
In 2015, it is estimated that 53% of all cancer deaths
will occur among males and 47% among females.
However, the distribution of cancer deaths between the
sexes differs according to age. Among people aged
30–49 years, females represent a larger proportion of
total cancer deaths than males (Table 4.1). This is
mainly due to the relatively higher number of deaths
from female breast cancer compared to prostate cancer
and the higher number of deaths among females at
younger ages for lung cancer and in the oldest age
group for colorectal cancer (Table 4.2).
Figure 4.1 shows the long-term trend in mortality rates
by sex. The mortality rate for all cancers combined has
been decreasing for both sexes since peaking in 1988.
The decrease in mortality rate in males is largely due to
reductions in lung cancer deaths (closely linked to
decreases in smoking prevalence). The decrease in
cancer deaths in females is attributed to declines in
breast cancer mortality (most likely due to improvements
in early detection and screening as well as advances in
treatment and related improvements in treatment
outcomes).(1,2)
FIGURE 4.1 Age-standardized incidence and mortality rates for all cancers combined, by sex, Canada, 1986–2015
Rate (per 100,000)
Introduction
600
600
As with new diagnoses of cancer, cancer deaths are not
distributed equally across sexes, ages and provinces or
territories. Examining deaths of cancer by sex, age or
geographic region provides a better sense of who is
dying from cancer and can help direct cancer control
services to address the needs of specific populations.
500
500
400
400
300
300
200
200
0
100
1986
1990
1995
2000
2005
2010
2015
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry, National Cancer Incidence Reporting System, Canadian Vital Statistics Death databases at Statistics
Canada and Quebec Cancer Registry (2008–2010)
n
Canadian Cancer Statistics 2015
Mortality
Incidence
Females
100
Canadian Cancer Society
Males
0
Mortality
Incidence
Note: Rates are agestandardized to the 1991
Canadian population. Actual
incidence or mortality data were
available to 2010. Dashed lines
represent estimated rates.
View data
51
CHAPTER 4
n
Mortality by sex, age and geography: Who dies of cancer in Canada?
Mortality by age
FIGURE 4.2 Distribution of cancer deaths for selected cancers by age group, Canada, 2006–2010
In 2015, almost 96% of cancer deaths in Canada will
occur in people aged 50 years and older, with the
median age range for cancer deaths estimated to be
70–74 years for both sexes (Table 4.1).
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
N=600
90
80
N=1,500
N=17,700
Leukemia
(16%)
Lung
(18%)
Brain/CNS
(15%)
Leukemia
(26%)
Connective
tissue (10%)
Colorectal (6%)
40
30
Lung
(25%)
Breast
(16%)
Neuroblastoma
and other PNC
(11%)
Malignant bone
(5%)
Renal tumours (4%)
Colorectal (9%)
Colorectal (11%)
Brain
(8%)
Breast
(8%)
Pancreas (4%)
Pancreas (6%)
Prostate
(7%)
Breast
(6%)
Pancreas (5%)
Non-Hodgkin
lymphoma (6%)
Hodgkin lymphoma (4%)
Melanoma (4%)
Soft tissue
(8%)
20
N=213,000
Colorectal (13%)
Bone
(11%)
60
50
N=118,200
Lung
(31%)
CNS
(34%)
70
% of cancer deaths
In 2015 it is estimated that:
• Canadians aged 70 years or older will account for
48,100 cancer deaths (or 62% of all cancer deaths).
• Canadians aged 60–69 years will account for an
additional 17,600 deaths (or 23% of all cancer deaths).
• Canadians aged 50–59 years will account for 8,800
deaths (or 11% of all cancer deaths).
Older adults account for the largest proportion of
deaths from the most common cancers (see Table 4.2):
• While the majority of new breast cancer cases (70%
of the total cases) occur in females under the age of
70 (see Chapter 2), breast cancer deaths are
proportionately lower (48% of the total breast cancer
deaths) in that younger age group than in females
aged 70 years and older. Breast cancer, however,
represents a higher proportion of total female cancer
deaths in the younger age groups (22% of cancer
deaths in 30–59 year old women versus 12% of
cancer deaths for women 60+). The reasons for
increased mortality observed for younger women
are complex but has been linked to aggressive tumor
biology(3,4) and delayed diagnosis.(5)
• Similarly, prostate cancer will be diagnosed most
frequently in males aged 60–69 years, but most
prostate cancer deaths will occur in males aged 80
years and older. These mortality patterns likely
reflect the often slow progression of the disease.
100
Other
(45%)
Other
(44%)
Other
(43%)
30–49
50–69
70+
Other
(28%)
10
Other
(11%)
0
0–14
15–29
Age group (years)
N is the total number of deaths
over 5 years (2006–2010) for each
age group; CNS=Central nervous
system; PNC=Peripheral nervous
cell tumours.
Note: Childhood cancers
(ages 0–14) are classified
according to ICCC-3.(6) and the
data are shown for 2005–2009.
The complete definition of the
specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
• Unlike many other cancers where the number of
deaths increases with age, deaths for lung cancer
peak in people aged 70–79 years for both males and
females. This peak occurs because the largest
proportion of new cases is in the same age group (see
Chapter 2) and survival is poor, so that deaths
typically occur within a short period after diagnosis
(see Chapter 5).
Cancer deaths among adolescents and
young adults
• Cancer deaths among older adolescents and young
adults (aged 15–29 years) accounted for less than
0.5% of all cancer deaths in Canada. An average of
290 people in Canada between the ages of 15 and 29
die from cancer each year (see Appendix Table A9).
Adolescent and young adult males are more likely to
die of cancer than females of that age group. The
52
CHAPTER 4
n
Mortality by sex, age and geography: Who dies of cancer in Canada?
male death rates are higher for every major cancer
except for tongue, stomach, liver, melanoma and
genitourinary.
• The leading causes of cancer deaths among children,
adolescents and young adults were cancers of the
central nervous system (CNS) and leukemia. These
two types of cancer accounted for 60% of all childhood
cancer deaths (ages 0–14) and 31% of all adolescent and
young adult cancer deaths (ages 15–29) (Figure 4.2).
Trends over time
Age-standardized mortality rate (ASMR)
The number of cancer deaths per 100,000 people, standardized to the age structure of the 1991 Canadian
population to account for changes in age distribution over time.
In this section, age standardization is used to adjust for differences in age distributions among the provinces and
territories, which allows for more accurate comparisons.
Province or territory
Refers to the province or territory of a person’s usual place of residence at the time of their death.
The most recent actual data for provinces and territories are available to 2010 (see Tables A5 and A6 in Appendix I:
Actual data for new cases and deaths).
Cancer mortality rates have decreased to varying
degrees over time for all age groups in males and for
the under-70 age groups in females (Figure 4.3).
FIGURE 4.3 Age-standardized mortality rates (ASMR) for all cancers, by age group, Canada, 1986–2015
800
700
20
15
15
10
10
5
5
0
1986 1990
1995
2000
Females (0–19)
Females (20–29)
Females (30–39)
2005
2010
600
600
400
400
300
300
200
200
100
100
0
1986 1990
Males (0–19)
Males (20–29)
Males (30–39)
1995
2000
Females (40–49)
Females (50–59)
Females (60–69)
2005
2010
3,000
2,500
700
500
0
Age groups 70–80+
800
500
2015
3,000
2,500
Estimated
20
900
25
ASMR per 100,000
ASMR per 100,000
25
Age groups 40–69
900
ASMR per 100,000
30
Estimated
Age groups 0–39
Estimated
30
2,000
1,500
1,000
500
0
2015
Males (40–49)
Males (50–59)
Males (60–69)
2,000
1,500
1,000
1986 1990
1995
2000
Females (70–79)
Females (80+)
2005
2010
500
Note: The range of rate
scales differs widely
between the age groups.
Actual mortality data
were available up to
2010.
2015
Males (70–79)
Males (80+)
View data
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Age Groups 0 to 39
30
Canadian Cancer Society
25
Age Groups 40 to 69
900
900
Canadian Cancer Statistics 2015
800
800
30
n
Age Groups 70 to 80+
25
700
700
3000
3000
2500
2500
53
CHAPTER 4
n
Mortality by sex, age and geography: Who dies of cancer in Canada?
• The age-standardized mortality rates for males aged
60–69, for example, has dropped by 39% from 802
per 100,000 in 1986 to 489 per 100,000 in 2015.
• By comparison, the mortality rate for females of the
same age group (60–69) dropped by 22% over the
same time period (from 483 to 376 per 100,000).
FIGURE 4.4 Geographic distribution of estimated cancer deaths and age-standardized mortality rates (ASMR) by province and territory, both sexes,
Canada, 2015
Mortality by geographic region
The estimated number of cancer deaths for all cancers
and both sexes combined by province and territory are
shown in Table 4.3, with age-standardized mortality
rates (ASMR) shown in Figure 4.4. Similar to the
pattern for incidence rates, the mortality rate for all
cancers combined generally increases from west to east
across the country. These patterns most likely reflect
differences in incidence (due to regional variations in
risk factors such as smoking or obesity) but also
potentially differences in access to and outcomes of
cancer control activities (e.g., screening, diagnosis,
treatment and follow-up).
Estimated deaths (Table 4.4) and ASMR (Table 4.5) for
specific cancer types show that there are several
geographic differences:
• Lung cancer mortality rates for both males and
females are highest in Quebec and the Atlantic
provinces. The mortality rates for this cancer are
lowest in British Columbia for both sexes and in
Ontario and Alberta for females. This pattern closely
mirrors variations in past tobacco smoking
prevalence in these provinces.
• Colorectal cancer mortality rates are highest in
Newfoundland and Labrador for both males and
females (which also has the highest incidence rate of
colorectal cancer for males and females).
• The prostate cancer mortality rate is highest in
Prince Edward Island, Saskatchewan and Manitoba.
The mortality rate for prostate cancer is lowest in
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
237.4 per 100,000
(85 deaths)
200.9 per 100,000
(75 deaths)
318.9 per 100,000
(55 deaths)
136.8 per 100,000
(10,100 deaths)
180.9 per 100,000
(1,500 deaths)
139.4 per 100,000
(6,500 deaths)
153.0 per 100,000
(2,800 deaths)
151.4 per 100,000
(2,400 deaths)
140.9 per 100,000
(28,500 deaths)
162.2 per 100,000
(20,900 deaths)
150.2 per 100,000
(1,950 deaths)
155.2 per 100,000
(380 deaths)
168.5 per 100,000
(2,700 deaths)
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
54
CHAPTER 4
n
Mortality by sex, age and geography: Who dies of cancer in Canada?
New Brunswick and Quebec (which also has the
lowest incidence rate of prostate cancer among the
provinces).
Interprovincial variations in mortality rates could
reflect variation in prevalence of risk factors, the
availability and use of screening and early detection
services, and access to treatment.
What do these statistics mean?
Differences in cancer mortality rates by age, sex and
geography can be driven by a broad range of factors.
These factors include those that are inherent to the
epidemiology of different cancers, particularly the age
at which the cancer tends to occur in populations of
males versus females (e.g., prostate cancer deaths
typically occur in older males compared to breast
cancer deaths that occur in relatively younger females).
Modifiable and non-modifiable risk factors such as
smoking, alcohol consumption, obesity and
environmental carcinogen exposure have a major
impact on mortality rates as they do on incidence
rates. Lung cancer mortality in men has dropped
substantially over the last 20 years because of the sharp
decline in smoking rates,(7) while lung cancer mortality
in females has continued to increase slightly due to the
later peak in smoking prevalence among women.(8)
Other factors, however, may be differences in access to
cancer control interventions (such as screening and
early detection) as well as variations in practice
patterns between provinces and within age and sex
groupings across provinces. There are likely also age
and sex differences in response rate to cancer
treatment,(9) which may contribute to variations in the
mortality rate.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
For further information
Publications
• Navaneelan T, Janz T. Cancer in Canada: Focus on lung,
colorectal, breast and prostate. Health at a Glance, Statistics
Canada (Catalogue no. 82-624-X); 2011.
• Greenberg ML, Barnett H, Williams J, editors. Atlas of
Childhood Cancer in Ontario. Toronto: Pediatric Oncology
Group of Ontario; 2015: http://www.pogo.ca/wp-content/
uploads/2015/02/POGO_CC-Atlas-1985-2004_Full-Report_
Feb-2015.pdf.
Databases
• Statistics Canada. Table 102-0552 — Deaths and mortality
rate, by selected grouped causes and sex, Canada, provinces
and territories, annual, CANSIM (database).
• Statistics Canada. Table 102-4309 — Mortality and potential
years of life lost, by selected causes of death and sex,
three-year average, Canada, provinces, territories, health
regions and peer groups, occasional (number unless
otherwise noted), CANSIM (database).
References
1. Autier P, Boniol M, LaVecchia C, Vatten L, Gavin A, Héry C, Heanue M. Disparities in
breast cancer mortality trends between 30 European countries: retrospective trend
analysis of WHO mortality database. BMJ. 2010 Aug 11. doi: 10.1136/bmj.c3620.
2. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev
AY, Habbema JD, Feuer EJ, Cancer Intervention and Surveillance Modeling Network
(CISNET) Collaborators. Effect of screening and adjuvant therapy on mortality from breast
cancer. NEJM. 2005;353(17):1784–92.
3. Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, Wang Y, Marcom PK,
Marks JR, Febbo PG, Nevins JR, Potti A, Blackwell KL. Young age at diagnosis correlates
with worse prognosis and defines a subset of breast cancers with shared patterns of
gene expression. J Clin Oncol. 2008;26(20):3324–30.
4. Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereakoglow S, Brachtel EF, Schapira L,
Come SE, Winer EP, Partridge AH. Pathologic features and molecular phenotype by patient
age in a large cohort of young women with breast cancer. Breast Cancer Res Treat.
2012;131(3):1061–6.
5. Partridge AH, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW,
Niland JC, Winer EP, Weeks JC, Tamimi RM. The effect of age on delay in diagnosis and
stage of breast cancer. Oncologist. 2012;17(6):775–82.
6. Steliarova-Foucher E, Stiller CA, Lacour B, Kaatsch P. International classification of
childhood cancer, third edition. Cancer. 2005;103:1457–1467.
7. Reid JL, Hammond D, Rynard VL, Burkhalter R. Tobacco use in Canada: patterns and
trends, 2014 edition. Propel Centre for Population Health Impact, University of Waterloo;
2014.
8. Corsi DJ, Boyle MH, Lear SA, Chow CK, Teo KK, Subramanian SV. Trends in smoking in
Canada from 1950 to 2011: progression of the tobacco epidemic according to
socioeconomic status and geography. Cancer Causes & Control. 2014;25(1):45–57.
9. Schmetzer O, Flörcken A. Sex differences in the drug therapy for oncologic diseases.
Handbook of Experimental Pharmacology. 2012;(214):411–42.
55
CHAPTER 4
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Mortality by sex, age and geography: Who dies of cancer in Canada?
TABLE 4.1 Estimated population and deaths for all cancers by age group and sex, Canada, 2015
Population (in thousands)
Deaths (2015 estimates)
Age
Total*
Males
Females
Total*
Males
Females
All ages
0–19
20–29
30–39
40–49
50–59
60–69
70–79
80+
36,104
7,991
4,938
4,950
4,846
5,383
4,132
2,350
1,516
17,913
4,102
2,512
2,480
2,436
2,688
2,012
1,100
583
18,191
3,889
2,426
2,470
2,409
2,695
2,120
1,250
933
78,000
170
200
640
2,300
8,800
17,600
21,500
26,600
41,000
90
110
270
1,050
4,500
9,700
12,000
13,300
37,000
75
90
370
1,300
4,300
7,900
9,500
13,300
* Column totals may not sum to row totals due to rounding.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Vital Statistics Death database and Census and Demographics Branch at Statistics Canada
TABLE 4.2 Estimated deaths for the most common cancers by age group and sex, Canada, 2015
Lung
Colorectal
Prostate
Breast
Age
Total*
Males
Females
Total*
Males
Females
Males
Females
All ages
0–19
20–29
30–39
40–49
50–59
60–69
70–79
80+
20,900
—
5
40
400
2,500
5,600
6,700
5,700
11,000
—
—
15
190
1,250
3,000
3,600
2,900
10,000
—
5
25
210
1,250
2,600
3,100
2,800
9,300
—
15
60
250
940
1,900
2,400
3,700
5,100
—
10
30
130
560
1,200
1,450
1,700
4,200
—
5
30
120
380
720
980
2,000
4,100
—
—
—
10
140
540
1,100
2,300
5,000
—
5
100
360
850
1,100
1,000
1,600
— Fewer than 3 deaths.
* Column totals may not sum to row totals due to rounding.
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
56
CHAPTER 4
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Mortality by sex, age and geography: Who dies of cancer in Canada?
TABLE 4.3 Estimated population and deaths for all cancers by sex and geographic region, Canada, 2015
Population (in thousands)
CANADA
British Columbia (BC)
Alberta (AB)
Saskatchewan (SK)
Manitoba (MB)
Ontario (ON)
Quebec (QC)
New Brunswick (NB)
Nova Scotia (NS)
Prince Edward Island (PE)
Newfoundland and Labrador (NL)
Yukon (YT)
Northwest Territories (NT)
Nunavut (NU)
Deaths (2015 estimates)
Total*
Males
Females
Total*
Males
Females
36,104
4,888
3,996
1,068
1,300
14,128
8,214
769
967
149
510
35
45
34
17,913
2,423
2,032
532
649
6,970
4,078
378
471
73
249
18
23
18
18,191
2,465
1,964
536
652
7,158
4,136
391
496
76
261
17
22
17
78,000
10,100
6,500
2,400
2,800
28,500
20,900
1,950
2,700
380
1,500
85
75
55
41,000
5,400
3,500
1,250
1,400
15,200
10,600
970
1,450
190
840
45
40
30
37,000
4,700
3,000
1,150
1,400
13,300
10,300
960
1,250
190
670
40
35
25
* Column totals may not sum to row totals due to rounding.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Vital Statistics Death database and Census and Demographics Branch at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
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Mortality by sex, age and geography: Who dies of cancer in Canada?
TABLE 4.4 Estimated deaths for selected cancers by sex and province, Canada, 2015
Canada*
Males
All cancers
Lung
Colorectal
Prostate
Pancreas
Esophagus
Bladder
Leukemia
Non-Hodgkin lymphoma
Stomach
Brain/CNS
Kidney
Liver
Oral
Melanoma
Multiple myeloma
Females
All cancers
Lung
Breast
Colorectal
Pancreas
Ovary
Non-Hodgkin lymphoma
Leukemia
Body of uterus
Brain/CNS
Stomach
Bladder
Kidney
Multiple myeloma
Esophagus
Melanoma
Oral
Cervix
BC
AB
SK
MB
ON
QC
41,000
10,900
5,100
4,100
2,300
1,600
1,600
1,550
1,450
1,300
1,250
1,150
860
810
750
740
5,400
1,250
670
600
360
250
260
200
190
130
150
130
160
110
90
95
3,500
830
420
400
180
170
130
120
120
130
120
95
70
75
60
60
1,250
290
160
170
65
50
55
55
55
35
30
40
10
20
20
25
37,000
10,000
5,000
4,200
2,300
1,750
1,200
1,150
1,050
860
780
680
660
640
460
420
390
380
4,700
1,250
610
560
300
250
160
150
110
130
85
90
70
75
75
55
50
40
3,000
780
400
330
210
150
100
95
85
65
65
50
60
60
45
35
35
40
1,150
290
160
120
70
55
40
40
25
25
20
15
20
20
15
10
10
20
NB
NS
PE
NL
1,400
360
180
180
75
65
55
60
45
55
35
55
25
30
20
30
15,200
3,700
1,850
1,600
840
620
600
620
540
470
500
410
350
320
330
280
10,600
3,500
1,300
890
590
310
390
370
370
340
310
270
210
180
170
190
970
340
120
95
60
45
35
35
45
35
30
35
10
20
15
20
1,450
350
200
130
75
60
55
55
55
45
45
50
20
25
30
30
190
60
25
25
10
10
5
5
5
5
5
5
—
5
—
5
840
230
140
65
40
25
30
20
20
45
20
25
10
15
15
10
1,400
350
200
160
75
80
45
45
35
25
25
20
25
25
15
10
15
20
13,300
3,400
1,900
1,500
810
660
440
440
420
310
280
260
250
240
180
190
150
150
10,300
3,000
1,350
1,150
630
400
320
270
280
240
230
190
160
170
90
85
100
70
960
260
110
100
70
45
35
30
20
20
25
10
20
20
10
10
10
10
1,250
360
150
160
75
55
50
40
35
30
25
20
25
20
20
10
15
15
190
50
25
20
10
5
5
10
5
5
5
5
5
—
—
—
—
—
670
170
100
100
30
30
20
15
15
15
25
10
15
10
10
5
5
10
CNS=central nervous system
— Fewer than 3 deaths.
* Column totals may not sum to row totals due to rounding. Canada totals
include provincial and territorial estimates. Territories are not listed due to
small numbers.
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
58
CHAPTER 4
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Mortality by sex, age and geography: Who dies of cancer in Canada?
TABLE 4.5 Estimated age-standardized mortality rates (ASMR) for selected cancers by sex and province, Canada, 2015
Deaths per 100,000
Canada*
BC
AB
SK
MB
ON
QC
NB
NS
PE
NL
174
46
22
17
10
7
7
7
6
5
5
5
4
3
3
3
159
37
20
17
10
7
8
6
6
4
5
4
5
3
3
3
165
39
19
19
8
7
6
6
6
6
5
4
3
3
3
3
178
41
22
22
9
7
7
8
8
5
5
6
1
3
3
3
174
45
22
21
9
8
7
8
6
7
4
7
3
4
3
4
169
41
20
17
9
7
7
7
6
5
6
5
4
3
4
3
188
61
23
16
10
5
7
7
7
6
6
5
4
3
3
3
170
59
21
16
11
7
6
6
8
6
5
6
2
4
3
3
204
50
29
19
10
8
8
8
8
6
6
7
3
4
4
4
177
58
22
23
10
9
7
7
6
5
6
7
—
5
—
5
224
59
38
19
10
7
8
6
6
12
5
7
2
4
4
3
128
36
18
14
8
6
4
4
4
3
3
2
2
2
2
2
1
2
119
32
16
13
7
7
4
4
3
4
2
2
2
2
2
1
1
1
119
32
16
13
8
6
4
4
3
3
2
2
2
2
2
1
1
2
132
34
19
13
8
6
5
5
3
3
2
2
3
2
2
1
1
3
139
36
20
15
7
8
4
4
3
3
3
2
3
2
2
1
2
2
119
32
18
13
7
6
4
4
4
3
2
2
2
2
2
2
1
2
144
44
19
15
9
6
4
4
4
4
3
2
2
2
1
1
1
1
136
38
17
14
9
7
5
4
3
4
4
2
3
3
2
1
1
2
142
41
18
18
8
6
5
4
4
4
3
2
3
2
2
2
1
2
140
40
22
16
7
5
5
6
3
4
3
3
4
—
—
—
—
—
148
39
22
21
7
7
4
3
4
4
5
2
4
3
2
1
1
2
Males
All cancers
Lung
Colorectal
Prostate
Pancreas
Esophagus
Bladder
Leukemia
Non-Hodgkin lymphoma
Stomach
Brain/CNS
Kidney
Liver
Oral
Melanoma
Multiple myeloma
Females
All cancers
Lung
Breast
Colorectal
Pancreas
Ovary
Non-Hodgkin lymphoma
Leukemia
Body of uterus
Brain/CNS
Stomach
Bladder
Kidney
Multiple myeloma
Esophagus
Melanoma
Oral
Cervix
CNS=central nervous system
— Fewer than 3 deaths.
* Canada totals include provincial and territorial estimates.
Territories are not listed due to small numbers.
Note: Rates are age-standardized to the 1991 Canadian population.
The complete definition of the specific cancers listed here can be found in
Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
59
CHAPTER 5
Relative survival: What is the likelihood of surviving cancer?
This section of the publication has been reproduced, as is, from the corresponding section in last year’s publication
(Canadian Cancer Statistics 2014). As such, the analytical techniques used and the interpretation of the results
reflect the state of knowledge at the time of the production of that publication.
There is one notable change to the content of this chapter from last year’s publication. In the past year, a large international
study of cancer survival called CONCORD-2 was published that included data from Canada. A brief summary of the study
and of some of its findings appear in the International comparison section near the end of this chapter.
Confidence interval (CI)
A range of values that provides an indication of the
precision of an estimate. Confidence intervals are
usually 95%, which means that one can be 95%
confident the range contains the true value for the
estimate of interest.
Five-year relative survival ratio (RSR)
Highlights
Introduction
• For 2006 to 2008, the five-year relative survival ratio
(RSR) for people diagnosed with cancer was 63%.
• Five-year RSRs are highest for thyroid (98%),
testicular (97%) and prostate (96%) cancers. They are
lowest for pancreatic (8%), esophageal (14%) and
lung (17%) cancers.
• Five-year relative survival generally decreases with age.
• People diagnosed with cancer today have a better
five-year relative survival than they did just over a
decade ago. Between 1992 to 1994 and 2006 to 2008,
the five-year relative survival for all cancers
combined increased by 7.3 percentage points from
55.5% to 62.8%.
• Five-year conditional RSRs demonstrate that survival
of people diagnosed with cancer generally improves
with time since diagnosis. Between 2006 and 2008,
the five-year RSR for all cancers combined increased
from 63% when measured from the date of diagnosis
to 81% when measured among those who survived
the first year after a cancer diagnosis.
• Differences in age-standardized five-year RSRs
across geographic regions and types of cancer help
point to areas where greater effort is required to
detect, diagnose and effectively treat cancer earlier.
Five-year relative survival ratios (RSRs) provide a
measure of disease severity and prognosis. Relative
survival estimates, when examined across cancer types
and geographic regions, can be used to establish priorities
for improving prognosis. Examining these estimates over
time, and in conjunction with cancer incidence and
mortality trends, can also give important information
about progress in cancer treatment and control.(1)
Canadian Cancer Society
n
Several factors can work together to influence the
likelihood of surviving cancer. These factors include
stage of the cancer at diagnosis and aggressiveness of
the tumour, as well as the availability and quality of
early detection, diagnostic and treatment services. In
addition, factors such as age, sex, existence of other
health conditions, socio-economic status and lifestyle
can also affect survival.
The RSR is a useful “average” indicator of survival(2)
and does not reflect any individual’s prognosis. It is
based on the experiences of a group of people rather
than a specific person’s chance of surviving for a given
period of time. Moreover, confidence intervals around
survival estimates represent statistical variation rather
than the range of possible prognoses for individual
people with cancer.
The ratio of the observed survival in a group of
people diagnosed with cancer to the expected
survival in a comparable group of people – free from
the cancer under study – in the general population.(3)
In practice, the expected survival is typically
estimated from general population life tables, which
include those persons previously diagnosed with
cancer. Relative survival estimates the excess
mortality that may be attributed to the diagnosis.
For example, a five-year RSR of 63% for a particular
cancer means that people with that cancer have a
63% likelihood of surviving at least five years after
diagnosis compared to their counterparts in the
general population.
Relative survival is the preferred measure for
assessing population-based cancer survival.
RSRs can be measured over various timeframes, but
as is standard in other reports, five years has been
chosen as the primary duration of analysis for this
publication.
Observed survival proportion (OSP)
The proportion of people with cancer who are alive
after a given period of time (e.g., five years) after
diagnosis.
60
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
n
Relative survival: What is the likelihood of surviving cancer?
It is also important to remember that survival ratios do
not distinguish among people who are free from
cancer, in a state of relapse or still undergoing
treatment. In addition, because survival statistics
describe the survival experience of people diagnosed
in the past, they do not reflect more recent advances in
detection and treatment that could lead to improved
cancer survival. Finally, five-year RSRs are different
from five-year observed survival proportions (OSPs),
which refer to the proportion of people with cancer,
who are alive five years after their diagnosis. The
current estimate for observed survival for all cancers
combined is 56% (Table 5.1).
Five-year relative survival
Table 5.1 shows the estimated five-year RSRs for
people diagnosed with selected cancers in Canada
between 2006 and 2008.
• For all cancers combined, the five-year RSR is 63%.
• The five-year RSRs are highest for thyroid (98%),
testicular (97%) and prostate (96%) cancers.
• The five-year RSRs are lowest for pancreatic (8%),
esophageal (14%) and lung (17%) cancers.
• For most of the cancers examined, the five-year RSRs
tend to be higher among females.
Other time periods commonly used to measure
relative survival include 1, 3 and 10 years. For
colorectal and lung cancers, RSRs demonstrate a
general pattern of substantial decline in the first year
after diagnosis (one-year RSR), a more gradual fall
over the next two years (three-year RSR) and then
smaller declines over the intervals from 3 to 5 years
and to 10 years (Figure 5.1).
Survival by sex
Table 5.1 shows that the five-year RSR differed by more
than five percentage points for four of the cancers
examined. In all four cancer types, relative survival was
better for females than for males: melanoma (92% vs.
85%), breast (88% vs. 80%), oral (68% vs. 61%) and
lung (20% vs. 14%).
Survival by province
Five-year RSRs are age-standardized to allow
comparisons across provinces. Table 5.2 shows
age-standardized five-year RSRs for the four most
common cancer types (prostate, breast, colorectal and
lung cancers). The following exceptions and caveats
should be considered when examining these data:
• Cancer cases in Newfoundland and Labrador may be
under-reported due to incomplete linkage of cancer
incidence data with death data. Such underreporting is likely to result in overestimation of
survival because these missed cases tend to have less
favourable survival. Consequently, survival ratios for
Newfoundland and Labrador are not shown.
• Territorial estimates are not presented because there
were too few cancer cases to calculate reliable
estimates. Territorial cases are, however, included in
the estimates for all of Canada.
• RSRs for Prince Edward Island are less precise than
for other provinces because of the relatively small
number of cancer cases in this province.
FIGURE 5.1 One-, three-, five- and ten-year relative survival ratios (RSRs) for the most common cancers, ages 15–99 at diagnosis, Canada
(excluding Quebec*), 2006–2008
100
90
80
98
96
96
88
82
82
Canadian Cancer Statistics 2015
80
Prostate
Female breast
Colorectal
Lung
70
70
60
64
61
50
40
40
40
30
30
20
20
22
17
10
0
60
50
13
1
3
5
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
n
100
90
92
Relative survival period (years)
Canadian Cancer Society
93
97
70
RSR (%)
CHAPTER 5
10
10
0
*Data from Quebec were
excluded, in part, because its
method for ascertaining the
date of cancer diagnosis
differs from the method used
by other provinces and
territories and because of
issues in correctly
ascertaining the vital status
of cases.
Note: The complete
definition of the specific
cancers listed here can be
found in Table A10.
61
CHAPTER 5
n
Relative survival: What is the likelihood of surviving cancer?
• Despite these constraints, several patterns are worth
mentioning:
■■ The highest RSRs for prostate cancer are in
Ontario (97%), New Brunswick (95%) and Nova
Scotia (95%). The lowest RSRs for prostate cancer
are in Manitoba (90%), Saskatchewan (91%) and
Alberta (92%).
■■ There is little provincial variation in RSRs for
breast cancer.
■■ The RSRs for colorectal cancer range from 60% to
62% in all provinces except Ontario (67%).
The RSRs for lung cancer range from a low of 14% in
Alberta and Nova Scotia to a high of 20% in Manitoba.
• The variation across provinces may be related to
differences in the following factors:
■■ the availability and patterns of use of screening,
early detection and diagnostic services that affect
how early cancer is diagnosed
■■ the availability of and access to specialized cancer
treatments
■■ population attributes (such as socio-economic
status and lifestyle factors) that affect survival
■■ provincial resources available to ensure
registration of all cancers and up-to-date vital
status information on registered cases
Age-standardized relative survival ratio
(RSR)
The RSR that would have occurred if the age
distribution of the group of people with cancer under
study had been the same as that of the standard
population (e.g., all people diagnosed with that cancer
in Canada between 2001 and 2005).
Canadian Cancer Society
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Canadian Cancer Statistics 2015
Survival by age at diagnosis
Trends over time
Relative survival is generally poorer among those
diagnosed with cancer at an older age. Poorer survival
among older people may be because they receive less
therapy due to the presence of other diseases or
conditions that reduce the body’s ability to tolerate and
respond to cancer treatments. Older people may also
receive less aggressive treatment, independent of any
other conditions, due to their advanced age.(4)
Age-standardized RSRs are used to examine changes in
relative survival over time. Figure 5.2 shows that there
was substantial improvement in five-year relative
survival between 1992 to 1994 and 2006 to 2008 for the
most commonly diagnosed cancers of today.
• The RSR for all cancers combined has risen by 7.3
percentage points to 62.8% in 2006 to 2008 from
55.5% in 1992 to 1994.
• The largest increases between the two time periods
among the cancers presented are seen for nonHodgkin lymphoma (16 percentage points) and
leukemia (15 percentage points); multiple myeloma
increased by 14 percentage points.
• A few factors have contributed to the increased
relative survival for non-Hodgkin lymphoma. First is
the advance in therapy, particularly the introduction
of antibody therapy with rituximab. Second is the
recent decrease in the number of cases of nonHodgkin lymphoma related to human
immunodeficiency virus (HIV). The lower number
of cases related to HIV is a consequence of improved
treatment, specifically with highly active
antiretroviral therapy (HAART) developed in the
late 1990s.(5)
• Age-standardized RSRs for prostate and colorectal
cancers each increased by nine percentage points.
Survival improvements in prostate and colorectal
cancers are due to increased use of screening and
early detection that have helped identify cancers at a
treatable stage.
• There has been virtually no change (less than one
percentage point) for cancers of the bladder and
body of uterus between 1992 to 1994 and 2006 to
2008.
Table 5.3 shows the five-year RSRs for the four most
common cancers by age group.
• RSRs for prostate cancer are consistently high
(>95%) among males diagnosed between the ages of
40 and 79 years; lower RSRs are seen at older ages.
• The highest RSRs for female breast cancer (87%–
90%) are among people diagnosed between the ages
of 40 and 79 years. Lower RSRs are seen for women
at both younger (85%) and older (79%) ages.
• RSRs for colorectal cancer are consistent at 68%
among people diagnosed between the ages of 15 and
69 years; RSRs then decrease with advancing age.
• For lung cancer, the RSR decreases with advancing
age. People aged 15–39 years at diagnosis have the
highest RSR at 45%, while people aged 80–99 years
have the lowest RSR at 10%.
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Five-year conditional relative survival
The five-year conditional RSR for people with cancer
who have already survived one to three years after
their diagnosis is often more meaningful for clinical
management and prognosis than the five-year RSR
measured from the date of diagnosis. Since the risk of
death due to cancer is often greatest in the first few
years after diagnosis, prognosis can substantially
improve among people surviving one or more years.
Thus, the five-year RSR measured at diagnosis no
longer applies.(6,7)
Table 5.4 presents five-year RSRs estimated from the
date of cancer diagnosis and five-year conditional RSRs
calculated using people who have survived the first,
second, third, fourth and fifth year after a cancer
diagnosis. Five-year conditional RSRs demonstrate
that the survival experience of people diagnosed with
cancer generally improves with time since diagnosis.
• The five-year RSR for all cancers combined increased
from 63% when measured from the date of diagnosis
to 81% when measured among those who survived
the first year after a cancer diagnosis.
FIGURE 5.2 Age-standardized five-year relative survival ratio (RSR) for selected cancers, Canada (excluding Quebec*), 2006–2008 versus
1992–1994
2006–08
All cancers
1992–94
Thyroid
Testis
Prostate
Melanoma
Female breast
Hodgkin lymphoma
CNS=central nervous system
Body of uterus
* Data from Quebec were
excluded, in part, because the
method for ascertaining the
date of cancer diagnosis differs
from the method used by other
provinces/territories and
because of issues in correctly
ascertaining the vital status of
cases.
Bladder†
Cervix
Kidney
Non-Hodgkin lymphoma
Colorectal
†
Excludes data from Ontario,
which does not currently report
in situ bladder cancers.
Larynx
Oral
Note: These data are based
on people aged 15–99 years
at diagnosis. “All cancers”
excludes adolescent
(15–19 years) bone cancers,
which are dissimilar to those
diagnosed in older adults, and
non-melanoma skin cancers
(neoplasms, NOS; epithelial
neoplasms, NOS; and basal and
squamous). Error bars refer to
95% confidence intervals. The
complete definition of the
specific cancers listed here can
be found in Table A10.
Leukemia
Ovary
Multiple myeloma
Conditional relative survival
A measure that reflects the likelihood a person will
survive an additional number of years (e.g., five years)
once he or she has already survived a fixed number of
years since a cancer diagnosis, compared to the
expected survival in a comparable group of people –
free from the cancer under study – in the general
population. In practice, the expected survival is typically
estimated from general population life tables, which
include those persons previously diagnosed with cancer.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
Stomach
Brain/CNS
Liver
Lung
Esophagus
Pancreas
0
20
40
60
Five-year relative survival ratio (%)
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
80
100
View data
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• Each additional year survived resulted in further,
although less dramatic, increases in the five-year
conditional RSR.
• The impact of time survived on the five-year
conditional RSR varied by type of cancer. Cancers
with low initial five-year RSRs (such as stomach,
brain, liver, lung, esophagus and pancreas) showed
the most dramatic increases in five-year conditional
RSRs.
• Conversely, since the potential for improvement is
limited for cancers that have an excellent prognosis
at diagnosis, cancers with high initial five-year RSRs
(such as thyroid, testis and prostate) showed little
improvement in five-year conditional RSRs.
International comparison
Five-year childhood cancer (0–14 years)
survival
The goal of the study was to produce comparable
estimates of five-year relative net survival across many
jurisdictions. Such studies serve to stimulate discussion
as to why cancer survival might differ between regions
and motivate investigations into possible
improvements to cancer control programs.
Table 5.5 shows the estimated five-year OSPs for
children, by childhood cancer diagnostic group and
selected subgroups,(8) diagnosed with cancer in Canada
between 2004 and 2008. Only OSPs are reported as the
estimates of observed and relative survival for the age
range 0–14 years are essentially the same. In general,
survival for childhood cancer is higher than it is
among adults. However, the rarity of childhood cancer
results in less precise estimates, even when more years
of data are considered.
• For all cancers combined, the five-year OSP is 83%.
• Among specific diagnostic groups, five-year OSPs are
highest for retinoblastoma and for other malignant
epithelial neoplasms – both at 94%. The five-year
OSP is also over 90% for lymphomas, germ cell
tumours and other and unspecified neoplasms.
• Among specific diagnostic groups, five-year OSPs are
lowest for malignant bone tumours (70%), soft tissue
(72%) and central nervous system (74%) cancers.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
A large international cancer survival study, called
CONCORD-2,(9) was published in November 2014 in the
prestigious medical journal The Lancet. The study was led
by the Cancer Research UK Cancer Survival group at the
London School of Hygiene and Tropical Medicine in
London, UK. The study reports trends in five-year
survival between 1995 and 2009 for cancer patients
diagnosed with one of 10 common cancers: breast
(women only), cervix, colon, leukemia, liver, lung, ovary,
prostate, rectum and stomach. It also reported survival
for 75,000 children diagnosed with the most common
childhood cancer, acute lymphoblastic leukemia. The data
came from 279 cancer registries in 67 countries, including
data from close to 1.4 million Canadians.
Some Canadian-specific highlights from the 2005 to
2009 period of this study include:
Canada was one of the only countries in the study for
which the data covered 100% of its population. As
such, data from all regions of Canada were reflected in
the national survival estimates.
In comparing five-year survival estimates across G7
countries (Canada, United Kingdom, United States,
Germany, France, Italy and Japan), it was observed that
Canada had the second highest survival for childhood
leukemia, the second highest survival for prostate
cancer and the 3rd highest survival for lung cancer.
Canada ranked 5th in colon cancer survival, ahead of
France and the United Kingdom.
Breast cancer survival tended to be similar among
most G7 nations. However, the United States showed
higher survival than the other countries and the
United Kingdom much lower.
It is important to note that the specific survival estimates
reported in the CONCORD-2 study cannot be directly
compared to the numbers given in other sections of this
publication. This is due to differences in the methodology
used between the CONCORD-2 study and this
publication – particularly the standard populations used
to age-standardize the estimates. As such, comparisons
can be made only across regions within the same study.
The CONCORD program(10) has undertaken other cancer
survival projects that have studied the survival experience
of Canadians with cancer including the International
Cancer Benchmarking Project.(11)
What do these statistics mean?
People diagnosed with cancer today have a better chance
of surviving the next five years after their diagnosis than
they did just over a decade ago. Despite this improvement
in survival, some cancers continue to have lower RSRs
than others because of the aggressiveness of the disease,
the late stage at which they tend to be diagnosed or the
lack of effective treatment options.
Among the most common cancers, there is variation in
age-standardized five-year RSRs across provinces for
prostate, lung and colorectal cancers, while there is
little provincial variation for breast cancer. These
differences in five-year RSRs across geographic regions
and types of cancer help point to areas where greater
effort is required to detect, diagnose and treat cancer at
an early stage, or where more research is needed to
develop better treatments. Cancer stage at diagnosis is
an important prognostic indicator that is available for
the most common cancers from most provincial
cancer registries. It is anticipated that cancer stage at
diagnosis and its impact on survival will be reported in
this publication in future years.
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CHAPTER 5
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Relative survival: What is the likelihood of surviving cancer?
For more information
Databases
References
Publications
• Statistics Canada. Table 103-1559 – Five-year survival
estimates for all primary sites of cancer combined, ICD-O-3
(October 2011 CCR file), by age group and sex, population
aged 15 to 99, 1 year of cases, Canada (excluding Quebec),
annual (percent), 1992 to 2003, CANSIM (database).
1. Dickman PW, Adami HO. Interpreting trends in cancer patient survival. Journal of Internal
Medicine. 2006;260(2):103–17.
2. Black RJ, Sankaranarayanan R, Parkin DM. Interpretation of population-based cancer
survival data. IARC Scientific Publications. 1998;145:13–7.
3. Ederer F, Axtell LM, Cutler SJ. The relative survival rate: A statistical methodology. National
Cancer Institute Monographs 1961;6:101–21
4. Brenner H, Arndt V. Recent increase in cancer survival according to age: Higher survival in
all age groups, but widening age gradient. Cancer Causes & Control. 2004;15(9):903–10.
5. Pulte D, Gondos A, Brenner H. Ongoing improvement in outcomes for patients diagnosed
as having Non-Hodgkin lymphoma from the 1990s to the early 21st century. Archives of
Internal Medicine. 2008;168(5):469–76.
6. Wang SJ, Emery R, Fuller CD, Kim JS, Sittig DF, Thomas CR. Conditional survival in gastric
cancer: A SEER database analysis. Gastric Cancer. 2007;10(3):153–8.
7. Ellison LF, Bryant H, Lockwood G, Shack L. Conditional survival analyses across cancer
sites. Health Reports. 2011;22(2):1–5.
8. Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International classification of
childhood cancer, third edition. Cancer. 2005;103:1457–67.
9. Allemani C, Weir HK, Carreira H et al. Global surveillance of cancer survival 1995–2009:
analysis of individual data for 25 676 887 patients from 279 population-based registries
in 67 countries (CONCORD-2). Lancet (e-pub Nov. 25, 2014); Available at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62038-9/abstract.
10.Global Surveillance of Cancer Survival: The CONCORD Programme. Available at:
http://www.lshtm.ac.uk/eph/ncde/cancersurvival/research/concord/concord_2.html
(accessed Dec. 22, 2014).
11.International Cancer Benchmarking Partnership. Available at:
http://www.cancerresearchuk.org/cancer-info/spotcancerearly/ICBP/
(accessed Dec. 22, 2014).
• Ellison LF. Estimating cancer relative survival: An analysis of
the bias introduced by outdated life tables. Health Reports.
2014; 25(2):13–9. Available at: http://www.statcan.gc.ca/
pub/82-003-x/2014002/article/11903-eng.pdf
(accessed, Apr. 28, 2015).
• Ellison LF. Measuring the effect of including multiple cancers
in survival analyses using data from the Canadian Cancer
Registry. Cancer Epidemiology. 2010;34(5):550–5.
• Ellison LF. An empirical evaluation of period survival analysis
using data from the Canadian Cancer Registry. Annals of
Epidemiology. 2006;16(3):191–6.
• Ellison LF, Gibbons L. Survival from cancer: Up-to-date
predictions using period analysis. Health Reports.
2006;17:19–30. Available at: http://www.statcan.gc.ca/
pub/82-003-x/2005002/article/9193-eng.pdf
(accessed Apr. 28, 2015).
• Ellison LF, Pogany L, Mery LS. Childhood and adolescent
cancer survival: A period analysis of data from the Canadian
Cancer Registry. European Journal of Cancer.
2007;43(13):1967–75.
• Ellison LF, Wilkins K. An update on cancer survival.
Health Reports. 2010;21(3):55–60. Available at:
http://www.statcan.gc.ca/pub/82-003-x/2010003/
article/11334-eng.pdf (accessed Apr. 28, 2015).
• Statistics Canada. Cancer Survival Statistics (Catalogue
82-226-x). Ottawa: Minister of Industry; 2012.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
• Statistics Canada. Table 103-1560 – Five-year survival
estimates for all primary sites of cancer combined, ICD-O-3
(October 2011 CCR file), by age group and sex, population
aged 15 to 99, 3 years of cases, Canada (excluding Quebec),
annual (percent), 1992/1994 to 2001/2003, CANSIM
(database).
• Statistics Canada. Table 103-1573 – Five-year survival
estimates for primary sites of cancer, ICD-O-3 (October 2011
CCR file), by sex, population aged 15 to 99, 1 year of cases,
selected provinces, annual (percent), 1992 to 2003, CANSIM
(database).
• Statistics Canada. Table 103-1574 – Five-year survival
estimates for primary sites of cancer, ICD-O-3 (October 2011
CCR file), by sex, population aged 15 to 99, 3 years of cases,
selected provinces, annual (percent), 1992/1994 to
2001/2003, CANSIM (database).
• Statistics Canada. Table 103-1571 – Age-standardized
five-year survival estimates for primary sites of cancer,
ICD-O-3 (October 2011 CCR file), by sex, 1 year of cases,
Canada and selected provinces, annual (percent), 1992 to
2003, CANSIM (database).
• Statistics Canada. Table 103-1572 – Age-standardized
five-year survival estimates for primary sites of cancer,
ICD-O-3 (October 2011 CCR file), by sex, 3 years of cases,
Canada and selected provinces, annual (percent), 1992/1994
to 2001/2003, CANSIM (database).
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TABLE 5.1 Five-year relative and observed survival for selected cancers by sex, ages 15–99 years at diagnosis, Canada (excluding Quebec*), 2006–2008
Relative survival ratio (%) (95% CI)
All cancers
Thyroid
Testis
Prostate
Melanoma
Breast
Hodgkin lymphoma
Body of uterus
Bladder†
Cervix
Kidney
Non-Hodgkin lymphoma
Colorectal
Larynx
Oral
Leukemia
Ovary
Multiple myeloma
Stomach
Brain/CNS
Liver
Lung
Esophagus
Pancreas
Observed survival proportion (%) (95% CI)
Both sexes
Males
Females
Both sexes
Males
Females
63 (63–63)
98 (98–99)
—
—
89 (88–89)
88 (87–88)
85 (83–87)
—
74 (72–75)
—
68 (66–69)
66 (65–67)
64 (64–65)
63 (61–66)
63 (62–65)
59 (58–60)
—
43 (41–44)
25 (24–26)
25 (24–27)
20 (18–22)
17 (17–17)
14 (13–15)
8 (7–8)
63 (62–63)
95 (94–97)
97 (96–98)
96 (95–96)
85 (84–86)
80 (74–86)
83 (81–86)
—
74 (73–76)
—
67 (65–68)
65 (63–66)
64 (63–65)
63 (60–66)
61 (60–63)
60 (58–61)
—
44 (42–47)
23 (22–24)
23 (22–25)
20 (18–22)
14 (14–15)
13 (12–15)
8 (7–9)
64 (64–64)
99 (99–100)
—
—
92 (91–93)
88 (87–88)
87 (85–90)
85 (84–86)
72 (69–74)
74 (72–75)
69 (67–71)
68 (67–70)
65 (64–66)
64 (58–69)
68 (65–70)
59 (57–61)
45 (44–46)
41 (38–43)
28 (26–30)
28 (26–30)
19 (16–23)
20 (19–21)
15 (13–18)
8 (7–9)
56 (56–56)
95 (95–96)
—
—
80 (79-80)
80 (80-81)
83 (81-84)
—
60 (59-61)
—
60 (59-61)
59 (58-60)
54 (54-55)
55 (53-57)
57 (55-58)
52 (51-53)
—
37 (35-38)
21 (20-22)
24 (23-26)
18 (17–19)
15 (15–15)
12 (11–13)
7 (6–7)
54 (53–54)
90 (89–92)
95 (94–96)
81 (81–82)
75 (74–76)
66 (61–71)
81 (78-83)
—
60 (58–61)
—
59 (58–60)
57 (56–58)
54 (53–54)
55 (52–57)
55 (53–56)
52 (50–53)
—
38 (36–40)
19 (18–21)
22 (21–24)
18 (17–20)
12 (12–13)
12 (10–13)
7 (6–8)
58 (58–58)
96 (96–97)
—
—
85 (84–86)
80 (80–81)
85 (83–87)
78 (77–79)
61 (59–63)
71 (69–73)
62 (61–64)
62 (60–63)
55 (54–56)
57 (51–62)
61 (59–62)
52 (50–53)
42 (41–43)
36 (33–38)
24 (23–26)
27 (25–29)
17 (14–20)
18 (17–18)
13 (11–15)
7 (6–8)
CI=confidence interval; CNS=central nervous system
— Not applicable.
* Data from Quebec were excluded, in part, because the method for
ascertaining the date of cancer diagnosis differs from the method
used by other provinces/territories and because of issues in correctly
ascertaining the vital status of cases.
†
Excludes data from Ontario, which does not currently report in situ
bladder cancers.
Note: “All cancers” excludes adolescent (15–19 years) bone cancers,
which are dissimilar to those diagnosed in older adults, and
non-melanoma skin cancers (neoplasms, NOS; epithelial neoplasms,
NOS; and basal and squamous). The complete definition of the
specific cancers listed here can be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
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TABLE 5.2 Age-standardized five-year relative survival ratios (RSRs) for the most common cancers by province, Canada (excluding Quebec*),
2006–2008
Relative survival ratio (%) (95% CI)
Province
Canada*
British Columbia (BC)
Alberta (AB)
Saskatchewan (SK)
Manitoba (MB)
Ontario (ON)
New Brunswick (NB)
Nova Scotia (NS)
Prince Edward Island (PE)
Prostate
Female breast
Colorectal
Lung
95 (95–95)
93 (92–94)
92 (91–93)
91 (89–93)
90 (88–92)
97 (97–98)
95 (93–97)
95 (93–97)
93 (89–97)
88 (87–88)
88 (87–89)
86 (85–88)
86 (84–88)
85 (83–87)
88 (88–89)
89 (87–91)
87 (86–89)
87 (81–92)
64 (64–65)
61 (60–63)
62 (60–64)
61 (59–64)
60 (58–63)
67 (66–68)
62 (59–65)
61 (58–63)
61 (54–67)
17 (17–18)
16 (15–16)
14 (13–15)
16 (14–18)
20 (19–22)
19 (18–19)
16 (14–17)
14 (12–15)
—
CI=confidence interval
— Estimate cannot be calculated.
* Data from Quebec were excluded, in part, because the method for
ascertaining the date of cancer diagnosis differs from the method
used by other provinces and territories and because of issues in
correctly ascertaining the vital status of cases.
Note: These data are based on people aged 15–99 years at
diagnosis. Survival ratios for Newfoundland and Labrador are not
shown as they are artefactually high. The complete definition of the
specific cancers listed here can be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
TABLE 5.3 Five-year relative survival ratios (RSRs) for the most common cancers by age group, Canada (excluding Quebec*), 2006–2008
Relative survival ratio (%) (95% CI)
Age
15–39
40–49
50–59
60–69
70–79
80–99
Prostate
Female breast
Colorectal
Lung
—
96 (94–97)
98 (97–98)
99 (98–99)
96 (95–97)
81 (79–84)
85 (84–87)
90 (89–90)
89 (88–90)
90 (90–91)
87 (86–89)
79 (77–81)
68 (64–71)
68 (66–70)
68 (67–69)
68 (67–69)
65 (64–66)
57 (55–58)
45 (38–52)
23 (21–25)
21 (20–22)
19 (18–20)
16 (15–17)
10 (9–11)
CI=confidence interval
— Estimate is not shown due to a small number of cases.
* Data from Quebec were excluded, in part, because the method for
ascertaining the date of cancer diagnosis differs from the method
used by other provinces/territories and because of issues in correctly
ascertaining the vital status of cases.
Note: The complete definition of the specific cancers listed here can
be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
Canadian Cancer Society
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TABLE 5.4 Five-year relative survival ratios (RSRs) conditional on having survived the specified number of years, for selected cancers, ages 15–99 years
at diagnosis, Canada (excluding Quebec*), 2006–2008
Conditional RSR (%) (95%CI)
Survived years
All cancers
Thyroid
Testis
Prostate
Melanoma
Female breast
Hodgkin lymphoma
Body of uterus
Bladder†
Cervix
Kidney
Non-Hodgkin lymphoma
Colorectal
Larynx
Oral
Leukemia
Ovary
Multiple myeloma
Stomach
Brain/CNS
Liver
Lung
Esophagus
Pancreas
0
1
2
3
4
5
63 (63–63)
98 (98–99)
97 (96–98)
96 (95–96)
89 (88–89)
88 (87–88)
85 (83–87)
85 (84–86)
74 (72–75)
74 (72–75)
68 (66–69)
66 (65–67)
64 (64–65)
63 (61–66)
63 (62–65)
59 (58–60)
45 (44–46)
43 (41–44)
25 (24–26)
25 (24–27)
20 (18–22)
17 (17–17)
14 (13–15)
8 (7–8)
81 (81–81)
100 (99–100)
98 (97–99)
97 (97–97)
91 (90–92)
89 (89–90)
93 (91–94)
90 (90–91)
82 (80–83)
82 (80–84)
82 (81–83)
82 (81–83)
77 (76–77)
71 (68–74)
75 (73–76)
80 (78–81)
57 (55–58)
52 (49–54)
51 (49–53)
50 (47–52)
42 (39–45)
39 (38–40)
34 (31–37)
30 (28–33)
87 (87–87)
100 (100–101)
99 (99–100)
98 (97–98)
93 (92–94)
90 (90–91)
94 (93–96)
94 (93–95)
85 (84–87)
88 (87–90)
87 (85–88)
85 (84–86)
83 (82–83)
77 (74–80)
82 (81–84)
83 (82–85)
65 (63–67)
54 (51–56)
71 (69–74)
65 (62–68)
55 (51–59)
55 (54–57)
55 (50–59)
53 (48–57)
90 (90–90)
100 (99–100)
99 (99–100)
98 (97–98)
95 (94–96)
92 (91–92)
94 (93–96)
96 (95–97)
88 (86–89)
92 (90–93)
89 (88–90)
87 (85–88)
88 (87–88)
80 (77–83)
86 (84–87)
84 (83–86)
72 (70–74)
55 (53–58)
83 (80–86)
73 (70–75)
67 (62–71)
65 (64–66)
68 (63–74)
67 (62–72)
92 (92–92)
100 (99–100)
100 (99–100)
98 (97–98)
96 (95–97)
93 (92–93)
96 (94–97)
98 (97–99)
89 (87–91)
94 (93–95)
91 (90–92)
88 (87–89)
91 (90–92)
82 (79–85)
87 (86–89)
85 (84–87)
79 (77–81)
59 (55–62)
91 (88–94)
76 (74–79)
77 (71–82)
70 (69–72)
75 (69–81)
78 (72–83)
93 (93–93)
99 (99–100)
100 (99–100)
98 (97–98)
97 (96–98)
94 (93–94)
96 (95–97)
99 (98–100)
89 (88–91)
97 (96–98)
93 (91–94)
89 (88–90)
94 (93–95)
84 (80–86)
89 (87–90)
85 (83–86)
85 (83–87)
62 (58–65)
94 (91–97)
79 (77–82)
83 (77–88)
75 (73–76)
80 (74–86)
82 (75–87)
CI=confidence interval; CNS=central nervous system
* Data from Quebec were excluded, in part, because the method for
ascertaining the date of cancer diagnosis differs from the method
used by other provinces/territories and because of issues in correctly
ascertaining the vital status of cases.
†
Excludes data from Ontario, which does not currently report in situ
bladder cancers.
Note: “All cancers” excludes adolescent (15–19 years) bone cancers,
which are dissimilar to those diagnosed in older adults, and
non-melanoma skin cancers (neoplasms, NOS; epithelial neoplasms,
NOS; and basal and squamous). The complete definition of the
specific cancers listed here can be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data sources: Canadian Cancer Registry database and life tables at Statistics Canada
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CHAPTER 5
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Relative survival: What is the likelihood of surviving cancer?
TABLE 5.5 Five-year observed survival proportions (OSP) by diagnostic group and selected subgroup,
ages 0–14 years at diagnosis, Canada (excluding Quebec*), 2004–2008
Diagnostic group
OSP (%) (95% CI)
All groups
83 (82–84)
I. Leukemias, myeloproliferative diseases, and myelodysplastic diseases
88 (86–90)
a. Lymphoid leukemias
91 (89–93)
b. Acute myeloid leukemias
73 (65–79)
II. Lymphomas and reticuloendothelial neoplasms
92 (88–94)
a. Hodgkin lymphomas
98 (94–99)
b. Non-Hodgkin lymphomas (except Burkitt lymphoma)
88 (81–93)
c. Burkitt lymphoma
92 (79–97)
III. CNS and miscellaneous intracranial and intraspinal neoplasms
74 (70–77)
b.Astrocytomas
84 (80–88)
c. Intracranial and intraspinal embryonal tumours
55 (47–63)
IV. Neuroblastoma and other peripheral nervous cell tumours
77 (71–82)
V.Retinoblastoma
94 (86–98)
VI. Renal tumours
84 (78–89)
85 (78–90)
a. Nephroblastoma and other non-epithelial renal tumours
VII. Hepatic tumours
—
VIII. Malignant bone tumours
70 (62–77)
IX. Soft tissue and other extraosseous sarcomas
72 (65–77)
70 (60–78)
a.Rhabdomyosarcomas
X. Germ cell tumours, trophoblastic tumours, and neoplasms of gonads
91 (84–95)
b. Malignant extracranial and extragonadal germ cell tumours
96 (76–99)
CI=confidence interval; CNS=central nervous system
c. Malignant gonadal germ cell tumours
95 (82–99)
— Estimate is not shown due to a small number of cases.
XI. Other malignant epithelial neoplasms and malignant melanomas
94 (88–97)
XII. Other and unspecified malignant neoplasms
91 (80–96)
* Data from Quebec were excluded, in part, because the method for ascertaining the date of cancer diagnosis
differs from the method used by other provinces/territories and because of issues in correctly ascertaining the
vital status of cases.
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
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CHAPTER 6
Prevalence: How many people diagnosed with cancer are alive today?
This section of the publication has been reproduced, as is, from the corresponding section in last year’s publication
(Canadian Cancer Statistics 2014). As such, the analytical techniques used reflect the state of knowledge at the time of the
production of that publication.
Highlights
Introduction
• At the beginning of 2009, a substantial number of
people in Canada – just over 810,000 – had been
diagnosed with cancer in the previous 10 years,
(10-year person-based prevalence). Among these
people, nearly 841,000 cancers were recorded
(10-year tumour-based prevalence).
• Breast and prostate cancer accounted for 40% of the
10-year tumour-based prevalent cases.
• The 10-year tumour-based prevalence peaked among
males aged 70–79 years and females aged 60–69
years. This sex difference is due to the high
prevalence of prostate and breast cancers in each of
these age groups.
• The majority of 10-year tumour-based prevalent
cases were diagnosed in the previous five years. Such
affected individuals were either undergoing
treatment, recovering from its effects or still dealing
with the physical and emotional consequences of
cancer. This has significant implications for the
planning and development of interdisciplinary
healthcare services.
The ongoing rise in the annual number of new cancer
diagnoses (due to a growing and aging population),
combined with an improving survival rate for most
types of cancer, has meant that a substantial number of
people are living with and beyond their cancer
diagnosis. This prevalent population of people with
cancer and cancer survivors is likely to have unique
healthcare needs during the course of their cancer
journey. Thus, prevalence statistics are required to
estimate the needs for ongoing healthcare(1) and
support services that improve the quality of life for
people with cancer, cancer survivors and their families.
Canadian Cancer Society
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Prevalence
Population-based cancer prevalence can be measured
by the number of living individuals previously
diagnosed with cancer or by the number of cancer
cases diagnosed in such individuals. Tumour-based
estimates refer to the number of cancers diagnosed
among individuals living with or beyond cancer on a
specified date (index date). Person-based estimates
refer to the number of individuals living with or
beyond cancer on an index date.
It is also possible to examine limited-duration
prevalence. In limited-duration prevalence, tumour- or
person-based prevalence estimates are limited to,
respectively, cancers or persons diagnosed within a
specified period prior to the index date. Limitedduration prevalence is generally measured in two-,
five- or 10-year periods prior to an index date.
Recent diagnoses of cancer (within the past two years)
include individuals who are either receiving primary
treatment or recovering from its effects. People
diagnosed in the more distant past (beyond two years)
have likely completed their treatment but may still
need clinical follow-up and supportive care.
Person-based estimates of prevalence are intuitively
easier to understand than tumour-based estimates,
although they may underestimate the true impact of
cancer because one person can have more than a single
diagnosis of a primary cancer.
70
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
CHAPTER 6
n
Prevalence: How many people diagnosed with cancer are alive today?
Tumour-based prevalence
Among Canadians alive on January 1, 2009, close to
841,000 cancers had been diagnosed in the previous 10
years (Table 6.1). These cases can be analyzed
according to the type of cancer, the sex and age of the
person and the amount of time since diagnosis.
Prevalence by type of cancer
Figure 6.1 shows that prostate and breast cancers
together accounted for 40% of all 10-year prevalent
cancers. Other common cancers included colorectal
cancer (13% of all 10-year prevalent cases), lung cancer
(5%), melanoma (5%), non-Hodgkin lymphoma (4%)
and bladder cancer (4%).
Prevalence reflects both the frequency of occurrence
and prognosis for particular cancers. For example,
even though the colorectal cancer incidence rate is
lower than that of lung cancer, the colorectal 10-year
cancer prevalence is 2.7 times greater, reflecting the
poorer prognosis for lung cancer. Similarly, while
melanoma accounts for 3% of all newly diagnosed
cancer cases, it represents 5% of all 10-year prevalent
cancer cases because of its high survival.
Prevalence by sex
FIGURE 6.1 Distribution of 10-year tumour-based prevalence for selected cancers, Canada,* January 1, 2009
All other
cancers
19.6%
Kidney 2.9%
Prostate
21.0%
Thyroid 3.7%
Breast
18.8%
Body of uterus 3.8%
Colorectal
12.5%
Bladder 4.1%
Non-Hodgkin lymphoma 4.3%
Melanoma 4.7%
Lung 4.7%
* During the estimation process, cases from Quebec were excluded because
of issues in correctly ascertaining the vital status of cases. The presented
estimates, however, are for all of Canada, including Quebec. These
estimates assume that sex- and age-specific tumour-based prevalence
proportions in Quebec are similar to the rest of Canada. Estimates for lung
and bladder cancers may be lower than in previous editions of this
publication because of the different method used to estimate Quebec’s
prevalence prior to 2013. For further details, see Appendix II, Data sources
and methods.
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
Prevalence by age
Table 6.2 shows that the number of 10-year prevalence
cases is generally highest in the 70–79 year age group.
Exceptions include female breast cancer and all cancers
combined among females – both of which peaked in
the 60–69 year age group – as well as colorectal cancer
among females (80 years or older age group).
Table 6.1 shows that 10-year tumour-based prevalence
counts are similar among males and females for several
types of cancer including lung, colorectal, nonHodgkin lymphoma, melanoma, pancreas, brain,
multiple myeloma and Hodgkin lymphoma. On the
other hand, large differences were seen between the
sexes for other types of cancer, including bladder,
thyroid, oral, stomach, liver, esophagus and larynx.
These sex differences primarily result from differences
in cancer incidence rather than observed survival.
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Prevalence: How many people diagnosed with cancer are alive today?
Prevalence by duration
Of the approximately 841,000 10-year prevalent cancer
cases at the beginning of 2009, 29% had been diagnosed
within the previous two years (2007 to 2008), 32%
within the previous two to five years and 38% within
the previous five to 10 years (Table 6.1). These data
have implications for planning healthcare and
supportive services.
• In the first couple of years post diagnosis, individuals
are likely receiving or recovering from treatment for
their cancer.
• The third to fifth year after a cancer diagnosis is a
period that typically requires close clinical follow-up
for recurrence and supportive care.
• Individuals alive five to 10 years after a cancer
diagnosis have likely completed their treatment but
some may still require clinical monitoring.
Figure 6.2 shows that the prevalence of certain types of
cancer depends on the length of the period considered.
For example:
• The prevalence of breast cancer and prostate cancer
rises with longer duration compared to other
common cancers, such as colorectal and lung
cancers.
• The poor prognosis for lung cancer cases means that
proportionately fewer individuals with this cancer
are alive beyond two years after diagnosis compared
to most other cancers.
Person-based prevalence
Among Canadians alive on January 1, 2009, just over
810,000 had been diagnosed with cancer in the
previous 10 years (Table 6.3). This number represents
approximately 1 in 41 Canadians or 2.4% of the
Canadian population (Table 6.4). More specifically, in
the 10 years prior to January 1, 2009, among those
alive:
• 1 in 94 males had been diagnosed with prostate
cancer.
• 1 in 107 females had been diagnosed with breast
cancer.
• 1 in 297 males and 1 in 351 females had been
diagnosed with colorectal cancer.
• 1 in 907 males and 1 in 813 females had been
diagnosed with lung cancer.
FIGURE 6.2 Tumour-based prevalence for the most common cancers by duration, Canada,* January 1, 2009
200,000
Number of prevalent cases
180,000
N=158,430
160,000
140,000
71,175
(40%)
120,000
67,745
(43%)
100,000
80,000
58,890
(33%)
60,000
0
N=105,195
37,975
(36%)
50,990
(32%)
40,000
20,000
0 to 2 years
>2 to 5 years
>5 to 10 years
N=176,360
34,610
(33%)
N=39,350
9,430 (24%)
11,165 (28%)
46,295
(26%)
39,695
(25%)
32,610
(31%)
18,755 (48%)
Prostate
Breast
Colorectal
Lung
* During the estimation process, cases from Quebec were excluded because of issues in correctly
ascertaining the vital status of cases. The presented estimates, however, are for all of Canada, including
Quebec. These estimates assume that sex- and age-specific tumour-based prevalence proportions in
Quebec are similar to the rest of Canada. Estimates for lung cancer may be lower than in previous
editions of this publication because of the different method used to estimate Quebec’s prevalence prior to
2013. For further details, see Appendix II, Data sources and methods.
Note: N is the total number of prevalent tumour cases for each cancer type. In the legend, 0 to 2 years
refers to those diagnosed in 2007 and 2008; >2 to 5 years refers to those diagnosed between 2004 and
2006; >5 to 10 years refers to those diagnosed between 1999 and 2003. The complete definition of the
specific cancers listed here can be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
Canadian Cancer Society
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Prevalence: How many people diagnosed with cancer are alive today?
Some of the individuals included in these numbers
were cancer-free, while others were newly or recently
diagnosed and were undergoing treatment.
What do these statistics mean?
Knowing the prevalence of cancer is important for
estimating and planning healthcare services for cancer.
For example, those diagnosed with cancer within the
past two years have different needs than those
diagnosed between two and five, five and 10 or more
than 10 years ago.(1,2)
Earlier chapters and other sources(3) have shown
ongoing increases in the number of newly diagnosed
cancer cases in Canada and increases in survival from
cancer.(4,5) The combined result of these factors is a rise
in the number of people living with or beyond a cancer
diagnosis. Long after the need for cancer treatment has
passed, individuals may still require rehabilitation and
supportive care services to address the physical,
emotional and spiritual consequences of cancer. The
growing demand for such services and the increased
complexity of survivors’ health needs are just two
factors that need to be considered when planning and
developing interdisciplinary healthcare.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
For more information
Publications
• Ellison LF, Wilkins K. Cancer prevalence in the Canadian
population. Health Reports. 2009;20(1):7–19. Available at:
http://www.statcan.gc.ca/pub/82-003-x/2009001/
article/10800-eng.pdf (accessed Apr. 28, 2015).
• Ellison LF, Wilkins K. Canadian trends in cancer prevalence.
Health Reports. 2012;23(1):7–16. Available at:
http://www.statcan.gc.ca/pub/82-003-x/2012001/
article/11616-eng.pdf (accessed Apr. 28, 2015).
References
1. De Angelis R, Grande E, Inghelmann R, Francisci S, Micheli A, Baili P, et al. Cancer
prevalence estimates in Italy from 1970 to 2010. Tumori. 2007;93(4):392–7.
2. Micheli A, Mugno E, Krogh V, Quinn MJ, Coleman M, Hakulinen T, et al. Cancer prevalence
in European registry areas. Annals of Oncology: Official Journal of the European Society
for Medical Oncology / ESMO. 2002;13(6):840–65.
3. Statistics Canada. Table 103-0550 – New cases for ICD-O-3 primary sites of cancer
(based on the July 2011 CCR tabulation file), by age group and sex, Canada, provinces
and territories. CANSIM (database). http://www5.statcan.gc.ca/cansim/a26?lang=eng&re
trLang=eng&id=1030550&paSer=&pattern=&stByVal=1&p1=1&p2=37&tabMode=dat
aTable&csid= (Accessed Jan. 2014)
4. Ellison LF, Wilkins K. An update on cancer survival. Health Rep. 2010;21(3):55–60.
5. Statistics Canada. Cancer Survival Statistics (Catalogue 82-226-x). Ottawa, ON: Minister
of Industry; 2012.
73
CHAPTER 6
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Prevalence: How many people diagnosed with cancer are alive today?
TABLE 6.1 Tumour-based prevalence for selected cancers by prevalence duration and sex, Canada,* January 1, 2009
10-year (diagnosed since 1999)
All cancers
Prostate
Breast
Colorectal
Melanoma
Lung†
Non-Hodgkin lymphoma
Bladder†
Body of uterus
Thyroid
Kidney
Leukemia
Oral
Ovary
Cervix
Testis
Multiple myeloma
Stomach
Brain/CNS
Hodgkin lymphoma
Larynx †
Pancreas
Liver
Esophagus
5-year (diagnosed since 2004)
2-year (diagnosed since 2007)
Total
Males
Females
Total
Males
Females
Total
Males
Females
840,985
176,365
158,430
105,195
39,495
39,350
36,220
34,255
31,610
30,930
24,175
22,510
19,510
10,695
10,200
7,935
7,460
7,420
7,385
7,160
5,575
3,750
2,985
2,740
423,760
176,365
1,045
56,650
19,895
18,435
19,140
25,650
—
6,515
14,435
13,040
12,835
—
—
7,935
4,100
4,625
4,015
3,890
4,625
1,845
2,245
2,035
417,225
—
157,380
48,545
19,600
20,920
17,080
8,610
31,610
24,410
9,740
9,470
6,675
10,695
10,200
—
3,360
2,790
3,370
3,270
955
1,905
745
710
520,025
105,180
90,685
67,215
23,365
29,920
23,145
21,130
18,540
19,240
15,195
14,620
12,145
7,025
5,500
4,210
5,615
5,170
4,790
3,905
3,415
3,140
2,295
2,165
266,175
105,180
640
36,860
11,985
14,165
12,440
15,945
—
4,125
9,205
8,505
8,070
—
—
4,210
3,110
3,250
2,680
2,100
2,830
1,560
1,725
1,610
253,855
—
90,050
30,360
11,380
15,755
10,705
5,180
18,540
15,120
5,995
6,120
4,080
7,025
5,500
—
2,510
1,920
2,110
1,805
585
1,575
575
555
247,310
46,295
39,695
32,610
10,640
18,755
10,760
9,940
8,450
8,625
7,480
7,150
5,960
3,535
2,480
1,755
2,885
3,045
2,735
1,685
1,645
2,320
1,455
1,485
127,775
46,295
285
18,130
5,530
9,100
5,900
7,530
—
1,935
4,500
4,180
4,005
—
—
1,755
1,560
1,955
1,580
900
1,375
1,165
1,080
1,130
119,535
—
39,410
14,480
5,105
9,650
4,865
2,410
8,450
6,695
2,980
2,970
1,950
3,535
2,480
—
1,320
1,095
1,155
785
275
1,155
370
355
CNS=central nervous system
— Not applicable
* During the estimation process, cases from Quebec were excluded because
of issues in correctly ascertaining the vital status of cases. The presented
estimates, however, are for all of Canada, including Quebec. These
estimates assume that sex- and age-specific tumour-based prevalence
proportions in Quebec are similar to the rest of Canada.
†
Prevalence estimates for lung, bladder and larynx cancers may be lower
than in previous editions of this publication because a different method
was used to estimate Quebec’s prevalence prior to 2013. For further details,
see Appendix II: Data sources and methods.
Note: The complete definition of the specific cancers listed here can be
found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
Canadian Cancer Society
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Prevalence: How many people diagnosed with cancer are alive today?
TABLE 6.2 Age distribution for 10-year tumour-based prevalence for the most common cancers by sex, Canada,* January 1, 2009
All cancers
Age (years)
0–19
20–29
30–39
40–49
50–59
60–69
70–79
80+
Lung†
Colorectal
Prostate
Breast
Total
N=840,985
Males
N=423,760
Females
N=417,225
Total
N=39,350
Males
N=18,435
Females
N=20,920
Total
N=105,195
Males
N=56,650
Females
N=48,545
Males
N=176,365
Females
N=157,380
%
%
%
%
%
%
%
%
%
%
%
0.9
1.3
3.0
8.0
17.1
25.9
26.3
17.4
1.0
1.2
2.2
5.0
13.9
27.7
31.3
17.7
0.8
1.3
3.9
11.1
20.5
24.0
21.2
17.2
0.1
0.2
0.5
3.3
13.8
29.7
33.7
18.6
0.1
0.2
0.5
2.7
12.0
30.1
35.7
18.8
0.1
0.2
0.6
3.9
15.5
29.4
31.9
18.4
0.0
0.2
0.8
4.1
13.1
24.4
30.7
26.6
0.0
0.2
0.8
3.9
13.5
27.0
32.6
21.8
0.0
0.2
0.9
4.3
12.6
21.4
28.4
32.1
0.0
0.0
0.0
0.7
10.2
31.8
38.5
18.8
0.0
0.2
2.0
11.9
24.3
26.1
20.4
15.2
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
N is the total number of prevalent tumour cases for each
cancer type by sex.
* During the estimation process, cases from Quebec were
excluded because of issues in correctly ascertaining the
vital status of cases. The presented estimates, however, are
for all of Canada, including Quebec. These estimates
assume that sex- and age-specific tumour-based
prevalence proportions in Quebec are similar to the rest of
Canada.
†
Prevalence estimates for lung cancer may be lower than
in previous editions of this publication because a different
method was used to estimate Quebec’s prevalence prior to
2013. For further details, see Appendix II: Data sources
and methods.
Note: “All cancers” excludes non-melanoma skin cancers
(neoplasms, NOS; epithelial neoplasms, NOS; and basal
and squamous). Due to rounding, columns may not total
100%. The complete definition of the specific cancers
listed here can be found in Table A10.
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CHAPTER 6
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Prevalence: How many people diagnosed with cancer are alive today?
TABLE 6.3 Person-based prevalence for selected cancers by prevalence duration and sex, Canada,* January 1, 2009
10-year (diagnosed since 1999)
All cancers
Prostate
Breast
Colorectal
Melanoma
Lung†
Non-Hodgkin lymphoma
Bladder†
Body of uterus
Thyroid
Kidney
Leukemia
5-year (diagnosed since 2004)
2-year (diagnosed since 2007)
Total
Males
Females
Total
Males
Females
Total
Males
Females
810,045
176,355
158,405
104,130
39,495
39,115
36,175
34,245
31,605
30,845
24,165
22,510
406,065
176,355
1,045
55,985
19,895
18,335
19,110
25,640
—
6,500
14,420
13,040
403,980
—
157,360
48,145
19,600
20,775
17,060
8,605
31,605
24,350
9,740
9,470
506,200
105,180
90,680
66,615
23,360
29,780
23,100
21,115
18,535
19,190
15,195
14,620
258,070
105,180
635
36,460
11,985
14,105
12,410
15,940
—
4,100
9,200
8,500
248,130
—
90,040
30,155
11,375
15,675
10,685
5,180
18,535
15,085
5,995
6,115
242,810
46,295
39,690
32,385
10,640
18,680
10,720
9,940
8,445
8,605
7,480
7,150
125,040
46,295
285
17,955
5,530
9,065
5,875
7,530
—
1,925
4,495
4,180
117,770
—
39,410
14,420
5,105
9,610
4,850
2,410
8,445
6,680
2,980
2,970
19,320
10,690
10,190
7,935
7,455
7,415
7,375
7,160
5,575
3,750
2,985
2,740
12,730
—
—
7,935
4,100
4,620
4,015
3,890
4,620
1,845
2,240
2,035
6,590
10,690
10,190
—
3,360
2,790
3,365
3,270
950
1,905
745
710
12,055
7,025
5,495
4,210
5,615
5,170
4,785
3,905
3,415
3,135
2,295
2,165
8,020
—
—
4,210
3,105
3,245
2,675
2,095
2,825
1,560
1,720
1,610
4,040
7,025
5,495
—
2,505
1,920
2,105
1,805
585
1,575
575
555
5,925
3,535
2,480
1,755
2,885
3,045
2,735
1,685
1,645
2,320
1,450
1,485
3,985
—
—
1,755
1,560
1,955
1,580
900
1,370
1,165
1,080
1,130
1,935
3,535
2,480
—
1,320
1,090
1,155
785
275
1,155
370
355
Oral
Ovary
Cervix
Testis
Multiple myeloma
Stomach
Brain/CNS
Hodgkin lymphoma
Larynx†
Pancreas
Liver
Esophagus
CNS=central nervous system
— Not applicable
* During the estimation process, cases from Quebec were excluded because
of issues in correctly ascertaining the vital status of cases. The presented
estimates, however, are for all of Canada, including Quebec. These
estimates assume that sex- and age-specific person-based prevalence
proportions in Quebec are similar to the rest of Canada.
†
Prevalence estimates for lung, bladder and larynx cancers may be lower
than in previous editions of this publication because a different method
was used to estimate Quebec’s prevalence prior to 2013. For further details,
see Appendix II: Data sources and methods.
Note: “All cancers” excludes non-melanoma skin cancers (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous). The complete
definition of the specific cancers listed here can be found in Table A10.
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
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Prevalence: How many people diagnosed with cancer are alive today?
TABLE 6.4 Ten-year person-based prevalence proportions for the most common cancers by sex, Canada,* January 1, 2009
Percentage of Canadian population
All cancers
Prostate
Lung†
Female breast
Colorectal
Total
Males
Females
Total
Males
Females
2.4
—
0.1
—
0.3
2.4
1.1
0.1
—
0.3
2.4
—
0.1
0.9
0.3
41
—
857
—
322
41
94
907
—
297
42
—
813
107
351
Analysis by: Health Statistics Division, Statistics Canada
Data source: Canadian Cancer Registry database at Statistics Canada
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— Not applicable.
One in:
Canadian Cancer Statistics 2015
* During the estimation process, cases from Quebec were excluded because
of issues in correctly ascertaining the vital status of cases. The presented
estimates, however, are for all of Canada, including Quebec. These
estimates assume that sex- and age-specific person-based prevalence
proportions in Quebec are similar to the rest of Canada.
†
“One in:” estimates for lung cancer indicate a lower prevalence
proportion for males than in previous editions of this publication because a
different method was used to estimate Quebec’s prevalence prior to 2013.
For further details, see Appendix II: Data sources and methods.
Note: “All cancers” excludes non-melanoma skin cancers (neoplasms,
NOS; epithelial neoplasms, NOS; and basal and squamous). The complete
definition of the specific cancers listed here can be found in Table A10.
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Led by members of the
Canadian Cancer Statistics Advisory Committee:
Lin Xie, Public Health Agency of Canada
Prithwish De, Canadian Cancer Society
Additional analysis and written contributions from:
Robert Semenciw, Public Health Agency of Canada
Les Mery, Public Health Agency of Canada
Keiko Asakawa, Statistics Canada
William Flanagan, Statistics Canada
Ryan Woods, BC Cancer Agency
Additional technical assistance from:
Natalie Fitzgerald, Canadian Partnership Against Cancer
Reviewed by:
Anthony B. Miller, Professor Emeritus, Dalla Lana School of Public Health
Howard Morrison, Public Health Agency of Canada
Andrew Coldman, BC Cancer Research Centre
Bjørn Møller, Cancer Registry of Norway
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Highlights
How many new cancer cases will there be in
the future?
• Between 2003 to 2007 and 2028 to 2032, it is
estimated that the average annual population of Canada
will grow by 29% or about 9.5 million residents. Over
this period, the proportion of Canadians aged 65 and
older will grow from approximately 1 in 8 to 1 in 4.
• By 2028 to 2032, the average annual number of new
cancer cases is estimated to increase 79% (84% in
males and 74% in females) compared to 2003 to
2007. This translates to 277,200 new cases in 2028 to
2032 (148,370 in males and 128,830 in females) up
from 154,975 cases in 2003 to 2007 (80,810 in males
and 74,165 in females). During the same period, the
number of new cancer cases is expected to more
than double in those aged 65 and over.
• The expected increase in the number of new cancer
cases in both males and females will primarily be due
to the aging of the Canadian population and, to a
lesser extent, population growth. Changes in the risk
of cancer will constitute a relatively small component
of the projected increase in new cases among females,
but will mitigate the overall expected increase in new
cases among males.
• If current trends hold true in the future, it is
expected that for the major cancer types by 2028
to 2032:
■■ The number of new lung cancer cases will
increase to 32,365 from 22,110 in 2003 to 2007.
■■ Prostate cancer cases will increase to 42,225
from 21,460.
■■ Female breast cancer cases will increase to 31,255
from 20,110.
■■ Colorectal cancers will increase to 35,075 from
19,630.
Will the risk of cancer change?
• It is estimated that the age-standardized cancer
incidence rate for males will decline (from 465 to
443 per 100,000) and increase for females (from 358
to 371 per 100,000).
• The projected incidence rates for various cancer
types are expected to change to varying degrees up to
2028–2032 when examined by their predominant
risk factors:
■■ Incidence rates for most smoking-related cancers
will decrease over time.
■■ Incidence rates for melanoma (associated with
UV overexposure) are expected to decline in the
long term for both sexes.
■■ Other major cancer risk factors such as excess
weight, physical inactivity, poor diet, alcohol
consumption and infection are expected to
impact different cancers to varying degrees.
• The pattern of cancer incidence rates across Canada
will remain similar to today – future rates for most
cancer types are expected to be highest in eastern
Canada and lowest in British Columbia.
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All other
cancers
Prostate
21.0%
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What are the implications?
• Projection of cancer incidence can provide an
evidence base for planning strategies, resources and
infrastructure at both national and provincial levels
for better cancer control.
• Cancer risk will play a smaller but still important
role in the future burden of cancer compared to
population growth and aging. As a result, there will
be a need for continued strengthening of cancer
prevention and early detection to lessen the future
incidence of cancer.
• The anticipated growth in new cases implies a
growing cancer survivor population, which may
require planning of appropriate strategies and
services related to continuing care.
Introduction
Growth and aging of the Canadian population are
expected to contribute to a substantial increase in the
cancer burden. While short-term projections like those
presented in other chapters of this publication are
useful for estimating the current impact of cancer on
Canadians, long-term projections are useful in a
variety of ways. For example, defining the expected
societal burden of cancer can provide evidence-based
input in the planning of cancer control programs,
whether for prevention, early detection, treatment,
psychosocial, palliative and medical care, or for
research and surveillance. Furthermore, estimating the
geographic variability in future cancer incidence can
help in developing priorities for public health policy at
both the national and regional levels.
The future incidence of cancer can be examined using
the estimated age-standardized rate and the number of
new cancer cases. Changes in rates convey changes in
risk of developing cancer over time. In contrast, the
future number of new cases is a consequence of
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changes in the cancer rates as well as in the population
size and age structure.
Future predictions depend on several assumptions.
Most notable are that:
• past trends will continue into the future
• the prevalence of most risk factors are stable or will
change little over the projection period.
However, changes in medical practice, advances in
diagnostic procedures, changes in histological
classification and completeness of cancer registration
can all lead to short-term changes in incidence, which
are difficult to foresee or incorporate into prediction
models. Generally, the accuracy of projections for the
most common cancers is of greatest concern because
these have the biggest influence over the total projected
number of cases.
The Public Health Agency of Canada has completed a
study on projected incidence counts and rates through
2028 to 2032 for 25 types of cancer (excluding nonmelanoma skin cancer) in Canada by sex, age and
geographic region using national cancer data from
1983 to 2007.(1) This chapter is partly based on that
study. At the time of writing of that study, the most
current available national data were for cancer
diagnoses in the year 2007. As a result, five-year
periods up to 2003 to 2007 are used as the baseline
periods for long-term projections in this chapter.
Estimates of future numbers of new cancer cases and
rates are provided for five-year periods from 2008–
2012 to 2028–2032.
The projection methods are described in Appendix II:
Data sources and methods. The Public Health Agency
of Canada mainly uses a statistical projections package,
Nordpred, to extrapolate current trends in cancer rates
into the future. The package requires input of past
numbers of cancer cases aggregated by 5-year time
periods and produces projections for 5-year durations,
as mentioned above. The projections also depend on
accurate national population projections, which are
prepared by Statistics Canada. Rates were age-adjusted
by standardizing to the 1991 Canadian standard
population (i.e., the standard currently used by
Statistics Canada and the Public Health Agency of
Canada). Standardizing to a more current population
may produce different rates than those presented here.
Microsimulation model
Microsimulation models are computer models that
simulate large populations using, for example,
characteristics of representative individuals. These
models allow one to explore the potential variation
in projection outputs that result from varying
scenarios for model inputs such as screening
participation, cancer incidence and survival from
cancer, among others.
Nordpred software
A software for predicting trends in cancer incidence
and the chosen software for the majority of the
current analyses.
Medium growth
The medium growth scenario combines assumptions
of fertility and immigration similar to recent years
along with moderate growth in life expectancy (as
opposed to low or high rates for each of these
factors).
Low-dose computed tomography (LDCT)
A type of scanning technology that combines special
x-ray equipment with sophisticated computers to
produce multiple, cross-sectional images or pictures
of the inside of the body. LDCT uses less ionizing
radiation than a conventional computed tomography
(CT) scan.
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This chapter also uses the Canadian Partnership
Against Cancer’s Cancer Risk Management Model
(CRMM) to develop a series of microsimulation
modelling scenarios that show the impact of selected
cancer control interventions. The CRMM is a webbased, decision-support modelling platform that
projects population-based health and economic
impacts of cancer control interventions in Canada.(2-5)
The microsimulation projections allow health system
leaders, researchers and policy makers to test “what-if ”
scenarios related to potential cancer control
interventions. Users can access the CRMM via a web
interface and develop customized scenarios to inform
current and future health policy decisions. The model
incorporates the risk of developing and dying from
cancer, as well as screening and clinical management
data with health care costs and labour data to allow
assessment of both health outcomes and economic
impact.
The “in-depth” analyses using the CRMM were
conducted for 3 types of cancer – lung, colorectal and
cervical – to assess the potential impacts of:
• low-dose computed tomography (LDCT) screening
of current and former heavy smokers on future lung
cancer incidence, mortality and prevalence and the
costs associated with the intervention
• fecal immunochemical blood screening on future
colorectal cancer incidence, mortality and prevalence
and the costs associated with the intervention
• human papillomavirus (HPV) vaccination and
routine Pap screening in conjunction with HPV
DNA testing on future cervical cancer incidence,
mortality, and prevalence and costs associated with
the interventions.
Because of differences in modelling approaches and
model assumptions, the estimates provided by the
CRMM may not be consistent with those derived from
the PHAC models (see Appendix II: Data sources and
methods for details on the different methods).
However, both approaches permit one to make
inferences about the future burden of cancer. The main
difference is that the PHAC models assume that past
trends estimated from data will continue into the
future with varying degrees whereas the CRMM
permits one to explore what might happen to cancer
burden if one or more interventions (such as cancer
screening or vaccination) are adopted in our
population.
Projected trends in population
Cancer counts are affected by demographic changes
such as population growth and changes in the age
distribution of the population. Figure 7.1 shows the
projected population distribution in males and females
in 2003–2007 and 2028–2032. Under Statistics Canada’s
medium growth scenario (M1), it is estimated that over
this period the average annual Canadian population
will grow by 29% or about 9.5 million people.
By 2028–32, people aged 65 and over are expected to
represent 1 in 4 Canadians, up from 1 in 8 in the years
2003–2007. Moreover, it is expected that the growth in
population in males age 65 or older will be greater than
FIGURE 7.1 Current and projected average annual population, by sex and age, Canada, 2003–07 and 2028–32
Age group
85+
Males
80-84
2003–07
75-79
2028–32
70-74
65-69
Females
60-64
55-59
2003–07
50-54
2028–32
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
View data
0-4
1,500
1,000
500
0
500
1,000
1,500
Population (in thousands)
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Statistics Canada; Demographic estimates compendium 2010; CANSIM table 051-0001; Population Projections for Canada, Provinces and Territories 2009 to 2036
(Catalogue no. 91-520-X)
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in females (increases of 137% vs. 109%). The increase
in population in the 65 years and over age group is
expected in several Western countries, but the extent
of increase will vary. Canada is expected to have
greater growth than others because of its larger baby
boom population.(6)
It is also important to note that the overall population
change may not be uniform across Canada. Some
provinces and territories are forecasted to grow more
than others. Generally population growth from
2003–2007 to 2028–2032 is forecast to be lower than
the Canadian average in Atlantic Canada, Quebec,
Saskatchewan and the Territories and above average
for Alberta and British Columbia. Ontario and
Manitoba are forecast to grow approximately in line
with the Canadian average over this period.(1)
Although all regions will experience a substantial
increase in the number of seniors over the period
2003–2007 to 2028–2032, it will not be uniform.
Manitoba, Saskatchewan, Quebec, Nova Scotia and
New Brunswick will experience lower than average
growth in the senior population, whereas Alberta and
the Territories are forecast to see a substantial
percentage increase in those aged 65 and older.
Consequently, these different changes will contribute
to differences in the predicted increase in cancer
burden, both across and within each province and
territory.
FIGURE 7.2 Average annual new cases and age-standardized incidence rates (ASIRs) for all cancers, Canada, 1983–2032
ASIR (per 100,000)
Average annual new cases (in thousands)
500
160
450
140
Males
ASIR
New cases
400
120
350
100
300
250
Females
ASIR
New cases
80
200
60
Estimated
150
40
100
20
50
0
0
1983–87
1988–92
1993–97
1998–02
2003–07
2008–12
2013–17
2018–22
2023–27
Period
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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2028–32
View data
Projected trends in cancer incidence counts
and rates
New cancer cases are predicted to increase in both
sexes (Figure 7.2). The annual number of new cases
is predicted to increase by 84% (from 80,810 in
2003–2007 to 148,370 in 2028–2032) in males
(Table 7.1) and by 74% (from 74,165 to 128,830)
among females (Table 7.2). These changes translate to
an overall 79% increase in new cases for both sexes
combined.
Consistent with the projected change in age
distribution in the population described above, the
greatest number of new cancer cases is expected in the
65 years and over age group (Figure 7.3). Together,
these age groups are expected to have more than a
doubling of new cases by 2028–2032 (188,720 average
annual cases) compared to 2003–2007 (88,210 cases).
An analysis of the drivers of change illustrates that the
projected rise in the number of all new cancer cases in
both males and females will primarily come from the
aging of the Canadian population and, to a lesser
extent, from an increase in population size (Figure 7.4).
Changes in the risk of cancer (i.e., exposure to risk
factors and diagnostic practices) will constitute a
relatively small component of the projected increase in
new cases among females, but will mitigate the overall
expected increase in new cases among males.
The age-standardized incidence rate (ASIR) for all
cancers combined in males began decreasing from
1993–1997 to 2003-2007 (Figure 7.2), while in females
it increased over this period. For the projected period
of 2003–2007 to 2028–2032, the ASIRs for all cancers
combined are predicted to continue decreasing among
males by 5% (from 465 to 443 per 100,000) and
continue increasing among females by 4% (from 358 to
371 per 100,000).
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Counts and rates by cancer type
FIGURE 7.3 Current and projected distribution of new cancer cases, by sex and age, Canada, 2003–07 and 2028–32
Age group
85+
Males
80-84
2003–07
75-79
2028–32
70-74
65-69
60-64
Females
55-59
2003–07
50-54
2028–32
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
View data
0-4
30
25
20
15
10
5
0
5
10
15
20
25
Average annual new cases (in thousands)
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Figure 7.5 shows that the relative percentage change in
new cancer cases in both sexes combined is expected
to differ by cancer type. Recent patterns in incidence
rates and the ages at which different cancers tend to
arise have an influence on the expected change of each
type of cancer. Cancer screening can also have a strong
influence on rates of new cancer diagnoses. Its
influence is reflected in current incidence rates for
individual cancer types but may not be adequately
captured in the projections of future cases. For
example, this may be the case for colorectal cancer, for
which the future impact of the recent implementation
of population-based screening is not well known and
also for lung cancer, for which the possible future
implementation of lung cancer screening in individuals
at high risk for the disease is not reflected in current
projections for lung cancer (see In-Depth boxes for
projections of screening-based scenarios).
The number of new cases in 2028–2032 will continue
to be highest in the four major cancer types – prostate,
lung, colorectal and breast. However, aside from
prostate cancer, the percentage change in new cases
compared to 2003–2007 is expected to be greatest for
many of the less common cancer types such as liver
(162% increase), thyroid (144%), multiple myeloma
(110%), pancreas (99%) and leukemia (94%).
Notably, larynx cancer is the only cancer type with an
expected decline in new cases (average annual 5%
decrease).
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Frequency distribution
The relative frequencies of major cancers are not
expected to change significantly over time. Figure 7.6
shows the frequency distribution of cancers by sex for
the periods of 2003–2007, 2018–2022 and 2028–2032.
Prostate, colorectal, lung and bladder cancers are
expected to be the four most common cancers
diagnosed in males in all periods. However, colorectal
cancer is projected to overtake lung cancer as the
second most frequently diagnosed cancer in males by
2018–2022. This change may be explained by the
decreasing incidence of lung cancer due to declining
smoking rates in males.
In females, four cancers – breast, lung, colorectal and
uterine – are the leading cancer types in the three
periods examined in this analysis. The distribution of
common cancers in females is expected to remain
unchanged over time except for thyroid cancer, which
is expected to outrank non-Hodgkin lymphoma as the
fifth most common cancer in females by 2018–2022.
Rates
While counts of new cases provide a measure of cancer
burden, the change in rates provides a population
measure of the changing risk for developing cancer. It
is possible for the trends in counts and rates to be
different. Even if incidence rates are stable or declining,
because the number of people in the age group that is
most often diagnosed with cancer is going up rapidly,
the number of new cancer cases will also trend
upward. As alluded to previously, as the baby boom
population in Canada continues to move into the
period of life at higher risk of cancer, the number of
new cancer cases is expected to rise.
FIGURE 7.4 Trends in average annual new cases for all cancers and ages, attributed to changes in cancer risk, population growth, and aging
population, Canada, 2003–2032
150
Average annual new cases (in thousands)
150
140
130
120
Aging population
110
100
90
Population growth
80
70
110
60
50
40
30
20
10
0
20
10
0
2008–12
2013–17
2018–22
2003−07
average annual
cancer count
100
90
40
30
2003–07
Males
80
70
Changes in cancer risk
60
50
140
130
120
2023–27
2028–32
Period
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
Average annual new cases (in thousands)
2003–07
Aging population
Population growth
Changes in cancer risk
2008–12
2013–17
2018–22
2023–27
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
Females
2003−07
average annual
cancer count
2028–32
Period
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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FIGURE 7.5 Average annual new cases by cancer type and percentage change, Canada, 2028–32 versus 2003–07
Oral
2028–32
58.9%
Esophagus
2003–07
89.2%
Stomach
36.6%
Colorectal
78.7%
Liver
162.2%
Pancreas
98.5%
Larynx
-4.6%
Lung
46.4%
The ASIR of lung cancer in females is projected to rise
by 2% from 2003–2007 to 2008–2012 and then
decrease by 18% to 2028–2032 (Figure 7.7). The breast
cancer ASIR is expected to change the least (an
increase of only 0.7%) of all cancers in females. Most of
the increase in female ASIR for all cancers combined
may be attributed to the collective effects of higher
future ASIRs for thyroid, liver and uterus cancer.
Smaller increases will occur for the cancer types
previously mentioned with high numbers of future
new cases (i.e., multiple myeloma, pancreas and
leukemia). Notable decreases in ASIR for females are
expected for larynx, stomach and cervix cancers.
72.1%
Melanoma
96.8%
Prostate
55.4%
Breast
6.7%
Cervix
87.6%
Body of uterus
53.0%
Ovary
29.7%
Testis
90.6%
Kidney
81.8%
Bladder
41.9%
Brain/CNS
144.2%
Thyroid
For all cancers combined, the ASIR in 2028 to 2032 is
expected to decline in males (5% lower than 2003–2007)
but increase in females (4% higher than 2003–2007).
Much of the expected decline in ASIR for all cancers
combined in males may be attributed to the decreasing
ASIR for lung cancer. The greatest declines in ASIR for
males are expected for larynx and stomach cancers.
The largest increases in ASIR for males are expected
for thyroid and liver cancer, while smaller increases
will occur for the cancer types previously mentioned
with high numbers of future new cases (i.e., multiple
myeloma, pancreas and leukemia).
26.0%
Hodgkin lymphoma
76.3%
Non-Hodgkin lymphoma
CNS=central nervous system
110.3%
Multiple myeloma
Note: Percentages refer to
changes in average annual
number of new cases in
2028–32 versus 2003–07.
93.8%
Leukemia
91.4%
All other cancers
0
10,000
20,000
30,000
40,000
50,000
Average annual new cases
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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View data
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FIGURE 7.6 Projected change in distribution of cancers in males and females, Canada, 2003–07, 2018–22 and 2028–32
2003–07
2018–22
Prostate
28.8%
Prostate
26.6%
Other
20.5%
2028–32
Other
20.5%
Lung
15.2%
Prostate
29.1%
Other
20.8%
Colorectal
13.1%
Males
Colorectal
13.7%
Stomach 2.4%
Oral 2.8%
Colorectal
13.1%
Melanoma 2.9%
Oral 2.6%
Leukemia 3.2%
Kidney 3.2%
Non-Hodgkin lymphoma 4.3%
Lung
11.9%
Pancreas 2.3%
Bladder 6.0%
Pancreas 2.5%
Melanoma 3.0%
Leukemia 3.3%
Kidney 3.4%
Non-Hodgkin lymphoma 4.2%
2003–07
Breast
27.1%
Other
23.1%
Colorectal
12.1%
Leukemia 2.5%
Other
18.2%
Lung
13.3%
Bladder 2.3%
Bladder 5.8%
Melanoma 2.8%
Ovary 3.2%
Thyroid 3.8%
Uterus 5.5%
Non-Hodgkin lymphoma 4.3%
Bladder 6.1%
2018–22
2028–32
Breast
25.2%
Breast
24.8%
Lung
13.7%
Colorectal
11.6%
Kidney 2.4%
Pancreas 2.7%
Melanoma 2.8%
Ovary 2.9%
Melanoma 2.8%
Kidney 3.5%
Leukemia 3.5%
Non-Hodgkin lymphoma 4.2%
Leukemia 2.6%
Pancreas 2.6%
Lung
11.3%
Oral 2.5%
Uterus 6.1%
Thyroid 5.4%
Non-Hodgkin lymphoma 4.1%
Other
18.5%
Lung
12.7%
Females
Colorectal
12.1%
Bladder 2.4%
Kidney 2.4%
Melanoma 2.8%
Leukemia 2.8%
Ovary 2.9%
Pancreas 3.0%
Uterus 6.1%
Thyroid 5.5%
Non-Hodgkin lymphoma 4.1%
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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FIGURE 7.7 Age-standardized incidence rates (ASIRs) for selected cancers, Canada, 1985–2030
ASIR (per 100,000)
500
All cancers
Oral
20
18
12
12
10
3
6
70
Colorectal
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Liver
9
8
60
7
50
6
40
5
30
4
3
20
2
10
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
100
Lung
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
16
90
6
4
1
2
Melanoma
14
2
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Pancreas
13
12
11
10
9
8
7
6
5
4
3
2
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
110
Female breast
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
9
7
6
5
4
3
2
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
12
100
11
90
10
80
9
60
10
70
50
8
40
6
40
4
30
70
30
20
2
10
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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60
50
Cervix
8
7
6
5
4
3
20
2
10
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Larynx
8
12
80
Females
ASIR
Estimate
8
2
4
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Males
ASIR
Estimate
14
4
8
100
Stomach
16
10
200
20
18
5
14
300
Esophagus
6
16
400
7
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Note: Years in the graphs
refer to the mid-year of
each 5-year period.
Dashed lines represent
estimated rates.
View data
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FIGURE 7.7 Age-standardized incidence rates (ASIRs) for selected cancers, Canada, 1985–2030 (continued)
ASIR (per 100,000)
30
Body of uterus
Ovary
14
25
20
140
Prostate
7
12
120
6
10
100
5
8
80
4
6
60
3
Testis
Males
ASIR
Estimate
15
10
4
40
2
5
2
20
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
16
Kidney
Bladder
40
9
Brain
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
30
Thyroid
8
14
12
7
30
20
6
10
8
5
20
4
6
10
3
4
10
2
2
1
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
4
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Females
ASIR
Estimate
Hodgkin lymphoma
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
20
Non-Hodgkin lymphoma
18
16
3
14
12
7
Multiple myeloma
6
5
4
10
2
8
6
1
4
2
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
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Canadian Cancer Statistics 2015
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
16
Leukemia
14
12
10
8
3
2
6
4
1
2
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
0
1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Note: Years in the graphs
refer to the mid-year of
each 5-year period.
Dashed lines represent
estimated rates.
View data
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n
FIGURE 7.8 Age-standardized incidence rates (ASIRs) for all cancers by age group, Canada, 1983–2032
Males (40–49)
Males (50–59)
Males (60–69)
Females (70–79)
Females (80+)
2
–3
28
7
Note: The range of rate
scales differs widely
between the age groups.
Incidence rates exclude
non-melanoma skin cancer
(neoplasms, NOS; epithelial
neoplasms, NOS; and basal
and squamous). Dashed
lines represent estimated
rates.
20
2
–2
23
20
7
–2
18
20
2
–1
13
20
7
–1
08
20
–0
20
03
2
1,000
7
1,000
–0
2
7
–3
28
20
2
–2
23
20
7
–2
18
20
2
–1
13
20
–1
08
7
Females (40–49)
Females (50–59)
Females (60–69)
20
2
–0
03
20
7
–0
98
19
2
–9
93
19
–8
83
Males (0–19)
Males (20–29)
Males (30–39)
1,500
98
0
0
1,500
19
200
2
200
2,000
–9
400
2,000
93
400
2,500
19
600
2,500
7
600
3,000
–9
800
3,000
–8
800
3,500
88
1,000
3,500
19
1,000
ASIR per 100,000
1,200
4,000
83
1,200
4,000
19
1,400
19
–3
28
20
–2
23
20
–2
18
20
–1
13
20
–1
08
20
–0
03
20
–0
98
19
–9
93
19
88
19
–8
83
19
Females (0–19)
Females (20–29)
Females (30–39)
1,400
7
0
1,600
–9
0
1,600
2
20
7
20
2
40
7
40
2
60
7
60
2
80
7
80
2
100
7
100
1,800
88
120
Age groups 70–80+
1,800
19
120
ASIR per 100,000
Age groups 40–69
140
–9
ASIR per 100,000
Age groups 0–39
140
Males (70–79)
Males (80+)
View data
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Rates by sex and age
Currently, cancer is more frequently diagnosed in
females than males between the ages of 20 and 49.
However, this pattern is expected to change for males
and females over time for those aged 20–29, for whom
ASIRs are predicted to converge (Figure 7.8).
The continuing gap in ASIRs between sexes in the age
group 30−49 can be attributed to the high incidence of
breast cancer in females, which accounts for 35–38% of
all female cancers in these age groups. Cancers of the
thyroid and cervix also explain the higher incidence
rate in young females compared to males of the same
age.
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The ASIRs for the age group 50–59 will continue to be
very close between the sexes. The male ASIRs for the
age groups 60 years and older have been dropping over
time and are expected to continue to do so. The
decrease in lung cancer rates in this age range and the
decrease in prostate cancer rates among individuals
aged over 70 have contributed to the overall decline.
Females aged 60–69 will experience notable increases
in ASIR while those aged 70 and older will see a
smaller increase (unlike their male counterparts who
will experience declines in rates).
Counts and rates by geographic region
Differences in incidence rates by regions are influenced
by variation in the prevalence of risk factors,
availability of screening and diagnostic services,
different rates of participation in cancer screening
programs (e.g., mammographic screening for breast
cancer) and variation in cancer registry practices.
Differences in demographics by region also impact the
numbers of new cases diagnosed as larger and older
populations will give rise to more cancers.
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While new cases for some cancer types are expected to
rise universally across most regions (e.g., liver, thyroid
cancers), others will differ by geographic region (Table
7.3). For example, new cases of esophageal cancer are
anticipated to rise substantially in Alberta and
Newfoundland by 2028–2032, but this cancer will
experience a smaller change elsewhere. Similarly,
uterus cancer is expected to have a bigger increase in
new cases in Ontario and British Columbia than in
other provinces. Population growth may partially
explain the larger increase in cases of uterus cancer in
Ontario and British Columbia.
The ASIRs for all cancers combined are projected to be
highest for males in the Atlantic region, highest for
females in Quebec over the next 15 years but in
Ontario thereafter, and lowest in British Columbia.(1)
By 2028–2032, the Atlantic region is projected to have
the lowest national rates for breast, uterus and ovarian
cancers, and for liver and leukemia in both sexes. The
historically higher smoking rates in Quebec and
Atlantic Canada likely account for the higher incidence
rates of lung cancer in these regions.
Low expected incidence rates of prostate cancer and
melanoma in Quebec are likely the result of the
registry relying on hospitalization data and missing
cancers diagnosed and treated outside the hospitals.(7)
The high incidence rates of liver and esophageal
cancers in British Columbia could partly be explained
by high numbers of immigrants from South Asia and
China where hepatitis B virus (HBV) is endemic and
higher rates of esophageal cancer in China and Central
Asia.(8)
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In-depth: Projected impact of screening and adjunct smoking
cessation program on lung cancer in current and former heavy smokers
Incidence
Annual population-based lung cancer screening with
low-dose computed tomography (LDCT) has the potential
to detect lung cancer early among 55–74 year old current
or former heavy smokers (30 pack-years). However, like
many screening modalities, LDCT can lead to over-diagnosis
– that is, detecting cancers that would not have been
diagnosed in the person’s lifetime in the absence of
screening. The CRMM projected that early detection
combined with the existing high prevalence of detectable
lung cancer cases at the beginning of such a screening
program would lead to an increase in new cases detected
in the first several years of screening and a higher than
expected number of new cases while screening continues
(Figure 7.9). The result would be similar with 30% LDCT
alone or when coupled with an adjunct smoking cessation
program that has a 22.5% success rate. The impact of
smoking cessation on incidence is muted because it takes
20–30 years in the simulation for risk to return to baseline
levels of the population.
Mortality
Participation rates of 30% in LDCT lung cancer screening
with an adjunct smoking cessation program with a 22.5%
success rate is expected to result in a modest reduction in
lung cancer deaths in Canada (Table 7.5), from 20,680 to
20,650 deaths in 2015 and 24,600 to 24,270 deaths in
2030. Although there is a relatively long lag time between
smoking cessation and a reduction in the incidence of lung
cancer, the short-term benefits of smoking cessation are
expected to be realized through its impact on other causes of
mortality and reflected in life-years gained (i.e., increased
longevity). The CRMM projects an increase in life-years of
8,700 and 5,500 by 2030 due to lung cancer screening with
and without smoking cessation, respectively.
Prevalence
The future prevalence of lung cancer, defined as the number
of individuals ever having been diagnosed with lung cancer,
will be influenced by smoking patterns (amount and duration
smoked) in prior years, the increased number of cancers
detected by screening, the increased life-years gained due to
the detection of lung cancer at earlier more treatable stages
of disease and better survival due to treatment. The prevalence
(person-years) of lung cancer in Canada would increase by
50% by 2030 (72,760 to 109,000) if LDCT screening were
implemented with an adjunct smoking cessation program
compared to an increase of 31% if these interventions were
not implemented (Table 7.5).
Costs
The CRMM projected the total cost of treatment, screening
and smoking cessation programs under different scenarios
in Canada (Table 7.5):
■■ $592 million in 2015 if there is no LDCT screening, rising
to $829 million by 2030
■■ $930 million in 2015 if there is annual screening with LDCT
for individuals 55–74 years (30% participation rate and
adjunct smoking cessation), rising to $942 million by 2030
The incremental cost-effectiveness ratios (ICERs) for lung
cancer screening were calculated to be $32,000 and
$78,000 per health-related quality-adjusted life-year
(QALY) for annual screening with and without smoking
cessation, respectively. Both costs and QALYs were
discounted at a rate of 3%.
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The influence of selected risk factors and
interventions on the burden of cancer
FIGURE 7.9 Projected number of new cases of lung cancer under selected screening strategies, Canada, 2015–2030
New cases
32,000
Annual screening with
LDCT (55–74 year olds)
with 30% participation
31,000
Annual screening with
LDCT (55–74 year olds)
with 30% participation
and smoking cessation
program with 22.5%
success rate
30,000
29,000
28,000
Status quo (no organized
screening)
27,000
26,000
25,000
24,000
2015
LDCT=low-dose computed
tomography
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Year
Analysis by: Statistics Canada
Data source: Canadian Partnership Against Cancer, Cancer Risk Management Model version 2.2.1.0
View data
Major modifiable cancer risk factors include smoking,
body weight (i.e., being overweight or obese), physical
inactivity, diet/nutrition, UV exposure, alcohol
consumption, infections, medicinal drugs,
occupational and environmental contaminants. The
major categories of modifiable risks and their relation
to various cancer types examined in this chapter are
shown in Table 7.4. The proportion of new cancer
cases attributed to each risk factor varies by cancer
type. In addition to modifiable risks, non-modifiable
risk factors, such genetic susceptibility to cancer, may
account for part of the risk of developing cancer.
As shown in Table 7.4, most cancer types examined in
this chapter have multiple and overlapping risk factors.
While the prevalence of some of these risk factors has
increased over time in the Canadian population, others
have decreased. Given these trends, it is difficult to
attribute a change in a cancer’s ASIR to a single risk
factor. Moreover, the role of current exposure to
various risk factors on future rates of cancer is limited
by the fact that exposures may change in the future.
Smoking
Smoking is an established risk factor for 18 different
cancer types(9), including some of those listed in Table
7.4. The strongest association of smoking is with lung
cancer. Lung cancer rates have been declining in males
and stabilizing in females between 2001 and 2010. The
trends reflect different periods when smoking began to
decline in each sex (see discussion in Chapter 1).
Considering the lag between a decline in smoking rates
and subsequent declines in lung cancer incidence, it is
likely that the lung cancer ASIR in females will begin
to drop more noticeably over the longer term, as
reflected by the projections up to 2032 (Figure 7.7).
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Despite their much higher ASIR, the rate in males is
expected to continue its decline, but at an increasingly
slower rate of decline, up to 2028–2032, eventually
nearing the much lower rate of females.
In-depth: Projected impact of screening on colorectal cancer
Incidence
Prevalence
The CRMM projected that, in the absence of organized
screening, the number of colorectal cancer cases is
expected to increase due to the aging of the population
from approximately 25,000 cases in 2015 to over 35,000
cases by 2030 (Figure 7.10). Screening detection and
removal of polyps can reduce the number of new cases of
colorectal cancer in the future. Screening can be undertaken
using recommended tests in organized programs for
average-risk individuals – the fecal immunochemical test
(FIT) or guaiac fecal occult blood test (gFOBT). Colonoscopy
is undertaken as a follow-up test to a positive FIT or gFOBT
result in average-risk patients or as a primary screening test
in high-risk individuals (e.g., those with a family or personal
history of colorectal cancer). For the purpose of this
analysis, the results for FIT are presented because most
provinces are using the FIT for average-risk programmatic
screening.
The CRMM projected a net increase in prevalence from
2015 to 2030 with FIT due to the detection of cancers at
earlier stages and improved survival among patients.
Mortality
Screening impacts the number of deaths from colorectal
cancer by reducing incidence through detection and
removal of polyps and from detection and treatment of
cancers at earlier stages when they have a better prognosis.
Between 2015 and 2030, a biennial FIT screening program
with a participation rate of 30% could lead to 21,000
cumulative deaths averted compared to 40,000 cumulative
deaths averted with a participation rate of 80%.
Costs
The incremental cost of screening would range from an
estimated $214 million to $369 million in 2015 and
$277 million to $747 million in 2030 (undiscounted),
depending on the participation rate of screening with
biennial FIT (see Table below). However, the increased
screening costs would be partially offset by treatment
savings due to the avoidance of expensive treatments for
advanced disease estimated at between $25 million and
$30 million in 2015 and $228 million and $490 million in
2030.
Both screening strategies projected increased demand for
colonoscopy resources to perform follow-up of positive FIT
results and follow-up of persons identified as moderate or
high-risk for cancer. This potential increase in resource
requirements is an important consideration when
implementing a FIT screening program.
For the scenario where the FIT participation rate is 30%,
1.6 million annual FIT screens are projected to result in an
increase of 90,000 annual colonoscopies. With an 80% FIT
participation rate, 3.8 million FIT screens would result in
210,000 additional colonoscopies per year.
2015
No organized
screening
($millions)
FIT 30%
Reductions in smoking may also contribute to some
degree to the expected reductions between 2003–2007
and 2028–2032 in male oral cancer, female esophageal
cancer and cervical cancer, as well as larynx, stomach
and bladder cancers in both sexes (Tables 7.1 and 7.2).
Sun and UV
Melanoma is the least common but most deadly form
of skin cancer. It is related to UV radiation, mainly
from overexposure to the sun or from the use of
indoor tanning equipment. About 90% of melanomas
are due to sun exposure.(10)
Between 2003–2007 and 2028–2032, there is expected
to be a 72% increase in the number of new melanoma
cases (Tables 7.1 and 7.2).
The increase in melanoma incidence rates is projected
to slow down in both sexes, and rates are expected to
decrease after 10–15 years (Figure 7.7). This may be a
result of the assumption that the risk of melanoma will
continue to decrease in the more recent birth cohorts.
National trends are heavily influenced by provincial
data. Therefore, projected melanoma rates in Canada
are likely to be underestimated because of the current
under-registration of this cancer in Quebec.(7)
2030
FIT 80%
No screening
FIT 30%
FIT 80%
Cost of screening
$103
$317
$472
$177
$455
$925
Cost of treatment
$1,340
$1,315
$1,310
$2,256
$2,028
$1,766
Total cost
$1,443
$1,632
$1,782
$2,433
$2,483
$2,691
Note: Values are undiscounted.
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FIGURE 7.10 Projected number of new cases of colorectal cancer under selected screening strategies and levels of participation,
Canada, 2015–2030
New cases
40,000
No organized screening
FIT 30% participation
35,000
FIT 80% participation
30,000
25,000
20,000
15,000
2015
FIT=fecal immunochemical test
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Year
Analysis by: Statistics Canada
Data source: Canadian Partnership Against Cancer, Cancer Risk Management Model version 2.2.1.0
View data
Other risk factors
Various other risk factors may account for the
observed and expected trends in cancer incidence. Five
such lifestyle factors are discussed in detail here –
excess weight, physical inactivity, poor diet, alcohol
and infections (Table 7.4).
The rising trend in excess weight among Canadians(11)
may partly account for the positive trend in many
cancers associated with weight. In 2013, 20.7% of
youth (aged 12–17 years) were considered overweight
or obese – a proportion that has changed little since
2005.(12) Among adults, 62.0% of males and 45.1% of
females were considered overweight or obese in 2013.
A diet low in fibre, vegetables and fruit, and high in red
or processed meat, as well as certain preservation
methods for food (i.e., Chinese-style salted fish) are
established risk factors for several cancers including
colorectal, stomach and oral cavity. Diet also affects
body weight as the foods people eat help them get to
and stay at a healthy weight. For example, eating plenty
of fibre can help maintain a healthy body weight.
In 2013, 40.8% of Canadians reported consuming
vegetables and fruit five or more times per day, which
is an amount considered to be beneficial for disease
prevention.(12) Part of the ongoing and predicted
decrease in stomach cancer is likely to be linked to
changes in diet and food preservation methods.
Alcohol consumption is an established risk factor for
cancers of the oral cavity (including pharynx), larynx,
esophagus, female breast, colon, rectum and liver.
Research suggests that more than 60% of alcoholattributable cancers occur in the oral cavity, pharynx
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and esophagus in males and about 60% of alcoholattributable cancers occur in the breast in females.(13) It
has also been shown that as the amount of alcohol
consumed increases, the risk also increases in a dosedependent manner for oral, pharynx, larynx,
esophageal, breast and colorectal cancers. Alcohol
consumption together with tobacco smoking increases
the risk of head and neck cancers (i.e., cancers of the
oral cavity, pharynx and larynx) more than either risk
factor alone.
According to the 2012 Canadian Alcohol and Drug Use
Monitoring Survey, 78.4% of Canadians reported
drinking alcohol in the past year, with more males than
females reporting drinking (82.7% versus 74.4%
respectively).(14) A survey of Canadians’ perceptions of
the health impacts of alcohol consumption shows that
67% of respondents were not aware that drinking
alcohol is associated with an elevated risk of cancer.(15)
Canada’s Low-Risk Alcohol Drinking Guidelines(16,17)
may also confuse Canadians because they are different
from the drinking guidelines for cancer prevention. It is
estimated that restricting alcohol drinking to no more
than 2 drinks a day for males and 1 drink a day for
females could avoid about 90% of cancers attributable to
alcohol in males and over 50% in females.(18)
Bacterial and viral infections are established risk
factors for several cancer types, most notably, the
cervix and parts of the oral cavity and pharynx (caused
by the human papillomavirus (HPV)), stomach
(caused by Helicobacter pylori (H.pylori)), liver (caused
by the hepatitis B (HBV) and C (HCV) viruses), and
lymphomas (caused by Epstein-Barr virus, Human
immunodeficiency virus (HIV), and Human T-cell
lymphotropic virus (HTLV-1)).
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In-depth: Projected impact of screening and HPV vaccination on cervical cancer
Incidence
According to the CRMM, it is anticipated that there will be
an increasing upward trend in the number of new cervical
cancer cases over time with the aging population. Despite
the status quo of cytology testing 21–69 year olds every
3 years and 70% participation of 12 year-old girls in HPV
vaccination programs, newly diagnosed cervical cancers are
expected to increase from about 1,500 cases in 2015 to
approximately 2,200 cases in 2030. As vaccinated cohorts
become eligible for screening, different screening protocols
may be considered that incorporate HPV DNA testing. By
2030, screening all women with a triennial cytology and
one-time HPV DNA test at age 30 or screening
unvaccinated women with a triennial cytology test and
vaccinated women with an HPV DNA test every 10 years
would result in similar health outcomes as compared to the
status quo.
Mortality
Over time, cervical cancer deaths are projected to increase
with the status quo due to the aging population. Regardless
of the screening protocol assessed in this comparison,
cervical cancer deaths are projected to increase from
approximately 430 deaths in 2015 to 620 deaths in 2030.
Prevalence
Prevalence is measured as the sum of person-years alive for
those who have ever been diagnosed with cervical cancer.
Prevalence could increase if more cancers were detected by
aggressive screening and/or screening with improved
accuracy. Prevalence might also decline over time from the
prevention of HPV infections through vaccination programs
or if precancerous lesions were treated before progressing
to cancer. With time, the increase in cervical cancer
prevalence would slow down as the proportion of
vaccinated females in the population becomes more
prevalent regardless of screening strategy.
Costs
If screening programs implement a one-time HPV DNA test
that is not tailored to vaccination status (i.e., all women
screened with cytology testing receive a one-time HPV DNA
test), the cost of screening is expected to increase, on
average, by $35 million annually. However, if screening
were to be tailored to individuals’ vaccination status such
that the vaccinated women were screened with an HPV
DNA test every 10 years and unvaccinated women were
screened with cytology testing every three years, the total
cost of screening and treatment would be reduced by
$33 million annually on average (undiscounted).
The tailored screening program (cytology for unvaccinated
+ HPV DNA for vaccinated) would generate a net saving in
total healthcare costs as early as 2015 (Figure 7.11). As
more and more females are vaccinated over time, the cost
savings for the tailored screening program would continue
to increase. By contrast, the untailored program would still
be more costly than the status quo strategy in 2030.
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The projected rising trend in liver cancer incidence in
Canada may be linked to the ongoing increase and
continued high incidence of hepatitis C virus
infection,(19) the aging of the population previously
infected and increasing immigration from areas where
the prevalence of chronic hepatitis B infection and
aflatoxin exposure are high.(20,21) The persisting
decrease in incidence of stomach cancer may be partly
explained by increased recognition and treatment of
infection with H. pylori.(22,23)
The expected downward trend in the cervical cancer
ASIR continues the past trend and can be attributed to
screening with the Papanicolaou (Pap) test and its
successful identification and treatment of precancerous
lesions. This downward trend in ASIR is expected to be
sustained as the impact of HPV vaccination is realized
over the coming years.(24) Potential reductions in the
ASIR for cancers in other areas of the body such as the
anus and oropharynx may also occur.
Comparisons of projections to other countries
The impending future impact of cancer has been
described in many countries with regard to
incidence,(25,26) deaths,(27) prevalence(28) and costs of
care.(29) Using a constant-rate projection method,
increases in cancer cases of 75% and 54% among males
and females, respectively, from 2008 to 2030 have been
projected in the very high human-development-index
regions, including Canada.(30) In this and other studies
described below, there is a consistent attribution of
demographic changes to the expected rise in cancer
incidence.
One study projected cancer incidence in the United
Kingdom (UK) for 2008–2030 based on 1975–2007
data and using a method similar to the Nordpred
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
FIGURE 7.11 Projected incremental (relative to status quo screening with vaccination) total healthcare costs (vaccination, screening, pre-cancer and
cancer treatment) by year, Canada, 2015–2030
Incremental cost (millions of dollars)
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
-10
-10
-20
-20
-30
-30
-40
-40
-50
-50
-60
-60
-70
-70
-80
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
-80
2030
One-time HPV DNA
test + HPV vaccination
Cytology for
unvaccinated +
HPV DNA test for
vaccinated
View data
Year
Analysis by: Statistics Canada
Data source: Canadian Partnership Against Cancer, Cancer Risk Management Model version 2.2.1.0
approach.(31) As in Canada, almost no change is
projected in the ASIR of all cancers combined to 2030
in the UK, although the number of new cases are
expected to rise 55% for males and 35% for females
compared to 2007. The projected change in the ASIR
will differ by cancer type. Among the major cancer
types, the ASIR for colorectal cancer is projected to
decrease 6% for both sexes in Canada, whereas the
rates in the UK are expected to decrease by a similar
amount in males but increase by 2% in females. For
lung cancer, the ASIR is projected to decrease by 34%
in males and 16% in females in Canada, compared
with a predicted decrease of 8% in males and increase
of 7% in females in the UK. Breast cancer incidence
rate among females is not predicted to change
substantially in both countries. In both sexes in the
UK, oral cancer and melanoma are expected to
increase. In the UK, it has been estimated that 40% of
total cancer risk is attributed to five lifestyle factors –
tobacco, diet, excess weight, alcohol and physical
inactivity.(32)
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In Switzerland, researchers used Nordpred to estimate
a 30% increase in new cases in males and 20% increase
in females over the period 2005–2009 to 2015–2019.(33)
But similar to the findings in Canada, the study
predicted that population size and structure will be
responsible for most of the observed increase and the
amount of change in the future will differ by cancer
type. The largest increases are expected in males for
melanoma, thyroid, NHL and prostate cancers and in
females for lung, oral, thyroid, and NHL, reflecting
some of the findings in Canada.
In Ireland, new cancer cases are projected to increase
between 2010 to 2040 by 107% for males and 84% for
females.(34) The greatest increases are expected for skin
(both melanoma and NMSC) and cancers of the upper
gastrointestinal tract such as esophagus and pancreas.
In Australia, the ASIR for liver, thyroid, melanoma,
testis and female lung is expected to increase the most
by 2020,(35) reflecting the situation in Canada. In
addition, as in Canada, ASIR for stomach cancer and
several smoking-related cancers, in particular bladder
and male lung, is expected to decline.
What do these statistics mean?
Comparing long-term cancer projections with current
rates provides a useful benchmark for evaluating
existing preventive and treatment interventions. Future
predictions are also important for future healthcare
planning including staff training and recruitment,
resource allocation and developing infrastructure. It
helps health planners and policy-makers anticipate the
resources needed to screen, diagnose and treat newly
diagnosed cancer patients, provide palliative and
end-of-life services and provide ongoing care to cancer
survivors.
Long-term cancer incidence projections inherently
carry some uncertainty. The reliability of projections
Canadian Cancer Society
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Canadian Cancer Statistics 2015
depends on the accuracy of the population forecasts.
The predicted populations were based on the
assumptions on rates of fertility, mortality,
interprovincial and international migration, among
others.(36) Assumptions are also required for the
extrapolation from current cancer trends – specifically,
that past trends will continue into the future. Although
this assumption seems reasonable based on historical
data, it is likely that increasing focus on lifetime cancer
prevention, especially reducing risk factors while
promoting protective behaviours and secondary
prevention through screening and early detection, will
exert an influence on future incidence rates of
modifiable cancers. Prevention is expected to have
differential impacts on various cancer types. For those
cancer types with organized screening programs, for
example, the decline in future cancer cases is likely to be
bolstered by enhancing screening opportunities today.
However, soon after screening is established, changes
in cancer rates can occur quite quickly and projections
for cancers potentially affected by screening need to be
interpreted cautiously. For example, the effect of
colorectal cancer screening is only partly captured in
the projected trend for this cancer because screening
programs have only recently been implemented across
Canada and continue to ramp up. Similarly, if
organized lung cancer screening for high-risk smokers
is adopted in provinces, the effects of screening will
not be reflected in the estimates for lung cancer shown
in the current analysis. Other future influences on
cancer rates include potential changes in testing, such
as HPV DNA testing for cervical cancer screening. The
expansion of such screening programs may bring some
transient increases in cancer incidence.
An increased uptake in the use of more sensitive
diagnostic tests can also increase the potential for
diagnosing cancers that might have otherwise remained
undetected throughout an individual’s life in the absence
of these tests. This contributes to an increase in cancer
rates that is difficult to separate from the increase
brought on by the cancer’s true risk factors. Therefore,
for some cancers, a recently increasing trend may be a
combination of both recent changes in diagnostic
technology and true risk and might not be expected to
continue to increase along the same trend in the future.
Thyroid cancer incidence has increased dramatically in
recent years and is one such cancer where the rise is
believed to be partly due to changes in diagnostic
technology. For this cancer, it is challenging to predict
whether the recent increases in risk will continue
throughout the entire projection period. However,
recent trends have shown a sustained increase.
Based on this analysis, the projected aging and growth
of the population is expected to cause a progressive and
significant increase in the total number of new cases of
cancer in Canada over the next 15 years. The analysis
indicates the average annual number of new cancer
cases in Canada is predicted to increase overall by 79%
(84% in males and 74% in females) from 2003–07 to
2028–32. The changes in the size and age structure of
the population constitute a large component of the
projected increase in new cancer cases.
Historical and ongoing declines in smoking have
resulted in significant reductions in the lung cancer
incidence and mortality rates in males (see Chapters 1
and 3), which have also substantially contributed to the
avoided deaths from all cancers combined (see
Introduction). These efforts have been significant, and
it is important to reflect that the expected cancer
burden in 2030 would have been far more significant
had these efforts to reduce the rates of smoking-related
cancers not been so successful.
The incidence rates are projected to decrease for many
cancers associated with other lifestyle risk factors,
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while the rates are estimated to increase for thyroid,
liver, uterus, pancreas and kidney cancers. These
increases may be driven by changes in the prevalence
of or exposure to risk factors and/or changes in
diagnostic practices. As such, prevention efforts to
reduce known modifiable risk factors for these cancers
must continue where possible. Furthermore, additional
etiological research is needed to better understand the
reason for these changes in order to help guide risk
reduction efforts.
Smoking, sun/UV overexposure, excess weight,
physical inactivity, poor diet, alcohol consumption and
infections continue to be important cancer prevention
targets for the purpose of reducing incidence and
disease-related costs. Research suggests that the annual
economic burden of tobacco smoking, excess weight
and physical inactivity in Canada were $50.3 billion in
2012 ($15.3 billion in direct and $34.9 billion in
indirect costs).(37) If there are no changes in the
prevalence of these risk factors, then by 2031 the cost
is predicted to increase to $59.2 billion. The projected
burden of cancer also has implications for secondary
prevention. Risk reduction could be further
strengthened when combined with improved uptake of
population-based cancer screening through organized
programs. If the numbers of cancers diagnosed in our
population are to increase so dramatically, an
important goal should be to detect them at their
earliest possible stage. This will reduce the mortality
risk associated with these diagnoses and permit them
to be treated at a more cost-effective stage.
The growing number of new cancer cases from an
aging Canadian population is expected to contribute to
more cancer survivors if survival rates also continue to
improve, as would be expected with advances in early
detection and treatment. Future analyses would benefit
from estimates of the long-term prevalence of cancer,
Canadian Cancer Society
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Canadian Cancer Statistics 2015
as has been undertaken in other countries.(28) The
growing number of cases and prevalence of cancer
survivors will have an increasingly important impact
on the demand for healthcare services and
management of follow-up care, as patients survive
longer. Cancer diagnosis, treatment and follow-up is
multidisciplinary, complex and requires significant
numbers of medical specialists. Thus in addition to
planning for infrastructure to treat cancer (such as
cancer centres and equipment within them), it is
necessary to anticipate the demand for medical
specialists trained in managing cancer.(38)
Additionally, analyses and projections of the costs
associated with the increasing cancer burden can help
guide healthcare planners to devise appropriate
strategies for allocating limited resources appropriately.(25)
Recent studies(39,40) have suggested that costs of treating
cancer are increasing and that for some cancers, these
increases are quite significant. A recent study using
data from the province of Ontario(39) demonstrated
rising costs for several common cancers and suggests
that the determinants of these increasing trends are
multi-faceted. Rising costs were attributed to both the
utilization and costs of providing major types of cancer
treatments, but also to how services such as posttreatment home care are utilized.
Together, these results suggest that the expected effect
of future changes in Canada’s demographic profile and
cancer trends should be addressed from
multidisciplinary perspectives, embracing prevention
and early detection, research and surveillance,
treatment and psychosocial, palliative and medical
care. The findings also emphasize the need to
strengthen cancer control strategies, leverage resources
to better meet future healthcare needs and evaluate
existing interventions.
For further information
• BC Cancer Registry 2013 Annual Report. Special focus: the
future of cancer in British Columbia. Vancouver, BC: BC
Cancer Agency; 2014.
• Nowatzki J, Moller B, Demers A. Projection of future cancer
incidence and new cancer cases in Manitoba, 2006–2025.
Chronic Dis Inj Can 2011; 31(2):71–8.
• CancerCare Manitoba. Community Health Assessment 2010.
CancerCare Manitoba, 2010.
• Alberta Health Services. Long-Term Projections for Cancer
Incidence and Mortality in Alberta. Alberta Health Services:
June 2011.
Databases
Canadian Partnership Against Cancer. Cancer Risk Management
Model. (accessed Dec. 1, 2014)
Disclaimer
Some analyses in this chapter are based on the Canadian
Partnership Against Cancer’s Cancer Risk Management Model.
The Cancer Risk Management Model was made possible by a
financial contribution from Health Canada, through the
Canadian Partnership Against Cancer. The assumptions and
calculations underlying the simulation results were not
prepared by the Canadian Partnership Against Cancer and the
Partnership is not responsible for the use and interpretation of
these data.
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cmajo.20130041.
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TABLE 7.1 Changes in average annual new cases and age-standardized incidence rates (ASIRs) for cancers in males, Canada, 2003–07 to 2028–32
Average annual new cases
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Prostate
Testis
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
ASIR (per 100,000)
2003–07
2028–32
Change (%)
2003–07
2028–32
Change (%)
80,810
2,285
1,095
1,925
10,620
1,025
1,810
900
12,245
2,320
21,460
825
2,580
4,815
1,365
795
490
3,455
1,065
2,570
7,005
148,370
3,595
2,110
2,680
19,815
2,845
3,635
900
16,420
4,065
42,225
1,070
5,020
8,825
1,965
1,895
615
6,050
2,395
5,095
13,390
83.6
57.5
92.7
39.1
86.6
177.8
100.7
0.0
34.1
75.4
96.8
29.7
94.7
83.4
43.8
138.8
26.6
75.0
125.1
98.3
91.1
464.8
12.6
6.2
11.1
60.8
5.7
10.3
5.1
70.7
13.1
123.3
5.6
14.4
27.9
7.9
4.5
3.1
19.7
6.1
15.1
40.7
443.2
11.8
6.2
7.7
57.0
8.2
10.5
2.7
46.4
12.4
123.3
6.0
15.5
24.0
7.1
7.0
3.0
18.1
6.8
15.8
38.7
-4.6
-6.0
0.6
-30.0
-6.3
43.3
1.4
-47.5
-34.4
-5.8
0.1
8.5
7.4
-13.9
-10.4
54.5
-3.4
-8.3
11.3
4.5
-5.1
CNS=central nervous system
Note: Counts are rounded to the nearest 5. ASIR and percentage change
for counts and ASIR are calculated before rounding. Rates are agestandardized to the 1991 Canadian population.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
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TABLE 7.2 Changes in average annual new cases and age-standardized incidence rates (ASIRs) for cancers in females, Canada, 2003–07 to 2028–32
Average annual new cases
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
ASIR (per 100,000)
2003–07
2028–32
Change (%)
2003–07
2028–32
Change (%)
74,165
1,085
385
1,080
9,010
350
1,900
195
9,865
2,055
20,110
1,345
4,105
2,385
1,665
1,705
1,055
2,810
395
2,915
875
1,875
6,995
128,830
1,760
690
1,425
15,260
760
3,730
145
15,945
3,465
31,255
1,435
7,700
3,650
3,070
3,030
1,470
6,910
500
5,180
1,685
3,520
13,405
73.7
62.4
79.5
31.6
69.4
116.6
96.2
-25.9
61.6
68.7
55.4
6.8
87.6
53.1
84.4
78.0
39.1
145.9
26.3
77.7
92.2
87.6
91.6
358.3
5.2
1.7
4.9
41.0
1.6
8.5
1.0
47.1
10.7
97.9
7.6
19.9
11.6
8.0
7.7
5.6
16.1
2.5
14.1
4.0
9.2
32.3
371.0
5.3
1.7
3.7
38.6
1.9
9.1
0.4
39.6
11.2
98.7
6.1
23.1
11.1
8.6
7.3
5.2
26.5
2.3
14.3
4.2
9.8
34.6
3.6
1.6
-2.3
-23.7
-6.1
15.1
7.1
-58.8
-15.9
4.6
0.7
-20.2
16.2
-4.0
6.8
-6.1
-7.6
64.8
-6.8
1.4
4.0
6.9
7.0
CNS=central nervous system
Note: Counts are rounded to the nearest 5. ASIR and percentage change
for counts and ASIR are calculated before rounding. Rates are agestandardized to the 1991 Canadian population.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
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Canadian Cancer Statistics 2015
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TABLE 7.3 Changes in average annual new cases for cancers in both sexes, by province/territory, 2003–07 to 2028–32
British Columbia
Alberta
Average annual new cases
Cancer type
2003–07
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Prostate
Testis
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
19,380
420
225
360
2,410
215
495
110
2,660
695
2,555
155
520
285
2,860
105
410
915
280
250
95
855
215
560
1,710
2028–32
33,630
655
450
535
4,625
580
985
150
4,140
1,270
4,405
150
1,080
415
5,580
175
695
1,605
395
455
125
1,520
455
1,140
3,230
Saskatchewan
Average annual new cases
Change (%)
2003–07
73.5
55.5
102.9
48.2
92.0
170.2
98.7
37.7
55.6
83.1
72.4
-4.1
107.7
44.7
95.0
65.3
69.8
75.2
41.0
82.8
27.0
77.7
110.8
103.7
88.7
13,425
275
130
245
1,555
130
335
65
1,675
430
1,770
150
380
175
2,055
100
395
590
205
335
90
555
165
425
1,180
2028–32
28,140
480
350
360
3,590
405
740
105
3,155
675
3,035
185
720
300
3,865
125
800
1,325
340
755
140
1,090
380
910
2,615
Average annual new cases
Change (%)
109.7
76.1
167.8
47.9
130.7
205.9
120.3
54.9
88.3
56.4
71.3
23.6
89.6
68.6
88.2
22.7
103.5
125.2
67.7
124.3
56.3
97.1
131.5
114.7
121.9
2003–07
4,955
95
40
85
665
25
130
30
670
115
615
40
130
75
850
25
140
215
70
60
25
205
60
170
425
2028–32
7,450
95
70
85
1,120
50
225
40
850
160
825
50
200
90
1,400
25
215
380
90
85
30
320
100
240
640
Change (%)
50.3
1.5
66.2
-0.7
68.8
83.7
75.1
42.6
26.9
37.6
34.8
21.4
54.7
23.2
64.8
1.4
53.9
73.9
30.4
43.2
8.4
54.1
70.1
42.7
50.3
CNS=central nervous system
Note: New cases are rounded to
the nearest 5. Percentage change
was calculated before rounding.
“Territories combined” refers to
Yukon, Northwest Territories and
Nunavut.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
100
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.3 Changes in average annual new cases for cancers in both sexes, by province/territory, 2003–07 to 2028–32 (continued)
Manitoba
Ontario
Average annual new cases
Cancer type
2003–07
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Prostate
Testis
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
5,540
140
50
120
740
45
135
30
810
125
730
45
175
90
665
30
185
245
70
80
30
245
65
170
500
2028–32
8,255
190
80
155
1,235
115
220
30
1,110
155
1,000
45
285
115
1,010
40
300
445
100
150
45
370
110
270
715
Quebec
Average annual new cases
Change (%)
2003–07
49.1
35.3
62.1
31.5
66.5
148.7
61.1
-3.5
37.4
23.4
37.5
-6.0
63.4
23.1
51.6
35.2
60.5
82.4
37.9
84.9
36.6
50.6
68.0
58.5
43.3
58,810
1,330
570
1,105
7,235
505
1,245
390
7,390
2,015
7,705
530
1,620
980
8,875
325
1,510
1,830
940
1,840
355
2,500
795
1,780
5,375
2028–32
110,945
2,250
1,060
1,635
13,290
1,395
2,460
460
10,810
3,650
12,730
610
3,295
1,665
19,085
450
3,120
3,370
1,325
5,015
510
4,435
1,705
3,770
11,530
Average annual new cases
Change (%)
88.6
69.0
86.6
48.4
83.7
174.8
97.3
17.3
46.3
81.0
65.2
15.3
103.4
69.6
115.1
37.9
106.9
84.2
40.6
172.8
44.9
77.4
114.1
112.0
114.6
2003–07
39,905
830
335
815
5,185
385
1,075
375
6,955
560
5,175
300
980
615
4,225
175
1,175
2,135
665
795
220
1,505
500
1,055
3,830
2028–32
65,995
1,310
615
935
8,470
870
1,865
305
9,870
745
7,095
300
1,560
730
7,855
240
2,115
4,205
945
2,000
265
2,480
1,005
1,830
7,025
Change (%)
65.4
57.8
84.5
14.8
63.4
127.7
73.4
-18.3
41.9
32.9
37.1
0.0
59.3
19.0
85.9
35.1
79.9
96.7
41.7
152.0
18.3
64.7
100.2
72.9
83.4
CNS=central nervous system
Note: New cases are rounded to
the nearest 5. Percentage change
was calculated before rounding.
“Territories combined” refers to
Yukon, Northwest Territories and
Nunavut.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
101
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.3 Changes in average annual new cases for cancers in both sexes, by province/territory, 2003–07 to 2028–32 (continued)
New Brunswick
Nova Scotia
Average annual new cases
Cancer type
2003–07
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Prostate
Testis
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
4,100
80
40
85
495
20
115
30
665
125
490
35
95
65
645
15
145
190
65
100
20
170
50
95
270
2028–32
6,970
115
75
90
875
40
225
30
960
210
700
35
140
100
1,230
20
290
355
75
290
25
275
90
180
465
Prince Edward Island
Average annual new cases
Change (%)
2003–07
69.9
41.3
81.9
6.2
77.6
96.5
96.3
1.2
44.8
68.0
42.8
-0.5
50.4
62.0
91.2
17.1
101.1
86.1
19.6
196.0
17.7
62.9
78.3
92.5
73.5
5,430
110
60
95
755
30
130
35
830
200
645
50
125
65
790
25
185
245
75
90
30
210
55
130
455
2028–32
8,560
180
100
105
1,260
60
195
40
1,085
335
910
50
190
105
1,465
40
335
450
105
175
35
350
100
205
715
Average annual new cases
Change (%)
57.6
61.8
67.9
10.3
67.3
109.6
50.2
6.5
30.8
65.4
41.3
-6.0
53.4
65.1
84.9
39.3
82.5
84.4
42.9
91.8
22.7
68.1
82.3
58.9
57.0
2003–07
785
15
5
10
100
5
20
5
110
30
90
10
20
10
135
5
25
35
10
10
0
30
10
25
65
2028–32
1,340
25
10
20
175
10
35
10
140
40
155
10
30
10
260
5
45
45
15
15
5
50
25
35
140
Change (%)
71.1
69.4
68.6
61.0
74.0
169.2
87.0
51.6
25.3
38.3
72.9
0.9
61.5
46.8
88.0
25.3
91.4
41.1
41.8
78.3
31.0
67.9
97.5
48.8
114.3
CNS=central nervous system
Note: New cases are rounded to
the nearest 5. Percentage change
was calculated before rounding.
“Territories combined” refers to
Yukon, Northwest Territories and
Nunavut.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
102
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.3 Changes in average annual new cases for cancers in both sexes, by province/territory, 2003–07 to 2028–32 (continued)
Newfoundland and Labrador
Territories combined
Average annual new cases
Cancer type
2003–07
All cancers
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Prostate
Testis
Kidney
Bladder
Brain/CNS
Thyroid
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
All other cancers
2,370
55
20
80
445
10
30
20
300
65
300
25
60
25
335
10
75
105
40
45
10
85
20
35
170
2028–32
4,040
70
45
75
890
30
95
25
495
100
470
15
100
30
585
10
120
195
50
80
10
140
35
45
305
Average annual new cases
Change (%)
2003–07
70.3
30.7
103.7
-9.2
99.1
145.4
208.3
17.6
64.7
52.6
56.9
-36.9
59.3
40.7
75.0
-1.0
66.1
81.6
26.0
76.0
3.1
63.8
71.0
44.3
77.4
270
10
5
5
50
0
5
0
50
5
40
5
5
0
25
0
5
5
5
5
0
10
0
10
20
2028–32
625
20
5
20
135
0
10
0
85
10
75
5
15
5
75
0
10
15
5
10
0
25
5
15
45
Change (%)
131.5
84.0
163.7
142.3
180.9
70.6
148.6
69.7
80.6
49.1
100.8
0.2
137.1
19.3
172.1
10.8
122.4
124.3
35.2
119.4
28.1
160.5
252.6
109.7
136.7
CNS=central nervous system
Note: New cases are rounded to
the nearest 5. Percentage change
was calculated before rounding.
“Territories combined” refers to
Yukon, Northwest Territories and
Nunavut.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry and National Cancer Incidence Reporting System databases at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
103
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.4 Modifiable risk factors associated with selected cancer types Risk factor
Overweight /
obesity
Physical
inactivity
Body of uterus
n
n
Breast
n
n
Cancer type
Smoking
Bladder
Poor diet
Sun
overexposure /
indoor tanning
Alcohol
consumption
Infections
(viruses
and
bacteria)
Pharmaceuticals
n
Occupational /
environmental
exposures
(non-solar)
n
n
n
n
Brain/CNS
n
n
Cervix
n
Colorectal
n
n
Esophagus
n
n
Kidney
n
n
Larynx
n
Leukemia
n
n
n
n
n
n
n
n
n
n
Hodgkin lymphoma
n
Liver
n
Lung
n
n
n
n
n
n
n
n
n
n
n
n
Melanoma
n
n
Multiple myeloma
CNS=central nervous system
Non-Hodgkin lymphoma
n
Oral
n
Ovary
n
n
Pancreas
n
n
Prostate
n
n
n
n
n
n
n
Stomach
n
n
n
Testis
Thyroid
Canadian Cancer Society
n
n
Canadian Cancer Statistics 2015
Note: Only cancer types with an
established association with a risk
factor are listed, based on
assessments by World Cancer
Research Fund/American Institute
for Cancer Research and its
Continuous Update Project
(2007–2015) and International
Agency for Cancer Research
(volumes 1 to 111).
104
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.5 Projections for selected measures for lung cancer for status quo (no organized screening) versus 30% participation to LDCT screening and 22.5% smoking cessation success
rate, by province/territory, Canada, 2015 and 2030
New cases
No organized screening
2015
CANADA
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Yukon
Northwest Territories and Nunavut
2030
25,312
3,064
2,285
793
946
8,812
6,954
846
996
102
479
12
22
30,292
3,820
2,927
988
1,128
10,614
7,959
1,005
1,180
130
509
12
20
Deaths from lung cancer
LDCT+smoking cessation
2015
29,386
3,458
2,622
923
1,058
10,197
8,241
998
1,178
117
556
12
25
2030
30,596
3,820
2,954
1,018
1,163
10,721
8,064
1,008
1,188
127
497
15
22
2015
CANADA
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Yukon
Northwest Territories and Nunavut
2030
70,608
8,535
5,822
1,957
2,652
24,851
19,749
2,494
2,938
262
1,263
48
38
92,379
11,407
8,343
2,843
3,618
32,537
24,497
3,383
3,661
328
1,651
51
60
LDCT+smoking cessation
2015
72,759
8,749
5,985
2,020
2,718
25,587
20,431
2,570
3,036
274
1,301
48
40
2015
20,679
2,435
1,834
574
806
7,021
5,898
709
866
100
407
12
17
2030
24,603
3,099
2,368
751
838
8,680
6,604
791
933
102
419
10
7
LDCT+smoking cessation
2015
2030
20,646
2,430
1,839
571
803
7,009
5,896
706
858
97
407
12
17
24,272
3,054
2,345
783
823
8,456
6,529
813
916
107
427
10
7
Total costs of screening, treatment and adjunct
smoking cessation program (in millions)
Prevalence (person-years)
No organized screening
No organized screening
2030
109,092
13,172
9,790
3,368
4,227
38,218
29,429
4,021
4,312
375
2,057
55
68
No organized screening
2015
591.6
70.5
52.2
17.7
21.9
204.5
166.4
19.8
24.2
2.4
11.1
0.3
0.4
2030
828.9
104.5
80.5
26.2
29.7
292.9
217.8
27.7
31.6
3.4
13.6
0.4
0.4
LDCT+smoking cessation
2015
929.9
110.6
83.3
28.9
32.3
325.0
260.1
29.7
36.4
4.1
18.0
0.6
0.9
2030
941.7
116.9
90.3
30.2
33.5
335.8
246.4
31.9
35.7
4.0
15.8
0.6
0.6
LDCT=low-dose computed
tomography
Note: LDCT screening eligible
population is 55–74 year olds, 30
pack-year smokers (current smokers
or former smokers who have quit
within past 15 years); costs are
undiscounted.
Analysis by: Statistics Canada
Data source: Canadian Partnership Against Cancer, Cancer Risk Management Model version 2.2.1.0
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
105
CHAPTER 7
n
Special topic: Predictions of the future burden of cancer in Canada
TABLE 7.6 Projections for selected measures for various screening scenarios for colorectal cancer, by province/territory, Canada, 2015 and 2030
New cases
Deaths from colorectal cancer
2015
CANADA
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Yukon
Northwest Territories and Nunavut
No
organized
screening
30% FIT
24,810
2,927
2,011
773
926
9,286
6,532
584
963
137
594
22
55
24,883
2,974
2,028
791
936
9,222
6,557
609
966
140
589
22
50
2030
80% FIT
No
organized
screening
30% FIT
25,070
2,942
2,003
771
918
9,476
6,544
634
963
142
606
25
45
35,619
4,536
3,283
1,068
1,205
13,378
8,925
928
1,215
220
791
30
40
32,602
4,149
3,044
1,015
1,100
12,261
8,026
861
1,115
205
758
32
35
2015
80% FIT
No
organized
screening
30% FIT
29,611
3,845
2,690
891
971
11,148
7,395
741
998
177
691
30
35
9,563
1,245
771
312
327
3,515
2,455
252
377
57
232
2
17
9,124
1,150
746
294
319
3,391
2,335
222
362
55
232
0
17
2030
80% FIT
No
organized
screening
30% FIT
80% FIT
8,822
1,143
716
304
294
3,266
2,290
185
352
50
205
0
17
14,401
1,856
1,255
434
544
5,502
3,416
389
571
100
317
7
10
12,513
1,627
1,120
382
484
4,718
2,982
344
489
80
272
5
10
10,065
1,297
921
332
364
3,830
2,353
287
389
62
215
5
10
Total costs of screening and treatment (in millions)
2015
CANADA
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Yukon
Northwest Territories and Nunavut
No
organized
screening
30% FIT
1,442.8
177.3
121.0
44.8
52.6
528.7
379.9
34.7
55.5
8.5
36.3
0.8
2.9
1,632.0
203.9
138.7
51.2
59.5
600.5
423.7
39.8
61.3
9.6
39.8
1.0
3.0
2030
80% FIT
No
organized
screening
30% FIT
80% FIT
1,782.2
224.0
152.7
54.7
63.8
664.9
456.5
44.5
65.0
10.4
41.4
1.2
3.1
2,433.0
309.4
219.8
71.6
81.5
918.2
617.5
61.2
81.3
14.8
53.3
2.2
2.1
2,482.2
321.8
228.5
73.1
83.8
945.1
612.0
62.4
81.1
14.6
55.0
2.5
2.2
2,691.0
356.0
251.1
78.9
90.3
1,032.7
654.9
64.4
87.1
14.6
55.6
2.8
2.6
FIT=fecal immunochemical test
Note: Screening eligible population
is 50–74 year olds; costs are
discounted at 3%.
Analysis by: Statistics Canada
Data source: Canadian Partnership Against Cancer, Cancer Risk Management Model version 2.2.1.0
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
106
APPENDIX I: Actual data for new cases and deaths
TABLE A1 Actual data for new cases of cancer, Canada, 2010 (based on September 2012 CCR file and Quebec 2010; see Statistics Canada CANSIM
Table 103-0553 for availability of later data releases)
Cancer
All cancers
Oral (buccal cavity and pharynx)
Lip
Tongue
Salivary gland
Mouth
Nasopharynx
Oropharynx
Other and unspecified
Digestive organs
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anus
Liver
Gallbladder
Pancreas
Other and unspecified
Respiratory system
Larynx
Lung
Other and unspecified
Bone
Soft tissue (including heart)
Skin (melanoma)
Breast
Genital organs
Cervix
Body of uterus
Uterus, part unspecified
Ovary
Prostate
Testis
Other and unspecified
Urinary organs
Bladder
Kidney
Other urinary
Eye
Brain and central nervous system
Endocrine glands
Thyroid
Other endocrine
Hodgkin lymphoma†
Non-Hodgkin lymphoma†
Multiple myeloma†
Leukemia†
Mesothelioma†
All other and unspecified cancers
ICD-O-3 Site/Type*
Total
Males
Females
All invasive sites
C00–C14
C00
C01–C02
C07–C08
C03–C06
C11
C10
C09,C12–C14
C15–C26,C48
C15
C16
C17
C18,C26.0
C19–C20
C21
C22.0
C23
C25
C22.1,C24,C26.8–.9,C48
C30–C34,C38.1–.9,C39
C32
C34
C30–31,C33,C38.1–.9,C39
C40–C41
C38.0,C47,C49
C44 Type 8720–8790
C50
C51–C63
C53
C54
C55
C56
C61
C62
C51–52,C57,C58,C60,C63
C64–C68
C67
C64–C65
C66,C68
C69
C70–C72
C37,C73–C75
C73
C37,C74–C75
Type 9650–9667
See Table A10
Type 9731,9732,9734
See Table A10
Type 9050–9055
See Table A10
172,910
3,945
290
1,040
450
775
250
220
925
35,405
1,795
3,010
740
14,250
7,035
580
1,685
500
3,915
1,900
25,280
1,155
23,780
350
340
1,175
5,495
23,170
33,520
1,415
5,105
175
2,520
22,185
975
1,145
12,750
7,265
4,980
505
355
2,615
5,350
5,040
305
915
7,085
2,355
5,130
515
7,520
88,245
2,685
200
695
260
445
175
175
730
19,640
1,360
1,900
410
7,140
4,335
195
1,265
165
1,940
920
13,840
970
12,660
205
195
665
2,965
215
23,375
—
—
—
—
22,185
980
215
8,920
5,485
3,110
325
185
1,470
1,275
1,125
155
495
3,825
1,295
2,960
415
3,820
84,665
1,260
85
345
195
330
75
45
190
15,765
435
1,105
330
7,110
2,700
385
415
335
1,975
975
11,440
180
11,110
150
150
510
2,535
22,955
10,145
1,415
5,105
175
2,520
—
—
930
3,830
1,780
1,870
180
170
1,145
4,065
3,915
150
420
3,260
1,060
2,175
95
3,700
— Not applicable
* Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin D, et al.
Editors. International Classification of Diseases for Oncology, Third Edition.
Geneva: World Health Organization; 2000.
†
For incidence, ICD-O-3 histology types 9590–9992 (leukemia, lymphoma
and multiple myeloma), 9050–9055 (mesothelioma) and 9140 (Kaposi
sarcoma) are excluded from other specific organ sites.
Note: Numbers are for invasive cancers and in situ bladder cancers (except
for Ontario) but exclude non-melanoma skin cancer (neoplasms, NOS;
epithelial neoplasms, NOS; and basal and squamous).
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
107
APPENDIX I: Actual data for new cases and deaths
TABLE A2 Actual data for cancer deaths, Canada, 2010 (see Statistics Canada CANSIM Table 102-0522 for availability of later data releases)
All cancers
Oral (buccal cavity and pharynx)
Lip
Tongue
Salivary gland
Mouth
Nasopharynx
Oropharynx
Other and unspecified
Digestive organs
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anus
Liver
Gallbladder
Pancreas
Other and unspecified
Respiratory system
Larynx
Lung
Other and unspecified
Bone
Soft tissue (including heart)
Skin (melanoma)
Breast
Genital organs
Cervix
Body of uterus
Uterus, part unspecified
Ovary
Prostate
Testis
Other and unspecified
Urinary organs
Bladder
Kidney
Other urinary
Eye
Brain and central nervous system
Endocrine glands
Thyroid
Other endocrine
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
Mesothelioma
All other and unspecified cancers
ICD-10*
Total
Males
Females
C00–C97
C00–C14
C00
C01–C02
C07–C08
C03–C06
C11
C10
C09,C12–C14
C15–C25,C26.0,C26.8–.9,C48
C15
C16
C17
C18,C26.0
C19–C20
C21
C22.0,C22.2–.7
C23
C25
C22.1,C22.9,C24,C26.8–.9,C48
C30–C34,C38.1–.9,C39
C32
C34
C30–31,C33,C38.1–.9,C39
C40–C41
C38.0,C47,C49
C43
C50
C51–C63
C53
C54
C55
C56
C61
C62
C51–52,C57,C58,C60,C63
C64–C68
C67
C64–C65
C66,C68
C69
C70–C72
C37,C73–C75
C73
C37,C74–C75
C81
C82–C85,C96.3
C90.0, C90.2
C91–C95, C90.1
C45
See Table A10
71,885
1,150
10
295
125
190
100
120
310
19,390
1,795
1,885
205
6,605
1,940
95
900
265
3,870
1,825
19,860
410
19,310
140
185
475
980
5,025
7,085
370
510
410
1,640
3,835
45
285
3,725
1,955
1,585
190
40
1,905
305
185
120
135
2,505
1,220
2,375
455
5,060
37,540
750
5
195
60
105
65
80
230
10,785
1,365
1,140
100
3,370
1,170
30
695
75
1,925
910
10,945
340
10,525
80
120
235
650
50
3,925
—
—
—
—
3,835
40
50
2,505
1,380
1,005
125
20
1,075
135
65
70
85
1,365
660
1,360
375
2,505
34,340
400
—
105
55
90
40
35
80
8,610
430
745
105
3,235
770
65
210
190
1,950
915
8,915
70
8,780
60
60
240
330
4,975
3,165
375
510
405
1,635
—
—
235
1,225
575
585
65
20
825
175
120
50
50
1,140
565
1,015
85
2,555
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
— Not applicable
*World Health Organization. International Statistical Classification of
Diseases and Related Health Problems, Tenth Revision. Volumes 1 to 3.
Geneva, Switzerland: World Health Organization; 1992.
108
APPENDIX I: Actual data for new cases and deaths
TABLE A3 Actual data for new cases for the most common cancers by sex and geographic region, Canada, 2010* (based on September 2012 Canadian Cancer Registry file and Quebec
2010; see Statistics Canada CANSIM Table 103-0553 for availability of later data releases)
New cases
Canada
†
Males
All cancers
Prostate
Lung
Colorectal
Bladder
Non-Hodgkin lymphoma
Kidney
Melanoma
Leukemia
Oral
Pancreas
Stomach
Brain/CNS
Esophagus
Multiple myeloma
Liver
Thyroid
Testis
Females
All cancers
Breast
Lung
Colorectal
Body of uterus
Thyroid
Non-Hodgkin lymphoma
Melanoma
Ovary
Leukemia
Pancreas
Kidney
Bladder
Cervix
Oral
Brain/CNS
Stomach
Multiple myeloma
Esophagus
Liver
BC
AB
SK
MB
ON
‡
QC§
NB
NS
PE
NL§
YT
NT
NU
88,200
22,200
12,700
11,500
5,500
3,800
3,100
3,000
3,000
2,700
1,950
1,900
1,500
1,350
1,300
1,250
1,150
980
11,000
2,900
1,350
1,400
770
550
280
430
350
370
250
220
190
180
190
200
100
130
7,700
2,100
910
1,000
500
330
260
270
300
260
180
160
120
120
120
120
100
120
2,500
610
350
360
190
130
95
60
110
75
55
60
40
45
40
20
20
30
3,000
740
400
450
200
140
150
90
120
110
85
70
45
45
40
25
30
35
33,700
9,300
4,400
4,000
1,550
1,500
1,150
1,400
1,200
1,050
690
710
570
560
520
520
500
380
22,800
4,500
4,200
3,100
1,750
880
860
470
680
670
570
500
400
310
320
330
300
220
2,400
670
370
300
180
95
120
65
90
45
40
50
25
40
30
15
35
25
2,900
720
440
450
210
140
120
130
55
75
60
55
60
55
35
30
30
30
420
130
80
55
15
15
20
25
10
5
5
15
—
5
5
—
5
5
1,650
480
230
280
100
60
75
40
35
35
20
65
30
15
20
10
15
10
50
15
5
5
5
—
—
—
—
—
—
—
—
—
—
—
—
—
60
15
10
10
—
5
—
—
—
5
5
—
—
—
—
—
—
—
25
—
10
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
84,700
23,000
11,100
9,800
5,300
3,900
3,300
2,500
2,500
2,200
1,950
1,850
1,800
1,400
1,250
1,150
1,100
1,050
440
420
10,200
3,000
1,300
1,150
680
240
430
390
290
250
220
140
210
180
150
120
130
140
60
60
7,000
2,100
880
770
440
320
290
230
170
190
160
160
150
150
100
80
85
80
30
35
2,400
660
350
340
160
60
110
70
65
75
60
65
70
45
30
25
25
35
5
10
3,000
790
430
400
220
90
140
75
90
75
80
75
60
40
60
35
40
40
10
5
33,000
9,000
3,900
3,600
2,100
2,000
1,300
1,150
1,050
960
760
700
510
580
490
490
460
430
200
160
22,500
5,700
3,400
2,700
1,300
950
740
400
670
520
550
550
600
320
340
330
310
260
100
130
1,950
530
270
260
130
95
75
50
55
55
55
55
55
25
25
15
20
20
10
5
2,800
720
420
380
160
90
95
120
70
45
60
85
75
35
45
30
25
30
20
15
380
130
50
40
15
10
15
10
15
5
10
10
5
5
5
—
—
5
—
—
1,300
340
150
210
110
45
60
25
35
10
25
40
35
40
15
20
20
20
5
—
55
15
10
5
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
55
20
5
10
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
25
5
10
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
CNS=central nervous system
— Fewer than 3 cases per year.
* 2006–2010 average for Yukon,
Northwest Territories and Nunavut.
The numbers of cases from death
certificate only for Ontario in
2008–2010, Quebec in 2010, and
Newfoundland and Labrador in
2008–2010 are estimated.
†
Row totals may not equal the
total for Canada due to rounding
and difference in the most recent
year of data presented. Canada
totals include provincial and
territorial estimates.
Ontario did not report on in situ
bladder cases at the time the data
were obtained. If Ontario in situ
cases were included, it is estimated
that the total number of Ontario
bladder cancers would be 2,400
among men and 830 among
women.
‡
§
The number of cases for some
cancers used to calculate the
overall 2015 estimates for this
province was underestimated.
Note: “All cancers” excludes the
estimated new cases of nonmelanoma skin cancer (neoplasms,
NOS; epithelial neoplasms, NOS;
and basal and squamous). The
complete definition of the specific
cancers listed here can be found in
Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
109
APPENDIX I: Actual data for new cases and deaths
TABLE A4 Actual age-standardized incidence rates (ASIR) for the most common cancers by sex and geographic region, Canada, 2010*
(based on September 2012 Canadian Cancer Registry file and Quebec 2010; see Statistics Canada CANSIM Table 103-0553 for availability of later data releases)
Cases per 100,000
Canada
†
Males
All cancers
Prostate
Lung
Colorectal
Bladder
Non-Hodgkin lymphoma
Leukemia
Kidney
Melanoma
Oral
Pancreas
Stomach
Brain/CNS
Esophagus
Multiple myeloma
Testis
Liver
Thyroid
Females
All cancers
Breast
Lung
Colorectal
Body of uterus
Thyroid
Non-Hodgkin lymphoma
Melanoma
Ovary
Leukemia
Kidney
Pancreas
Cervix
Bladder
Brain/CNS
Oral
Stomach
Multiple myeloma
Esophagus
Liver
BC
AB
SK
MB
ON
‡
QC§
NB
NS
PE
NL§
YT
NT
NU
440
108
63
57
28
19
15
15
15
13
10
9
8
7
6
6
6
6
390
103
48
50
27
20
13
10
15
12
8
8
7
6
6
6
7
4
420
113
52
56
28
18
17
13
14
12
10
9
6
6
6
7
6
5
406
98
57
58
30
22
17
16
9
12
8
10
7
7
6
6
4
4
439
105
57
64
27
19
17
20
12
15
12
9
6
6
6
7
4
5
444
121
58
52
21
20
17
15
18
13
9
9
8
7
7
6
7
7
468
89
85
64
36
18
15
17
10
13
12
10
9
6
6
6
7
6
477
130
74
59
36
20
19
24
13
10
7
10
6
7
6
8
3
7
476
114
70
72
34
22
9
18
22
11
9
9
10
9
6
8
5
5
459
132
83
57
17
17
9
21
29
9
9
13
—
5
3
10
—
7
485
133
64
82
30
19
12
20
13
10
6
20
10
4
5
4
4
6
324
90
46
46
24
—
—
—
—
—
—
—
—
—
—
—
—
—
418
101
69
83
—
17
—
—
—
24
12
—
—
—
—
—
—
—
381
25
170
60
—
—
—
—
—
—
—
—
—
—
—
—
—
—
369
101
47
40
23
21
14
12
11
10
8
8
8
7
5
5
4
4
2
2
330
100
40
34
22
9
14
14
9
8
5
7
7
6
4
5
4
4
2
2
342
100
44
37
21
16
14
11
8
9
8
7
8
7
4
5
4
4
1
2
348
95
48
44
22
11
15
11
10
10
9
8
8
9
3
4
4
5
1
1
373
101
51
45
28
14
16
10
12
9
9
9
6
7
5
7
4
4
1
1
377
103
43
38
24
28
15
14
12
11
8
8
8
5
6
6
5
5
2
2
389
101
57
43
22
21
13
8
12
9
9
9
7
10
6
6
5
4
2
2
351
96
45
42
22
20
13
10
10
12
9
9
7
10
3
5
3
4
2
1
388
104
57
50
22
15
13
19
9
6
11
8
6
10
4
6
3
4
2
2
365
115
45
38
15
12
15
13
13
8
8
9
9
6
—
7
—
4
—
—
356
89
38
54
28
16
16
7
9
3
11
6
14
8
6
3
5
6
1
—
333
91
65
45
22
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
384
96
60
89
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
369
51
149
74
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
CNS=central nervous system
— Rate cannot be calculated
because there were fewer than
3 cases per year.
* 2006–2010 average for Yukon,
Northwest Territories and Nunavut.
The numbers of cases from death
certificate only for Ontario in
2008–2010, Quebec in 2010 and
Newfoundland and Labrador in
2008–2010 are estimated.
†
Canada totals include provincial
and territorial estimates.
‡
Ontario did not report on situ
bladder cancers at the time the
data were obtained; this should be
considered when making
comparisons across provinces.
§
The number of cases for some
cancers used to calculate the
overall 2015 estimates for this
province was underestimated.
Note: Rates for “All cancers”
exclude non-melanoma skin cancer
(basal and squamous). Rates are
age-standardized to the 1991
Canadian population. The complete
definition of the specific cancers
listed here can be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
110
APPENDIX I: Actual data for new cases and deaths
TABLE A5 Actual data for cancer deaths for the most common cancers by sex and geographic region, Canada, 2010*
(see Statistics Canada CANSIM Table 102-0552 and CANSIM Table 102-0522 and for availability of later data releases)
Deaths
Canada
Males
All cancers
Lung
Colorectal
Prostate
Pancreas
Bladder
Esophagus
Non-Hodgkin lymphoma
Leukemia
Stomach
Brain/CNS
Kidney
Oral
Liver
Multiple myeloma
Melanoma
Females
All cancers
Lung
Breast
Colorectal
Pancreas
Ovary
Non-Hodgkin lymphoma
Leukemia
Body of uterus
Brain/CNS
Stomach
Kidney
Bladder
Multiple myeloma
Esophagus
Oral
Cervix
Melanoma
Liver
BC
AB
SK
MB
37,500
10,500
4,500
3,800
1,900
1,400
1,350
1,350
1,350
1,150
1,100
1,000
750
690
660
650
4,800
1,200
560
540
280
200
200
200
190
120
140
120
90
110
85
85
3,000
770
360
370
160
110
130
110
100
85
110
75
55
50
50
60
1,200
290
150
180
50
55
45
40
50
35
25
35
10
15
20
20
34,300
8,800
5,000
4,000
1,950
1,650
1,150
1,000
920
830
740
580
580
560
430
400
370
330
210
4,400
1,150
590
520
250
260
160
150
120
120
70
65
75
80
60
45
50
40
25
2,600
660
390
320
160
130
80
80
55
60
60
40
40
30
35
30
30
25
15
1,100
280
180
130
70
40
35
45
25
20
20
15
20
15
15
15
15
5
0
†
ON
QC
NB
NS
PE
NL
YT
NT
NU
1,350
340
190
180
65
45
55
40
40
40
35
45
15
15
25
20
13,900
3,700
1,650
1,450
680
530
530
510
550
420
410
370
320
300
260
280
10,200
3,300
1,200
810
530
330
280
370
330
330
280
250
200
170
160
140
930
290
120
80
45
35
35
30
30
25
25
30
15
—
15
15
1,300
350
160
130
55
45
65
40
40
40
40
45
25
25
25
30
160
60
10
15
10
—
5
5
—
5
5
5
5
—
5
—
710
200
130
55
40
25
15
20
25
40
10
25
10
5
5
5
35
5
5
5
—
—
—
—
—
—
—
—
—
—
—
—
25
5
5
—
—
—
—
—
—
—
—
—
—
—
—
—
20
10
5
—
—
—
—
—
—
—
—
—
—
—
—
—
1,350
340
190
150
75
70
45
35
35
25
20
25
20
25
15
20
15
10
5
12,800
3,100
1,900
1,400
720
630
460
400
360
310
300
230
210
210
180
150
170
160
100
9,200
2,500
1,300
1,100
510
380
270
240
250
220
210
150
170
150
85
120
70
80
50
870
240
120
95
60
25
30
25
20
15
25
20
15
20
10
15
10
10
5
1,200
330
190
150
60
55
40
20
35
30
30
20
15
20
15
10
10
5
5
150
45
20
25
5
10
—
5
—
5
—
—
—
—
—
—
—
5
—
600
130
110
85
30
30
15
5
20
15
20
15
10
10
10
—
10
—
—
30
10
5
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
20
5
5
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
15
5
—
5
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
CNS=central nervous system
— Fewer than 3 deaths per year.
* 2006–2010 average for Yukon,
Northwest Territories and Nunavut.
Row totals may not equal the total
for Canada due to rounding. Canada
totals include provincial and
territorial estimates.
†
Note: The complete definition of
the specific cancers listed here can
be found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
111
APPENDIX I: Actual data for new cases and deaths
TABLE A6 Actual age-standardized mortality rates (ASMR) for the most common cancers by sex and geographic region, Canada, 2010*
(see Statistics Canada CANSIM Table 102-0552 and CANSIM Table 102-0522 for availability of later data releases)
Deaths per 100,000
Canada
†
Males
All cancers
Lung
Colorectal
Prostate
Pancreas
Bladder
Esophagus
Non-Hodgkin lymphoma
Leukemia
Stomach
Brain/CNS
Kidney
Oral
Liver
Multiple myeloma
Melanoma
Females
All cancers
Lung
Breast
Colorectal
Pancreas
Ovary
Non-Hodgkin lymphoma
Leukemia
Body of uterus
Brain/CNS
Stomach
Kidney
Bladder
Multiple myeloma
Esophagus
Oral
Cervix
Melanoma
Liver
BC
AB
SK
MB
ON
QC
NB
NS
PE
NL
YT
NT
NU
189
53
167
42
171
44
185
46
194
49
183
48
211
68
190
60
213
58
181
67
217
61
258
57
223
55
366
182
23
20
10
7
7
7
7
6
5
5
4
3
3
3
20
19
10
7
7
7
7
4
5
4
3
4
3
3
20
23
9
7
7
6
6
5
5
4
3
3
3
3
23
26
8
8
7
7
7
5
4
5
2
2
3
3
27
25
9
6
8
6
6
5
5
7
2
2
4
3
22
20
9
7
7
7
7
6
5
5
4
4
3
4
25
18
11
7
6
8
7
7
6
5
4
3
3
3
25
17
9
8
7
6
7
5
5
6
3
—
3
3
27
23
9
8
10
7
7
6
7
7
4
4
4
5
13
19
12
—
8
4
—
6
8
6
3
—
7
—
40
18
12
8
4
6
8
12
4
7
3
2
2
2
30
31
—
—
—
—
—
—
—
—
—
—
—
—
39
—
—
—
—
—
—
—
—
—
—
—
—
—
66
—
—
—
—
—
—
—
—
—
—
—
—
—
136
36
20
15
8
7
4
4
4
4
3
2
2
2
2
2
2
1
1
129
34
18
15
7
8
5
4
4
4
2
2
2
2
2
1
2
1
1
125
33
18
14
7
7
4
4
3
3
2
2
2
1
2
1
1
1
1
142
36
23
16
9
6
4
5
3
3
2
2
2
2
2
2
3
1
0
146
39
21
15
8
8
4
4
4
3
2
3
2
3
2
2
2
1
1
132
33
20
13
7
7
5
4
4
4
3
2
2
2
2
1
2
2
1
145
42
21
16
8
6
4
4
4
4
3
2
2
2
1
2
1
1
1
140
40
19
14
9
4
5
5
3
3
4
2
2
3
2
2
2
1
1
155
44
24
18
7
7
5
3
4
5
4
3
2
3
2
1
2
1
1
134
40
16
19
6
8
—
6
—
5
—
—
—
—
—
—
—
5
—
151
33
27
21
7
7
4
1
6
5
4
4
2
2
3
—
2
—
—
219
64
23
26
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
185
46
20
41
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
277
132
—
48
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
CNS=central nervous system
— Rate cannot be presented
because there were fewer than
3 deaths per year.
* 2006–2010 average for Yukon,
Northwest Territories, Nunavut.
Canada totals include provincial
and territorial estimates.
†
Note: Rates are age-standardized
to the 1991 Canadian population.
The complete definition of the
specific cancers listed here can be
found in Table A10.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
112
APPENDIX I: Actual data for new cases and deaths
TABLE A7 New cases and average annual age-standardized incidence rates (ASIR) by diagnostic group,
in children (0–14 years), Canada, 2006–2010
Diagnostic group
Total (5 years)
Average per year
I. Leukemia
a. Lymphoid
b. Acute myeloid
III. Central nervous system
a. Ependymoma
b. Astrocytoma
c. Intracranial & intraspinal embryonal
II. Lymphoma
a. Hodgkin lymphoma
b. Non-Hodgkin lymphoma
c. Burkitt lymphoma
IV. Neuroblastoma & other PNC
a. Neuroblastoma
IX. Soft tissue
a. Rhabdomyosarcoma
VI. Renal tumours
a. Nephroblastoma
XI. Other malignant epithelial
b. Thyroid
d. Malignant melanoma
VIII. Malignant bone
a. Osteosarcoma
c. Ewing sarcoma
X. Germ cell and other gonadal
c. Gonadal germ cell tumours
V. Retinoblastoma
XII. Other and unspecified cancers
VII. Hepatic tumours
New cases*
(both sexes)
4,550
910
1,465
1,145
200
860
100
370
190
500
185
160
45
355
355
295
145
235
225
210
90
50
200
100
80
140
55
120
90
70
ASIR
(per 1,000,000)
per year
163.2
53.4
41.8
7.1
30.9
3.6
13.2
6.8
17.5
6.3
5.6
1.6
13.2
13.0
10.5
5.1
8.8
8.4
7.0
3.1
1.7
6.8
3.4
2.7
4.9
1.9
4.4
3.2
2.7
PNC=peripheral nervous cell tumours
* Steliarova-Foucher E, Stiller C, Lacour B, Kaatsch P. International Classification of Childhood Cancer, Third Edition.
Diagnostic groups are listed in descending order of disease incidence. Only selected subgroups within each
diagnostic group are listed.
Note: Rates are age-standardized to the 1991 Canadian population and are expressed per million per year due to
disease rarity.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
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Canadian Cancer Statistics 2015
113
APPENDIX I: Actual data for new cases and deaths
TABLE A8 New cases and average annual age-standardized cancer incidence rates (ASIR) by sex and diagnostic group in adolescents and young
adults (15–29 years), Canada, 2006–2010
Males
Diagnostic group
Total (5 years)
Average per year
Leukemias
Acute lymphoid leukemia
Acute myeloid leukemia
Chronic myeloid leukemia
Other and unspecified leukemia
Lymphomas
Non-Hodgkin lymphoma
Hodgkin lymphoma
CNS and other intracranial and intraspinal neoplasms
Specified low-grade astrocytic tumours
Glioblastoma and anaplastic astrocytoma
Other glioma
Osseous and chondromatous neoplasms
Osteosarcoma
Ewing tumour
Soft tissue sarcomas
Specified (excluding Kaposi sarcoma)
Germ cell and trophoblastic neoplasms
Germ cell and trophoblastic neoplasms of gonads
Other nongonadal
Melanoma and skin carcinomas
Melanoma
Carcinomas
Thyroid carcinoma
Other sites in lip, oral cavity and pharynx
Carcinoma of breast
Carcinoma of kidney
Carcinoma of gonads
Carcinoma of cervix and uterus
Carcinoma of colon and rectum
Miscellaneous specified neoplasms, NOS
Other specified neoplasms, NOS
Unspecified malignant neoplasms
New cases*
5,765
1,153
460
175
160
60
65
1,195
445
745
470
85
85
130
240
90
85
270
130
1,700
1,600
65
305
300
905
340
65
0
65
10
—
185
110
40
115
Females
ASIR
per 1,000,000
per year
344.9
26.5
9.5
9.7
3.6
3.8
69.8
26.3
43.5
27.9
4.8
5.2
7.7
13.3
5.1
4.6
16.2
7.8
103.7
97.7
3.8
18.9
18.8
55.6
21.0
4.2
—
4.3
0.6
—
11.4
6.3
2.4
6.7
New cases*
6,540
1,308
305
90
130
45
40
1,005
285
720
425
80
65
100
165
60
55
245
125
150
130
20
665
665
3,155
1,590
105
475
55
110
420
180
165
110
260
ASIR
per 1,000,000
per year
409.0
18.3
5.2
8.1
2.7
2.4
60.8
17.6
43.2
25.4
4.6
4.1
6.1
9.6
3.2
3.2
14.7
7.6
9.1
7.7
1.2
42.3
42.1
202.3
100.4
6.4
31.5
3.3
6.9
27.9
11.5
10.3
6.6
16.2
CNS=central nervous system
— Not applicable.
* AYA Site Recode ICD-O-3/WHO 2008 Definition. Surveillance,
Epidemiology, and End Results Program (SEER).
Note: Rates are age-standardized to the 1991 Canadian population and
are expressed per million per year due to disease rarity. Cases were
classified according to the SEER adapted classification scheme for tumours
of adolescents and young adults (AYA). Only selected subgroups within
each diagnostic group are listed.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data sources: Canadian Cancer Registry database at Statistics Canada and Quebec Cancer Registry (2008–2010)
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
114
APPENDIX I: Actual data for new cases and deaths
TABLE A9 Deaths and average annual age-standardized cancer mortality rates (ASMR) by sex and diagnostic group in adolescents and young adults
(15–29 years), Canada, 2006–2010
Males
Diagnostic group
Total (5 years)
Average per year
Oral (buccal cavity and pharynx)
Lip
Tongue
Salivary gland
Mouth
Nasopharynx
Oropharynx
Other and unspecified
Digestive organs
Esophagus
Stomach
Small intestine
Large intestine
Rectum
Anus
Liver
Gallbladder
Pancreas
Other and unspecified
Respiratory system
Larynx
Lung
Other and unspecified
Bone
Soft tissue (including heart)
Melanoma
Breast
Genital organs
Cervix
Body of uterus
Uterus, part unspecified
Ovary
Prostate
Testis
Other and unspecified
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
Deaths
855
170
15
0
0
0
5
10
0
0
85
10
10
0
30
15
0
5
0
5
10
20
0
15
5
95
95
30
0
55
—
—
—
—
0
55
0
Females
ASMR
per 1,000,000
per year
50.7
0.8
0.0
0.1
0.0
0.1
0.5
0.1
0.0
5.3
0.5
0.6
0.1
1.9
0.9
0.1
0.3
0.0
0.3
0.5
1.2
0.0
0.9
0.3
5.5
5.6
1.7
0.0
3.3
—
—
—
—
0.0
3.3
0.1
Deaths
605
120
5
0
0
0
0
5
0
0
75
0
20
0
25
15
0
10
0
5
5
15
0
15
5
60
50
30
35
60
25
0
0
30
—
—
0
ASMR
per 1,000,000
per year
37.5
0.4
0.0
0.2
0.0
0.1
0.2
0.0
0.0
5.1
0.2
1.3
0.1
1.6
0.8
0.0
0.5
0.0
0.3
0.4
0.9
0.0
0.9
0.1
3.8
2.7
1.9
2.2
3.7
1.7
0.0
0.2
1.8
—
—
0.1
continued…
115
APPENDIX I: Actual data for new cases and deaths
TABLE A9 Deaths and average annual age-standardized cancer mortality rates (ASMR) by sex and diagnostic group in adolescents and young adults
(15–29 years), Canada, 2006–2010 (continued)
Males
Diagnostic group
Urinary organs
Bladder
Kidney
Other urinary
Eye
Brain and central nervous system
Endocrine glands
Thyroid
Other endocrine
Hodgkin lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukemia
Mesothelioma
All other and unspecified cancers
Deaths
10
0
10
0
0
140
20
5
20
40
60
0
140
5
45
Females
ASMR
per 1,000,000
per year
0.6
0.2
0.4
0.0
0.0
8.3
1.0
0.1
1.0
2.4
3.7
0.0
8.4
0.1
2.8
Deaths
10
0
10
0
0
80
15
0
15
25
30
0
85
0
25
ASMR
per 1,000,000
per year
0.7
0.1
0.6
0.0
0.1
5.0
0.9
0.1
0.9
1.4
1.7
0.0
5.2
0.1
1.6
— Not applicable.
Note: Rates are age-standardized to the 1991 Canadian population and
are expressed per million per year due to disease rarity. For ICD-10 codes,
see Table A2.
Analysis by: Surveillance and Epidemiology Division, CCDP, Public Health Agency of Canada
Data source: Canadian Vital Statistics Death database at Statistics Canada
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
116
Appendix II: Data sources and methods
Data sources
Incidence data: The Canadian Cancer Registry
(CCR)
Actual cancer incidence data used in this publication
cover the period of 1986 to 2010. Data for 1992 to 2010
were obtained from the CCR(1) (September 2012 CCR
Tabulation Master File), except for Quebec 2008 to
2010 data, which were received in a summary format
from the Quebec Cancer Registry. Data for earlier years
(before 1992) were retrieved from the predecessor to
the CCR, the National Cancer Incidence Reporting
System (NCIRS). The NCIRS is a fixed, tumouroriented database containing cases diagnosed as far
back as 1969.
• Incidence data originate with the provincial and
territorial cancer registries, which provide data
annually to Statistics Canada for inclusion in the
CCR.
• The CCR is a person-oriented database that includes
clinical and demographic information about
residents of Canada newly diagnosed with cancer.
• The Health Statistics Division at Statistics Canada
maintains the CCR. It links data internally to
identify duplicate person and tumour records. The
Health Statistics Division also links cancer data with
mortality data (described below) to ensure the
completeness and correctness of vital status
information. Both linking procedures optimize the
accuracy of incidence, prevalence and survival
statistics.
Canadian Cancer Society
n
• Cancer diagnoses are classified according to the
International Classification of Diseases for Oncology,
Third Edition (ICD-O-3).(2)
• International Agency for Research on Cancer (IARC)
rules(3) for multiple primaries were used for cases
from the CCR, whereas during the period covered by
the NCIRS, registries other than Quebec and
Ontario used multiple primary rules that allowed a
small percentage of additional cases.
Mortality data: The Canadian Vital Statistics
— Death database (CVS: D)
The actual cancer mortality data cover the period of
1986 to 2010 and were obtained from the CVS: D.(4,5)
• Death records originate with the provincial and
territorial registrars of vital statistics and are
provided regularly to Statistics Canada for inclusion
in the CVS: D.
• The CVS: D includes demographic and cause of
death information for all Canadian residents and
non-residents who died in Canada between 1950 and
2010. Information on non-residents is not used for
this publication.
• Data are also included for Canadian residents who
died in a small number of states within the United
States from which abstracted death data were
received. Starting with the 2010 data year, this
information is no longer available.
• The Health Statistics Division at Statistics Canada
maintains the CVS: D.
• Cause of death is classified according to the
International Statistical Classification of Diseases and
Related Health Problems, Tenth Revision (ICD-10).(6)
• Cancer deaths are those for which some form of
cancer, as certified by a physician, is the underlying
cause of death.
Population data: The Census of Canada
• Population estimates for Canada and the provinces
and territories are based on censuses conducted
every five years from 1986 to 2011.
• Intercensal estimates prepared by Statistics Canada
are used for the years between these censuses, and
postcensal estimates are used for 2012 to 2013.(7)
• Projected population estimates are used for 2014 and
2015, as prepared by Statistics Canada under
assumptions of medium growth (scenario M1).(8) The
scenario M1 incorporates medium-growth and
historical trends (1981 to 2008) of interprovincial
migration.
• All population estimates include non-permanent
residents and are adjusted for net census
undercoverage and Canadians returning from
abroad.
117
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
APPENDIX II: Data sources and methods
Life tables
• Life tables are required to estimate relative survival.
Sex-specific provincial life tables are produced by
Statistics Canada.
• Expected survival data for the years 2006, 2007 and
2008 were respectively derived from 2005 to 2007,(9)
2006 to 2008(10) and 2007 to 2009(11) complete life
tables. The methodology used to produce these life
tables(12) was retroactively used to produce annual
life tables from 1991 to 1993 to 2004 to 2006.(13)
• As complete life tables were not available for Prince
Edward Island or the territories, expected survival
proportions for these areas were derived, up to the
age of 99 years, from abridged life tables for
Canada(13) and the affected jurisdictions(9-11,13) and
complete Canadian life tables(9-11,13) using a method
suggested by Dickman et al.(14) Where this was not
possible (i.e., ages 100–109 years), complete
Canadian life table values were used.
Cancer definitions
• Cancers are generally defined according to the
groupings of ICD-O-3(2) for incidence and ICD-10(6)
for mortality (Table A10).
• Some definitions have changed slightly over time.
Changes occurring since the 2004 edition of this
publication are outlined in Tables A11-1 and A11-2.
• For children aged 0–14 years, cancers were classified
and reported according to the International
Classification of Childhood Cancer, Third Edition
(ICCC-3).(15) This system is most appropriate for
reporting childhood cancers because it acknowledges
the major differences between cancers that develop
during childhood and those that occur later in life.
The category “intracranial and intraspinal” excludes
non-malignant tumours.
Canadian Cancer Society
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Canadian Cancer Statistics 2015
• For cancer incidence of adolescents and young adults
aged 15–29, cancers were classified and reported
according to the Surveillance, Epidemiology, and
End Results Program (SEER) adapted classification
scheme for tumours of adolescents and young adults
(AYA).(16)
• Bladder cancer includes bladder in situ carcinomas,
which are considered invasive for the purpose of
incidence reporting and are included for provinces
and territories. Such cases were not collected until
recently in Ontario and were not available for the
years of data reported in this publication.
Methods
Incidence and mortality rates
Records from each province or territory were extracted
from the relevant incidence or mortality files and then
classified by year of diagnosis or death and by sex,
five-year age group (0–4, 5–9,…, 80–84 and 85+ years)
and cancer type.
• Rates for each category were calculated by dividing
the number of cases or deaths in each category (i.e.,
province or territory, year, sex, age group, cancer
type) by the corresponding population figure. These
formed the basis for calculations of age-standardized
rates and for estimates beyond the most recent year
of actual data.
• For the sections Incidence and mortality by sex, age
and geography, age-specific rates were computed for
broader age groups (0–19, 20–29,…, 70–79 and 80+
years) in the same way.
• Age-standardized incidence rates (ASIR) and
mortality rates (ASMR) were calculated using the
direct method, which involves weighting the
age-specific rates for each five-year age group
according to the age distribution of the 1991
Canadian population:
1991 Canadian standard population
Age group
Population (per 100,000)
0–4
6,946.4
5–9
6,945.4
10–14
6,803.4
15–19
6,849.5
20–24
7,501.6
25–29
8,994.4
30–34
9,240.0
35–39
8,338.8
40–44
7,606.3
45–49
5,953.6
50–54
4,764.9
55–59
4,404.1
60–64
4,232.6
65–69
3,857.0
70–74
2,965.9
75–79
2,212.7
80–84
1,359.5
85+
1,023.7
Total
100,000
Note: The Canadian population distribution is based on the final
postcensal estimates of the July 1, 1991, Canadian population, adjusted for
census undercoverage. The age distribution of the population has been
weighted and normalized.
Data source: Census and Demographics Branch, Statistics Canada
Figure C (Introduction) shows the number of deaths
avoided since the mortality rate for all cancers
combined peaked in 1988.
• The year 1988 was chosen as the baseline year when
the overall cancer mortality rate was at its highest for
Canadian men and women.
• The age-specific cancer mortality rates from 1988 for
males and females in each five-year age group were
applied to the age-specific populations for each of
the subsequent calendar years up to 2010 to obtain
the expected number of deaths for each of those
years if the 1988 death rates had prevailed.
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APPENDIX II: Data sources and methods
• To obtain the excess deaths that would have
occurred, the expected deaths for each year were
summed and then the observed number of deaths
for each year was subtracted from this total.
• Similar charts are included for lung cancer and
breast cancer in women.
Figure D (Introduction) shows the relative
contributions to the changes in the total number of
new cases and deaths that can be attributed to changes
in cancer risk and cancer control practices, population
size and aging of the population.
• The lowest solid line represents the total number of
new cancer cases (or deaths) that would have
occurred each year if the population size and age
structure had remained the same as they were in
1986. This line reflects the impact of changes in
cancer risk and cancer control practices.
• The middle line represents the number of new cases
(or deaths) that would have occurred if the age
structure of the population had remained the same
as it was in 1986. This line reflects the impact of
changes in cancer risk and cancer control practices,
together with population growth.
• The top line represents the number of new cases (or
deaths) that actually occurred and thus reflects the
combined impact of changes in risk and cancer
control practices population growth and aging of the
population.
The series shown in Figure D were calculated as
follows:
• Uppermost series: the annual number of Canadian
cancer cases or deaths, for males or females
• Next-to-uppermost series: annual total population
multiplied by the annual age-standardized rate, using
the 1986 population distribution for males or
females as the standard weights
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• Next-to-baseline series: the 1986 total population
multiplied by the annual age-standardized rate, using
the 1986 population distribution for males or
females as the standard weights
• Baseline (dotted line): the observed number of
Canadian cancer cases or deaths during 1986, for
males or females
Estimation of incidence (new cases) and
mortality (deaths) for 2015
Two methods were used to estimate incidence and
mortality data: the Nordpred Power5 regression model
and five-year averaging.
Nordpred Power5 modelling
The Nordpred Power5 regression model was the
primary method for estimating the number of new
cases and deaths in 2015 for each cancer type by sex
(except new cases of prostate cancer and nonmelanoma
skin cancer; see Prostate cancer incidence and Nonmelanoma skin cancer incidence below) reported in
Tables 1.2 and 3.2. Nordpred is based on an ageperiod-cohort Poisson regression model but has
enhancements that overcome difficulties in the
standard Poisson model and improve projection
accuracy.(17) Nordpred was developed into a software
package(18) and is now one of the most frequently used
methods for cancer projections worldwide.(19-23) The
Nordpred Power5 regression model was used when the
average annual number of cases for a type of cancer for
the most recent five years was greater than 50. The
assumption underlying the Nordpred Power5
regression model is that the annual number of new
cases and deaths are independent Poisson random
variables with mean values equal to the product of the
population size for a particular year and the (true)
annual rate.
• A separate Nordpred Power5 regression model was
fit for each province, sex and type of cancer for the
period of 1986 to 2010 for both incidence and
mortality.
• The Nordpred Power5 regression model is Rap = (Aa +
D∙p + Pp + Cc)5 where a, p and c represent age, period
and cohort respectively in five-year groups. Input
data were aggregated into five-year calendar periods
and 18 five-year age groups (described above).
Cohorts were created synthetically by subtracting
age from period. Rap is the incidence/mortality rate
in age group a in calendar period p, Aa is the age
component for age group a, and D is the common
linear drift parameter of period and cohort.(24) Pp is
the nonlinear period component of period p, and Cc
is the nonlinear cohort component of cohort c.
• Nordpred uses a goodness-of-fit test to choose the
number of five-year periods to be included in the
dataset used for calculating future values (projection
base).
• The software determines whether the average trend
across all observed values, or the slope for the last 10
years of observed values, is used for projection,
based on a significance test for departure from linear
trend. This approach serves as an approximate way of
looking for significant changes in the observed trend.
The software also allows the user to make this
selection.
• For each age group, a minimum of five cases in each
five-year period was required. For age groups below
this limit, the average number of cases in the last two
periods is used to calculate future rates.
• To allow for a damping of the impact of current
trends in the future time periods, a “cut-trend”
option is used, which is a vector of proportions
indicating how much to cut the trend estimate for
each five-year projection period. A gradual reduction
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APPENDIX II: Data sources and methods
in the drift parameter of 25% and 50% in the second
and third five-year period respectively was used as
the default in this publication.
• Age was included in all models as a factor. Agespecific incidence rate trends were then extrapolated
to 2015. The predicted numbers of cancer cases in
2015 were calculated by multiplying these
extrapolated incidence rates by the sex-, age- and
province-specific population projections for the
same year.
• The Nordpred “recent” and “cut-trend” options were
modified from the default values for selected types of
cancer, including thyroid cancer incidence and
prostate cancer mortality, since recent trends are not
expected to continue with as large an annual percent
change. The values were chosen so that estimates
were consistent with the most recent data available to
the provincial cancer registries.
Five-year averaging
New cases and deaths in 2015 for each type of cancer
were also estimated based on the average of the five
most recent years of data. This method may be more
realistic for cancers for which there are recent changes
in trend (the Nordpred Power5 regression model
results in poor estimates for these cancers because it is
based on a medium- or longer-term trend) or when
frequencies are low and result in unstable estimates
using the Nordpred model. The average of rates for the
most recent five years was calculated for each sex,
five-year age group, cancer type and province. The
predicted numbers were then obtained by multiplying
these rates by the corresponding projected population
sizes.
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Selection of “best” estimates
Estimates from the two methods were compared for
each sex, cancer type and geographic region for all ages
combined. The “best” estimate for each category was
selected in consultation with individual provincial or
territorial cancer registries, according to the following
guidelines:
• The Nordpred model was preferred except when
frequencies were low.
• Five-year average estimates were used when the
average annual number of cases during the most
recent five years was less than or equal to 50.
• Five-year average estimates were used for the
territories and are reported only for “all cancers”
because of small sample sizes.
• The absolute value of the difference between the
age-standardized rates estimated by the two methods
was calculated and expressed relative to the five-year
average estimate. For example, if the Nordpred
Power5 regression model estimated a rate of 4.0 and
the five-year average estimated a rate of 4.5, the
relative difference would be |4.0 – 4.5| ÷ 4.5, or
11.1%.
• Provinces closely examined estimates for cancers
where the absolute value of the relative difference
exceeded 15%. Such situations may be indicative of
important deviations from the long-term trend.
• Provinces provided feedback based on the
availability of in-house projections, knowledge of
local trends or access to more current data, which
permitted an assessment of the estimates produced
by the two different estimation methods.
• Estimates for Canada as a whole were computed as
sums of the estimates for the individual provinces
and territories.
Tables A12 and A13 indicate the cancer types that were
reported according to the five-year average method for
2015. In these situations, the age-standardized rates for
2015 reported in this publication were calculated using
the most recent five years of actual data.
All cancers combined
Provincial estimates of incidence counts for “all
cancers” for males were computed as the sum of the
“best” estimates for prostate cancer and all cancers
excluding prostate, as estimated by the Nordpred
modelling.
Prostate cancer incidence
The results of the Nordpred Power5 regression model
are not satisfactory for prostate cancer. An annual
age-specific trend Power5 projection model was fitted
to a minimum of seven and a maximum of nine years
of data, as selected by a goodness-of-fit test. The model
is Rap = (Aa + Da∙p)5, where a is age, p is period, Aa is the
age effect of age group a and Da is the slope parameter
at the ath age group, which takes the differentiation in
trend from different 10-year age groups into
consideration.
New cases of prostate cancer in 2015 were also
estimated based on the most recent year of data
available. This method may be more realistic when
there are recent changes in trend (the age-specific
trend model results in poor estimates for prostate
cancers because it is based on a medium-term trend).
The predicted numbers were then obtained by
multiplying these rates by the corresponding projected
population sizes.
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APPENDIX II: Data sources and methods
Non-melanoma skin cancer incidence
Rounding for reporting
Precision of 2015 estimates
Only a few provinces routinely collect data on the
incidence of basal cell and squamous cell carcinoma of
the skin (generally referred to as non-melanoma skin
cancer, or NMSC). The numbers of NMSC in all of
Canada, by sex, were estimated using these data.
• Counts of NMSC for 2002 to 2011 by year, sex and
age group were provided by the Alberta Cancer
Registry, the Manitoba Cancer Registry, the New
Brunswick Cancer Registry and the Newfoundland
and Labrador Cancer Registry. Linear regressions
using a logarithmic transformation of the annual
rates for each province and age group (0–39, 40–59,
60–79 and 80+ years) were conducted and projected
to 2015. For Newfoundland and Labrador, data
starting from 2006 were used for the projection
because of the detection of a change in trend by
changepoint analysis. The predicted numbers of
NMSC cases for all of Canada were calculated by
multiplying the projected incidence rates for each of
the four provinces by the sex- and age-specific
Canadian population projections for 2015.
• Reported new cases of NMSC for all of Canada are
the average of 2015 estimates from Alberta,
Manitoba, New Brunswick and Newfoundland and
Labrador registries.
• Predicted estimates of incidence and mortality
presented in this publication have been rounded as
follows:
■■ Numbers between 0 and 99 were rounded to the
nearest 5.
■■ Numbers between 100 and 999 were rounded to
the nearest 10.
■■ Numbers between 1,000 and 1,999 were rounded
to the nearest 50.
■■ Numbers greater than or equal to 2,000 were
rounded to the nearest 100.
• Percentages, age-standardized rates and age-specific
rates were rounded to the nearest 10th, except in
Tables 2.5, 4.5, A4 and A6, where space restrictions
forced rounding to the nearest whole number.
• Age-specific and sex-specific numbers or rates were
combined before rounding, so it is possible that the
totals in the tables do not add up. However, any such
discrepancies are within the precision of the
rounding units described above.
• Estimates of incidence counts presented in Tables
A1, A3, A7, A8 and Figures 1.3 and prevalence
counts in Tables 6.1, 6.2, 6.3, 7.5, 7.6 and Figures 6.2
and 7.6 have been randomly rounded either up or
down to a multiple of 5.
Estimates of precision (standard errors, coefficients of
variation and confidence intervals) for 2015 counts
and rates are available on request from the Surveillance
and Epidemiology Division (Centre for Chronic
Disease Prevention, Public Health Agency of Canada).
The precision of an estimate depends primarily on the
number of observed cases and the population size for
each combination of cancer type, age, sex and province
or territory.
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Annual percent change (APC) in cancer
incidence and mortality rates
The estimated APC was calculated for each cancer type
by fitting a piecewise linear regression model,
assuming a constant rate of change in the logarithm of
the annual ASIR or ASMR in each segment. The
models incorporated estimated standard errors of the
ASIR or ASMR. The tests of significance used a Monte
Carlo Permutation method. The estimated slope from
this model was then transformed back to represent an
annual percentage increase or decrease in the rate.
• Joinpoint analysis was applied to annual agestandardized rates over the period of 1986 to 2010
for both incidence and mortality to determine years
in which the APC changed significantly. Such years
are referred to as changepoints.
• The minimum time span on which to report a trend
was set at five years. Thus, the most recent possible
trend period in this study was 2006 to 2010.
• If no changepoint was detected within the periods of
2001 to 2010, then the APC was estimated by fitting
a model within these time periods, in the same way
as described above.
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APPENDIX II: Data sources and methods
• If a changepoint was detected within this decade,
then the APC was estimated from the trend in the
last segment. Both the changepoint year and the
APC for the years beyond the changepoint are
indicated in Tables 1.5 and 3.5.
Probability of developing or dying from cancer
Probabilities of developing or dying from cancer were
calculated according to the age- and sex-specific cancer
incidence and mortality rates for Canada in 2010 and
life tables based on all-cause mortality rates from 2008
to 2010. The methodology used was that of Zdeb(25)
and Seidman et al.(26)
• The method used for the probability of developing
cancer assumes that current age-specific incidence
rates will prevail throughout the future lifetime of a
person as they advance in age. Since this assumption
may not be true, the probabilities should be regarded
only as approximations.
• The probability of dying from cancer represents the
proportion of people who die of cancer in a cohort
subjected to the mortality conditions prevailing in
the population at large in 2010. It was estimated by
determining the proportion of deaths attributed to
specific types of cancer for each sex and age group,
multiplying this proportion by the corresponding
number of deaths in the life table and summing the
life table deaths over all age groups for each sex to
obtain the probability of dying from each cause.
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Potential Years of Life Lost (PYLL)
The indicator was calculated by obtaining deaths for
ages <1, 1–4, 5–9, . . . 90+ for Canada in 2010 and life
expectancy at the midpoints of the age groups. The
PYLL is the total number of years of life lost obtained
by multiplying, for each age group, the number of
deaths by the life expectancy of survivors.(27)
Survival
This section of the publication has been reproduced, as
is (with the exception of a new section on international
comparisons), from the corresponding section in last
year’s publication (2014). As such, the analytical
techniques used reflect the state of knowledge at the
time of the production of that publication.
• Analyses were based on all primary cancers. The
effect of including multiple cancers in survival
analyses has been studied both internationally(28,29)
and in Canada.(30)
• Analyses were based on those individuals aged
15–99 years at diagnosis excluding adolescent (15–19
years) bone cancers, which are dissimilar to those
diagnosed in older adults. An exception was the
analysis of childhood cancers, which was based on
children under the age of 15 years at diagnosis.
• Deaths of people diagnosed with cancer are
identified through record linkage of the CCR to the
CVS: D and from information reported by provincial
or territorial cancer registries. For deaths reported by
a registry but not confirmed by record linkage, it was
assumed that the individual died on the date
submitted by the reporting province or territory. At
the time of the analysis, registration of new cases and
follow-up for vital status were complete through
December 31, 2008.
• Persons whose diagnosis was established through
death certificate only or autopsy only were excluded.
• Relative survival ratios (RSRs) were estimated by
comparing the actual survival experience of persons
diagnosed with cancer to that expected in the
general population of people in Canada of the same
age, sex, province of residence and time period. They
were computed as ratios and expressed as
percentages.
• Analyses were based on a publicly available
algorithm,(31) with some minor adaptations. Expected
survival proportions were derived using the Ederer
II approach,(32) from sex-specific provincial life tables
produced by Statistics Canada.
• Only observed survival proportions are reported for
the analysis of childhood cancers as the estimates of
observed and relative survival for the 0–14 year age
range are essentially the same.
• Survival analyses were conducted using both period
and cohort analysis methods.(33) The period approach
to survival analysis provides up-to-date predictions
of cancer survival.(34) With this method, follow-up
data do not relate to a fixed cohort of people with
cancer. Rather, estimates of period survival are based
on the assumption that persons diagnosed in the
period of interest will experience the most recently
observed conditional probabilities of survival.
• When survival is generally improving, a period
estimate tends to be a conservative prediction of the
survival that is eventually observed.
• Conditional five-year relative survival is calculated as
per five-year RSRs but using only the data of people
who have already survived specified amounts of time
since diagnosis.(35,36)
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APPENDIX II: Data sources and methods
• As an indication of the level of statistical uncertainty
in the survival estimates, confidence intervals
formed from standard errors estimated using
Greenwood’s method(37) are provided. To avoid
implausible lower intervals less than zero or upper
limits greater than one for observed survival
estimates, asymmetric confidence intervals based on
the log (–log) transformation were constructed. RSR
confidence intervals were derived by dividing the
observed survival limits by the corresponding
expected survival proportion.
• Age-standardized estimates were calculated using
the direct method by weighting age-specific
estimates for a given cancer to the age distribution of
persons diagnosed with that cancer from 2001 to
2005. Confidence intervals for age-standardized
RSRs were formed by multiplying the corresponding
age-standardized observed upper and lower limits by
the ratio of the age-standardized relative survival
point estimate to the age-standardized observed
survival point estimate.
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Prevalence
This section of the publication has been reproduced, as
is, from the corresponding section in last year’s
publication (2014). As such, the analytical techniques
used reflect the state of knowledge at the time of the
production of that publication.
The primary type of prevalence reported in this
publication is tumour-based. Two-, five- and 10-year
limited duration prevalence estimates are based on the
number of cancers diagnosed in the previous two, five
and 10 years among people who are alive.
Estimating prevalence requires current, accurate
information about both the incidence and vital status
of cases. Because of issues in correctly ascertaining the
vital status of persons diagnosed while residing in
Quebec, the following approach was used:
• Cancer site-, sex- and age-specific limited duration,
tumour-based, prevalence estimates for all of
Canada, excluding Quebec, were determined directly
using the counting method.(38,39) Specifically, all
primary invasive cancers (including in situ bladder
cancers) diagnosed among persons residing outside
of Quebec in the relevant time period and alive on
January 1, 2009, were counted, regardless of whether
they were first or subsequent primaries.
• Sex- and age-specific population estimates for
January 1, 2009, were derived by averaging the 2008
and 2009 mid-year population estimates for all of
Canada, excluding Quebec.
• Cancer site-, sex- and age-specific limited duration
prevalence proportions for all of Canada, excluding
Quebec, were then estimated by dividing counts by
the appropriate population estimates.
• Cancer site-, sex- and age-specific counts for all of
Canada, including Quebec, were then obtained by
applying the prevalence proportions to Canadian
sex- and age-specific population estimates, which
included Quebec, and then summing across the
strata.
• Person-based limited duration prevalence counts are
estimated as the number of individuals represented
in the tumour-based limited duration prevalence
counts. For example, a person diagnosed with two
primary cases of cancer A and one of cancer B in the
10 years preceding the index date would be counted
once under cancer A, once under cancer B and once
under all cancers combined for 10-year person-based
prevalence. In terms of 10-year tumour-based
prevalence, the same person would contribute twice
to cancer A, once to cancer B and three times to all
cancers combined.
• Age-specific prevalence estimates were obtained
using the age attained as of January 1, 2009.
• The indirect approach for estimating cancer
prevalence in Quebec is different from that used in
previous versions of this publication. The current
approach’s primary assumption is that sex- and
age-specific limited duration cancer prevalence
proportions, calculated using cancer cases and
population estimates from all of Canada excluding
Quebec, are an accurate estimate of cancer
prevalence proportions within Quebec.
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APPENDIX II: Data sources and methods
Data and methods issues
Incidence
Although the Canadian Council of Cancer Registries
and its Standing Committee on Data Quality make
every effort to achieve uniformity in defining and
classifying new cancer cases, reporting procedures and
completeness still vary across the country. The
standardization of case-finding procedures, including
linkage to provincial or territorial mortality files, has
improved the registration of cancer cases and
comparability of data across the country. Some specific
issues remain:
• Benign tumours and carcinomas in situ are not
routinely captured or reported except for in situ
carcinomas of the bladder. All cancer registries
except Ontario report in situ bladder cancers to the
CCR.
• There may be under-reporting of cancer cases in
Newfoundland and Labrador due to incomplete
linkage of cancer data with death data. This underreporting could result in death counts or rates
exceeding those for incidence in a specific year; this
especially affects highly fatal cancers. The number of
“death certificate only” (DCO) cases for 2008 to 2010
in Newfoundland and Labrador was estimated from
2007 data.
• In Quebec, cases diagnosed through DCO are
incompletely captured prior to 2000. In addition,
because of the registry’s dependence on hospital data
for the period included in the present report, the
numbers of cases of some cancers are
underestimated, particularly for those where
pathology reports represent the main source of
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Canadian Cancer Statistics 2015
diagnostic information. Prostate cancer, melanoma
and bladder cancer are affected in particular.(40) The
2015 estimates for these sites may be an
underestimate because an increase in cases in the
registry is expected with the inclusion of pathology
reports starting with 2011 data.
• The number of DCO cases for 2010 in Quebec was
estimated from the average of 2005 to 2009 data.
• The number of DCO cases for 2008, 2009 and 2010
in Ontario was estimated from the average of 2003 to
2007 data.
• The number of DCO cases is less than 2% of total
cases.
• Non-melanoma skin cancers are excluded since most
provincial and territorial cancer registries do not
collect information on these cases. These cancers are
difficult to register completely because they may be
diagnosed and treated in a variety of settings and are
numerous. Estimates based on four registries that
include these cancers (see Non-melanoma skin
cancer incidence above) are therefore likely to be
underestimates.
Mortality
Although procedures for registering and allocating
cause of death have been standardized both nationally
and internationally, some lack of specificity and
uniformity is inevitable. The description of cancer type
provided on the death certificate is usually less
accurate than that obtained by the cancer registries
from hospital and pathology records.
Although there have been numerous small changes in
definitions over the years (see Tables A11-1 and
A11-2), there is one major earlier change of note:
• In the versions of this publication published before
2003, mortality due to colorectal cancer was based
on the International Classification of Diseases, Ninth
Revision (ICD-9),(41) codes 153–154, to be consistent
with other publications. However, this
underestimates colorectal cancer mortality by about
10% because most deaths registered as ICD-9 code
159.0 (intestine not otherwise specified) are cases of
colorectal cancer.
• Starting in the 2003 edition of this publication, these
deaths were included in the definition of colorectal
cancer. As a consequence, mortality figures for
colorectal cancer appearing in this publication
cannot be directly compared with those appearing in
publications prior to 2003.
Survival
Cases diagnosed in the province of Quebec were
excluded from survival analyses, in part because the
method of ascertaining the date of diagnosis of cancer
cases in this province clearly differed from that of the
other provincial cancer registries(42) and because of
issues in correctly ascertaining the vital status of cases.
Prevalence
Because of issues in correctly ascertaining the vital
status of persons diagnosed while residing in Quebec,
prevalence data for this province were determined
indirectly (see the Methods section above). Prevalence
estimates were derived using the corresponding
observed prevalence proportion calculated for the rest
of Canada, stratified on age group, sex and cancer type.
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APPENDIX II: Data sources and methods
Chapter 7: Special topic: Predictions of the
future burden of cancer in Canada
Public Health Agency of Canada modelling
Data
The observed cancer incidence data used for the
projections cover 1983 to 2007, which represents the
most recent period for which data are available for all
parts of Canada when this study was undertaken. We
extracted data from the Canadian Cancer Registry
(CCR) for 1992 to 2007 and from the National Cancer
Incidence Reporting System (NCIRS) for the earlier
years. While the CCR is a person-oriented database,
the NCIRS is an event-oriented database with cases
diagnosed from 1969 to 1991. The cases in the NCIRS
were coded in or converted to the International
Classification of Diseases, Ninth Revision (ICD-9).(41)
Projections were prepared for the most frequent
invasive primary cancers (including in situ bladder
cancers but excluding non-melanoma skin cancer (i.e.,
basal and squamous carcinoma). We generally defined
cancer cases based on the International Classification of
Diseases for Oncology, Third Edition (ICD-O-3) and
classified them using Surveillance, Epidemiology, and
End Results (SEER) Program Incidence Site Recode
shown in Box 1.(2,43) Cases retrieved from the NCIRS
used equivalent ICD-9 codes. Changes in cancer
definition over time were derived following the
methods outlined in the Canadian Cancer Statistics.(44)
BOX 1 Cancer definitions for incidence in Chapter 7
Cancer
Oral
Esophagus
Stomach
Colorectal
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Ovary
Prostate
Testis
Kidney
Bladder (including in situ)
Central nervous system
Thyroid
Hodgkin lymphomab
Non-Hodgkin lymphomab
Multiple myelomab
Leukemiab
All other cancers
Mesotheliomab
Kaposi sarcomab,c
Small intestine
Anus
Gallbladder
Other digestive system
Other respiratory system
Bone and joints
Soft tissue (including heart)
Other skin
Other female genital system
Penis
Other male genital system
Ureter
Other urinary system
Eye
Other endocrine
Other, ill-defined, and unknown
All cancers
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ICD-O-3 site/histology typea (incidence)
C00–C14
C15
C16
C18–C20, C26.0
C22.0
C25
C32
C34
C44 (Type 8720–8790)
C50
C53
C54–C55
C56.9
C61.9
C62
C64.9, C65.9
C67
C70–C72
C73.9
Type 9650–9667
Type 9590–9596, 9670–9719, 9727–9729
Type 9823, all sites except C42.0,.1,.4
Type 9827, all sites except C42.0,.1,.4
Type 9731, 9732, 9734
Type 9733, 9742, 9800–9801, 9805, 9820, 9826, 9831–9837, 9840,
9860–9861, 9863, 9866–9867, 9870–9876, 9891, 9895–9897, 9910,
9920, 9930–9931, 9940, 9945–9946, 9948, 9963–9964
Type 9823 and 9827, sites C42.0,.1,.4
All sites C00–C80, C97 not listed above
9050-9055
9140
C17
C21
C23
C22.1, C24, C26.8–9, C48
C30–31, C33, C38.1–9, C39
C40–41
C38.0, C47, C49
C44 excl. 8050:8084, 8090:8110, 8720:8790
C51–52, C57–58
C60
C63
C66
C68
C69
C37.9, C74, C75
Type 9740, 9741, 9750–9758, 9760–9769, 9950–9962, 9970–9989;
C76.0–76.8 (type 8000–9589); C80.9 (type 8000–9589);
C42.0–42.4 (type 8000–9589); C77.0–C77.9 (type 8000–9589)
All invasive sites
ICD-O-3 refers to the
International Classification of
Diseases for Oncology,Third
Edition.2 Cancers are classified
by SEER Incidence Site
Record.(43)
a
Histology types 9590–9989
(leukemia, lymphoma and
multiple myeloma),
9050–9055 (mesothelioma)
and 9140 (Kaposi sarcoma)
are excluded from other
specific organ sites.
b
c
Data are not available for
Ontario and Canada.
125
APPENDIX II: Data sources and methods
Population estimates for Canada and the provinces/
territories are based on quinquennial censuses
conducted from 1981 to 2006. We used intercensal
estimates prepared by Statistics Canada for the years
between these censuses and postcensal estimates for
2007 to 2010.(45) Projected population estimates were
used for 2010 to 2032, as prepared by Statistics Canada
under assumptions of medium growth (scenario M1).(8)
The scenario M1 incorporates medium growth and
historical trends (1981 to 2008) of interprovincial
migration. For the total population, the low and high
growth scenarios are about 6% below and above the
M1 scenario, but this range is reduced to 3% for ages
65 or older.
Data on cancer incidence counts and population
estimates were summarized into 5-year age groups
(0–4, 5–9, …, 80–84, 85+) and 5-year periods of
diagnosis (1983 to 1987, 1988 to 1992, 1993 to 1997,
1998 to 2002, 2003 to 2007) by sex and province/
territories as a whole. The projected population figures
were similarly aggregated for 5 projection quinquennia
(2008 to 2012, 2013 to 2017, 2018 to 2022, 2023 to
2027, 2028 to 2032). The single-year data from 1994 to
2007 were used for projecting prostate cancer
incidence. Rates for each category were calculated by
dividing the number of cases in each category (a
combination of cancer site, sex, region, period and age
group) by the corresponding population figure. These
age-specific rates were standardized to the 1991
Canadian population, using the direct method,(46) to
obtain the age-standardized incidence rates (ASIR).
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Methods
Projection models
There are several methods for projecting cancer
burden, differing in terms of the type of statistical
model, selection of the data used for model fitting and
the method of extrapolating the model components
into the future. The model type diverges from simple
linear or log-linear regression of age-specific rates or
counts against time(47-49) to age-period-cohort (APC)
modelling.(17,46,50) Within the framework of APC
models, effects of age, period and cohort are addressed
in heterogeneous ways such as generalized linear
models(51,52) including their derivative, Nordpred
method, based on a step function on 5-year
intervals,(17,23) generalized additive models(53,54) with
polynomial(17,55) or spline smoothing methods,(56) and
Bayesian models(57) with Markov chain Monte Carlo
(MCMC) simulation.(58) The link function is either
common exponential(46,50,57) or non-canonical power.(17,23)
A model is fitted to all available data or their subset for
an adequate fit through a goodness-of-fit test.(17,23) The
assumptions used for extrapolating the observed
trends include keeping current rates unchanged in
future,(59) continuing overall historical trend,(47,57)
extending only the most recent trend(17,23) and adjusting
the extent to which the observed trends are likely to
influence the future.(17,23) To develop the most accurate
profile of future cancer burden, the Public Health
Agency of Canada used the major projection models
to produce projections of current rates as would have
been forecast 15 or 20 years ago based on the longterm data series in Canada, then compared the
projected rates with those observed and concluded
with a cancer-dependent modelling approach.
The following models were considered for our
projections:
• Nordpred power-5 models
• Bayesian Markov chain Monte Carlo (MCMC)
method
• five-year average model
• age-specific trend power-5 model fitting single-year
data for short-term projections of prostate cancer
• relative percent adjustment method
These models are described in further detail as follows:
1. N
ordpred power-5 models (NP_ADPC and
NP_ADP)
The Nordpred APC model,(17,23,60) based on a standard
APC Poisson regression model,(24,50,51) uses the power-5
link function instead of the traditional logarithmic link
to reduce the exponential changes and summarizes the
linear trends in period and cohort over the observed
data into a drift component. The model can be written
as
caseap  Poisson(µap ),
  µap
Rap  or , 
  nap
 

  = ( Aa + D ⋅ p + Pp + Cc )5 ,


(NP_ADPC )
where Rap is the incidence rate in age group a in
calendar period p, which is the mean count map of caseap
divided by the corresponding population size nap, Aa is
the age component for age group a, D is the common
linear drift parameter of period and cohort,(24) Pp is the
non-linear period component of period p and Cc is the
non-linear cohort component of cohort c. Cohorts
were calculated as c =A + p – a, with A = total number
of age groups (=18).
126
APPENDIX II: Data sources and methods
Nordpred also arithmetically attenuates the drift into
the future to damp the impact of past trends in the
future, chooses data for model fitting and chooses the
drift for extrapolations. Nordpred with its standard
drift reduction and with various increased or
decreased reductions of the default “cut trend” vector
was the primary method used in the projections in this
study. In addition, for cancers with average annual
counts of fewer than 50 over the last 5 observation
years when cohort effects were not present based on a
significance test, a Nordpred model without cohort
component (denoted as NP_ADP) was also considered.
2. B
ayesian Markov chain Monte Carlo (MCMC)
method
Instead of a maximum likelihood approach, we applied
a Bayesian framework to the APC model. Bayesian
models for cancer projection estimate the age-specific
rates from their posterior distribution by using MCMC
techniques.(57,58) We considered this approach for
situations where there are too few observed cases to
properly estimate model parameters via the Nordpred
method or where projections from Nordpred seem
unlikely. We considered 2 Bayesian approaches.
2.1. Bray approach (B_APC)
For the classical APC Poisson model,(24) Bray specified
a second-order autoregressive prior model to smooth
age, period and cohort effects and to extrapolate
period and cohort effects.(57,58) The model can be
written as:
caseap  Poisson(µap ),
 µap
log 
 nap


 = Aa + Pp + Cc ,


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Supposing that we compute N-period projections
based on P-period observed data, there are total
C = A + P − 1 cohorts. With the Nordpred model, an
individual cohort c can be calculated as c = A + p − a.
The prior distributions are defined as follows. For the
A age effects:
A ~ normal(0,1000000
1
1
τ
);
A
A2 | A1 ~ normal(0,1000000
1
τ
);
A
Aa | A1,..., a −1 ~ normal(2 Aa −1 − Aa −2 ,
1
τ
), 3 ≤ a ≤ A.
A
1
τ
);
P
P2 | P1 ~ normal(0,1000000
1
τ
);
1
τ
), 3 ≤ p ≤ P + N .
P
For the C + N cohort effects:
C1 ~ normal(0,1000000
1
τ
C 2 | C1 ~ normal(0,1000000
1
τ
);
C
C c | C1,..., c −1 ~ normal(2C c −1 − C c −2 ,
1
τ
), 3 ≤ c ≤ C + N .
C
The variance parameters τA, τP and τC (determining
the smoothness of age, period and cohort effects,
respectively) are given the same gamma prior,
τ ∼ gamma(0.001, 0.001).
 µap
log 
 nap


 = Aa + Pp ,


We first used the model to estimate national-level age
ˆ and Pˆ ,
and period coefficients, denoted as A
a
p
respectively. Regional age Aa and period Pp effects were
then given normally distributed priors with means
equal to the corresponding national estimates,
);
C
Three MCMC chains were run for a “burn-in” of
50,000 iterations. Parameter estimates (posterior
medians) were based on an additional 50,000 iterations
for each chain, thinned to every thirtieth sample
(150,000 samples). Chain convergence was assessed via
the Gelman-Rubin statistic, examination of sample
autocorrelation and visual inspection. All Bayesian
modelling was implemented in WinBUGS.(61)
Additional details can be found elsewhere.(62)
caseap  Poisson(µap ),
P
Pp | P1,..., p −1 ~ normal(2Pp −1 − Pp −2 ,
Rap = exp(Aa + Pp + Cc).
2.2. To stabilize regional estimates, initial or “prior”
distributions based on national data were assumed for
regional parameters and then updated using the actual
regional data. The model can be written as:
For the P + N period effects:
P1 ~ normal (0,1000000
Fitted and projected rates are derived by combining
the simulated age, period and cohort effects based on
ˆ , 1 ),
Aa ~ normal( A
a
τA
1
Pp ~ normal(Pˆp , ) ,
τP
where variance parameters , were given the same
gamma prior,
τ ∼ gamma(0.001, 0.001)
127
APPENDIX II: Data sources and methods
Following Spiegelhalter et al.,(63) corner constraints
were imposed on the first age effect (A1 = 0) to
facilitate computations.
5. R
elative percent adjustment method – regional
projections derived from scaling down
national-level projections (SD)
3. Five-year average model (AVG)
For a cancer type in a region with average annual
counts over the last observed 5 years of fewer than 10,
the age-specific counts were also calculated by
adjusting the national estimates (based on a modified
method used in the Cancer Registry of Norway).(65) Let
w denote the relative difference of the averages of the
ASIR in the last 5 observation years between the region
and the whole country, that is,
The 5-year average model assumes that the age-specific
average rates of cancer incidence in the most recent 5
years of observed data will remain constant in future
years, so that future numbers of cancer would be
affected only as a consequence of demographic
changes in the population.
4. A
ge-specific trend power-5 model fitting
single-year data for short-term projections of
prostate cancer (ADa)
Trends in prostate cancer incidence since the early
1990s have been subject to over-diagnosis (the
detection of latent cancer that would never have been
diagnosed in the absence of screening) because of the
rapid dissemination of the PSA test.(64) The projections
of period analysis from Nordpred seem unlikely.
Therefore, an age-specific trend power-5 model based
on yearly data was fitted to a minimum of 8 years of
observations from 1994 to 2007 for projections of
prostate cancer incidence in the first 5 (2008 to 2012)
future years: Rap = (Aa + Da∙p)5, where Da is the slope
parameter in age group a, which takes the differentiation
in trend from different age groups into consideration.
This model also allowed for the “spike” value in the
year 2001. Another peak year was in 1993, which was
excluded from the modelling.
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2007
2007
t=2003
t=2003
w=
∑ ASIRRt / ∑ ASIRNt ,
then the cancer incidence rate in a region R, age group
a and period p,
RRap = RNap*w=( CNap /PNap)*w,
where RNap, CNap and PNap are the national cancer
incidence rate, count and population size at age group
a and period p, respectively. For example, if the region
had 5% lower rates than the national average in the last
5 observation years, the age-specific rates in each
future period were adjusted down by 5% for that
region. We therefore have the corresponding number
of new cancer cases,
CRap=RRap *PRap.
Comparison of models
Projected average annual numbers of cancer cases
from the models described above based on observed
incidence counts in 1972 to 1991 were compared with
observed values in 1992 to 2007 in Canada. Quebec
was excluded from the comparison because of data
quality issues prior to 1983.(66,67) Median absolute
relative difference between predicted and observed
values, |observed-predicted|/observed, was calculated
to examine each model’s overall tendency to
overestimate or underestimate the actual number of
cancer cases. The absolute difference was used when
comparing for rare cancers. We compared median
prediction errors for each model across combinations
of cancer type, geographical area and sex. We also
separately compared model performance for each
cancer type, across all geographic areas and sexes.
Friedman’s test was used to test for statistical difference
in medians between different projection models.(68)
Projection validation and adjustment
The model selection was performed by assessment of
the models and integrating these model comparison
results with those from other published studies.
However, a model created on cohorts in early periods
may give inaccurate predictions when applied to
contemporary cohorts. Owing to limitations in the
availability of different long-term datasets used for
validating the selected models, we examined the
projections from the selected models using our
knowledge of data quality, trends in cancer rates in
different regions, risk factors or interventions to ensure
the estimates are appropriate. When the estimated
trends seemed unlikely, we used such knowledge to
adjust the extrapolation methods of the fitted models
or used Bayesian simulations instead of the generalized
linear models.
128
APPENDIX II: Data sources and methods
Selected models by cancer
Data issues and limitations
The following projection methods were used in this
study.
• Common cancers (average annual count over the
latest 5 observation years for a national or regional
series, N > 50): NP_ADPC model with varied
“recent” and “drift” values.
• Less common cancers (10<N ≤ 50): NP_ADPC or
NP_ADP model (based on the significance of the
cohort effect and comparison with AVG results) with
varied “recent” and “drift” values. The simple
age-effect only AVG model has been proven to be the
best approach for rare cancers in our model
evaluation and other studies(69) and has been used in
recent reports.(70) With this, we adopted either NP_
ADPC or NP_ADP, from which the projections were
closer to the AVG results, instead of basing them
solely on linear extrapolation of the 5-year average
rate into the future. One exception is that B_APC
was applied to multiple myeloma in males in New
Brunswick.
• Rare cancers (N ≤ 10): NP_ADPC, NP_ADP, B_
APC, B_AP or SD model, whichever projections
were closer to the AVG results.
• Prostate cancer: ADa + AVG, defined as
■■ using ADa to project for the first 5 future years
and then
■■ using the age-specific average rates of the
predicted 5-year data to estimate counts for the
second to fifth 5-year periods.
• “All cancers” for males: The estimates of incidence
counts were computed as the sum of the estimates
for prostate cancer and for all cancers excluding
prostate, as estimated by NP_ADPC modelling.
Our model comparison exercise, based on the more
recent observed data that were not available when the
present study was undertaken, addressed the accuracy
of the projection methods used in this study. For
example, Box 2 presents the medians of the absolute
relative differences between the observed and
projected average annual number of cases at the
national level only and across the provinces in 1992 to
2010 by length of projection for the combinations of
cancer type (excluding prostate cancer), sex and
province (excluding Quebec because of data quality
issues prior to 1983).(66,67) The projected numbers were
calculated by the projection method used in this study
(denoted as PHACpred, which, for this comparison,
includes only the Nordpred APC models (NP_ADPC)
with the Nordpred standard drift (D) reduction and its
modifications), and the 3 versions of NP_ADPC with
its default drift reduction – using the average trend
over the whole observation period for projections
(M0F), using the slope between the 2 most recent
periods for projections (M0T), and automatically
determining whether the recent trend (or the average
trend) is projected based on a significance test for
departure from a linear trend (M0A). The medians are
shown with and without all male cancers combined.
Box 2 shows that the medians from PHACpred are the
smallest in the 4 models for any length of projection
period. The differences in the medians among the 4
models or between PHACpred and M0A are not
statistically significant when across the provinces (each
p≥0.05), but are statistically significant for nationallevel 15- and 20-year projections. The performances of
M0F and M0T were published for the population of
the 4 Nordic countries.(17) In this study, Moller et al.(17)
made projection model comparisons for 20 cancer sites
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in each sex for Denmark, Finland, Norway and Sweden
for 1983 to 1997 based on 1958 to 1977 data. The
respective median deviations (over the combinations
of site, sex and country) of M0F and M0T are 13% and
12% for 10-year projections and 20% and 18% for
20-year projections. The median numbers are similar
to ours for M0T model in the scenario from across the
provinces, but M0F seems to perform better for our
specified data. Consequently, we can see that our
PHACpred multiple modelling approach produced
more accurate projections than the default Nordpred
method applied uniformly.
Although the standardization of case ascertainment,
definition and classification has improved the
registration of cancer cases and comparability of data
across the country, reporting procedures, accuracy and
completeness still vary.(44) International Agency for
Research on Cancer (IARC) rules(3) for multiple
primaries were used for cases from the CCR, whereas
during the period covered by the NCIRS, registries
other than Quebec and Ontario used multiple primary
rules that allowed a small percentage of additional
cases.
Non-melanoma skin cancer is difficult to register
completely because it is quite plentiful and may be
diagnosed and treated in a variety of settings. Most
provincial and territorial cancer registries do not
register these cases. For this reason, non-melanoma
skin cancer is excluded from our analysis.
129
APPENDIX II: Data sources and methods
BOX 2 Median of absolute relative difference (%) between observed and projected number of average annual
cancer cases in 1992–2010, Canadaa
Length of projection
10 years
15 years
20 years
National
level
Across
provinces
National
level
Across
provinces
National
level
Across
provinces
M0F
10.6
11.1
13.6
15.5
10.3
15.2
M0T
7.8
11.8
10.6
16.1
14.9
18.3
M0A
7.8
11.6
10.6
14.6
16
16.3
PHACpred
Projection method
Exclusion of prostate cancer
5.8
10.9
6.9
13.9
7.6
15.1
p-valueb of differences
among the 4 models
0.02
0.36
<0.01
0.12
<0.01
0.06
p-value of differences between
PHACpred and M0A
0.12
0.35
<0.01
0.4
<0.01
0.53
Exclusion of prostate cancer and all male cancers combined
M0F
10.6
11.7
14.3
15.8
10.4
15.8
M0T
7.8
12.3
10.9
16.7
15.2
18.9
M0A
8.5
11.8
12
15.5
16.1
17.1
PHACpred
6.3
11.3
7
14.4
7.6
15.5
p-value of differences
among the 4 models
0.03
0.34
<0.01
0.17
<0.01
0.05
p-value of differences between
PHACpred and M0A
0.12
0.42
<0.01
0.52
<0.01
0.61
For the observed data years covered by this analysis,
death certificate only (DCO) cases were not reported to
CCR by Quebec and Newfoundland and Labrador, with
the exception of the 2000 to 2006 Quebec data and 2007
Newfoundland and Labrador data. The number of DCO
cases for 2007 in Quebec was estimated by averaging the
numbers in 2002 to 2006. This missing reporting has
likely led to underestimates of the incidence rates in
these provinces, especially for highly fatal cancers such
as lung and pancreas. In Canada, the number of DCO
cases is less than 2% of the total new cancer cases. In
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addition, the incidence of some cancers in Quebec,
particularly for those that rely more heavily on pathological
diagnosis, are underestimated as a result of the registry’s
dependence on hospitalization data. Prostate cancer,
melanoma and bladder cancer estimates are affected.(40)
Owing to changes to the Quebec registry that increase
registration for data after 2007, the number of
melanoma cases is underestimated in the current report.
The principal projection models used are based on
decomposition of the observed incidence data into
a
Excluding Quebec, see Methods.
b
p-value of Friedman’s test.
Note:
1. Comparisons were presented for the combination of cancer
site, sex and area, for which the Nordpred APC models (NP_
ADPC) with varied drift reductions (denoted as PHACpred) were
used for projections.
2. Three versions of NP_ADPC with its default drift reduction:
using the average trend over the whole observation period for
projections (M0F), using the slope between the two most
recent periods for projections (M0T), and automatically
determining whether the recent trend (or the average trend) is
projected based on a significance test for departure from linear
trend (M0A).
3 time dimensions of age, period and cohort. While the
effects of risk factors, screening and intervention were
not incorporated into the models because of insufficient
data in most circumstances, they have been modelled
indirectly to some extent, through the period and cohort
effects in the model.(23) However, the models will be
insensitive to any recent changes not foreshadowed in
the observed time series of cancers because of the long
latency between exposure and cancer outcomes.
130
APPENDIX II: Data sources and methods
The observed incidence rates for the cancers of female
genital system also reflect the fact that many females
who underwent a hysterectomy or bilateral salpingooophorectomy were not at risk of developing the
disease. The prevalence of hysterectomy was high in
the Atlantic provinces and Quebec based on the 2003
Canadian Community Health Survey (Cycle 2.1) (data
not shown). Using all females as the denominator in
the rate calculation can result in artefactual differences
in regional rates. In addition, changes in trends of the
rates of these procedures can impact the cancer
projections. For example, if surgery rates decrease
more than expected based on current trends, the
incidence rates of cervical, uterine and ovarian cancers
would be greater than our projections.
It is useful to acknowledge that forecasting prostate
cancer incidence is subject to some uncertainty as a
result of over-diagnosis of this cancer because of the
PSA test. The common Nordpred approach would
predict extreme increases in prostate cancer incidence
rates, so this necessitated a model adjustment and/or
exclusion of the observed data for certain periods. We
used the 2-step approach of the short-term modelling
projection following by the long-term constant-rates
projection for projecting prostate cancer incidence in
this study. The method that future numbers of cancer
would be affected only by the demographic changes
has been adopted for prostate cancer projection in
several publications.(65,22,70) Quon et al.(70) assumed that
the age-specific incidence rates of prostate cancer in
the current year would remain in the future in their
“best-case” scenario and predicted that the number of
new prostate cancers will increase to 35,121 cases by
2021 in Canada. This is consistent with our estimate of
34,460 new cases annually in 2018 to 2022. Moller et
al.(65,22) used the 5-year average method for their
projections of prostate cancer incidence in England
and Norway. These constant-rate projection methods
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would result in underestimates of the future burden of
prostate cancer if the prevalence of screening is
increased or the diagnosis is improved. The future use
of the PSA test will principally determine the accuracy
of our projections for prostate cancer incidence.
Projection of thyroid cancer should be interpreted with
caution. Even though we used the long-term trends
instead of the more recent rapid increasing trends for
thyroid cancer projection, the future increasing of the
rates may not be as large as projected.
Canadian Partnership Against Cancer modelling
The Cancer Risk Management Model (CRMM), developed
by the Canadian Partnership Against Cancer and
Statistics Canada, was designed to evaluate the impact
of healthcare policy changes in the Canadian system.(71,72)
The CRMM incorporates the risk of developing and
dying from cancer and other causes, as well as
screening and clinical management with healthcare
costs and labour data, and can be used to assess both
health outcomes and economic impact. The cancers
evaluated in this report are lung, colorectal and cervix.
The CRMM is a discrete event micro-simulation
model that operates in a competing risk, continuous
time framework and is supported by a user-friendly
web-enabled platform to enable browsing and custom
scenario development by registered users
(cancerview.ca).
All CRMM simulation results are based on version
2.2.1.0 of 32 million simulated cases (scaled to
Canadian population size).
Data
The CRMM simulates and projects a representative
sample of the Canadian population using Statistics
Canada’s official demographic projections. CRMM
takes into account births, mortality, immigration and
inter-provincial migration to represent the age-sexprovincial structure of the population.
The Canadian Cancer Registry is a fundamental source
of cancer data used to inform the incidence and
staging of colorectal, lung and cervical cancers.
Smoking behaviour was simulated to match Canadian
survey data across time by age, sex and province from
the Canadian Health Survey (1979), National
Population Health Survey (1994) and Canadian
Community Health Survey (2008), and the model was
assessed against tobacco manufacturer’s data.
Healthcare costs were obtained predominantly from
Ontario sources and included the Ontario Health
Insurance Plan Schedule of Benefits for physician fees,
the Ontario Case Costing Initiative for hospital costs
and Cancer Care Ontario’s New Drug Funding
Program and are in 2008 dollars. Sources for economic
data included census and other simulation models at
Statistics Canada. Additional parameters were
obtained from the literature, including survival data,
data to inform natural history of cancer progression,
end-of-life care costs and efficacy of screening.
Methods
Lung cancer simulations
The CRMM simulates the hazard of developing lung
cancer using a risk equation from the literature(53) that
combines the risk associated with cumulative lifetime
radon and smoking exposure and was aligned with the
number of cases reported to the Canadian Cancer
Registry by age, sex and province. Recent trends in
smoking were assumed to continue into future years.
Radon exposure is based on estimates from Health
Canada Survey for selected locations.
Screening populations at high risk of lung cancer with
three annual screens using low-dose computed
tomography (LDCT) was shown in the National Lung
131
APPENDIX II: Data sources and methods
Screening Trial (NLST) to reduce lung cancer
mortality by 20% after approximately 6 years of
follow-up. The CRMM includes a screening module
that can be used to assess LDCT for a variety of
screening strategies including thresholds of risk for
eligibility to program, age to start and end screening,
screening frequency, and participation and cost
assumptions. The simulation has been assessed against
the NLST results.(73)
The screening scenarios presented here aligned with
the NLST eligibility criteria, that is, persons aged
55–74 with at least a 30 pack-year smoking history in
current smokers or in former smokers who quit within
the last 15 years. The participation rates were set at
30% starting in 2015 and remained at those levels to
2030 under an annual screening program.
Additionally, the simulation can evaluate the potential
benefit of achieving smoking cessation through an
adjunct program. In this scenario, the smoking
cessation success rate among screeners has been set to
22.5% at a cost of $350.
including randomized control-led trials(75-77) and
through model calibration to a variety of published
studies including the Prostate, Lung, Colorectal and
Ovarian (PLCO) randomized trial.(78 )
Participation rates
Cancers can be diagnosed clinically or through
screening and are staged and treated at diagnosis with
follow-up protocols in place. Simulated patients have a
risk of relapse and death from colorectal cancer, which
varies by stage at diagnosis. Population-based
screening strategies can be evaluated for various
screening modalities including fecal occult blood test
(guaiac or immunological), flexible sigmoidoscopy or
colonoscopy, or combined modalities. In this report,
fecal immunochemical blood test (FIT) was evaluated
compared to no organized screening with 30% and
80% participation rates.
Both screening scenarios evaluated assumed that
participation to organized screening started in 2007
using fecal immunochemical blood testing and
participation ramped up gradually to 30% by 2015.
From 2015 to 2030, the alternative screening scenarios
were evaluated at constant 30% participation or
gradually increasing to 80% participation by 2030.
Screening can detect polyps and cancers
The efficacy of screening modalities is expressed
through the test’s sensitivity to detect polyps and
cancer, as well as the test’s specificity (Box 3):
Box 3 Sensitivity and specificity of screening tests for colorectal cancer screening
Colonoscopy
Polyp or Cancer state
FIT*
Distal
Proximal
Colorectal cancer simulations
Polyp less or equal to 5 mm in size
0.025
0.75
0.65
The CRMM simulates the natural history of colorectal
cancer that is benchmarked to incidence and staging
reported in the Canadian Cancer Registry.(74) The
model simulates growth of polyps in seven different
sites within the proximal and distal colon, which can
grow in size and become cancerous. Cancers can
progress from stage I to stage IV. Polyp prevalence was
estimated from the literature. Survival data were
obtained through chart review and benchmarked to
the Canadian Mortality Database. Screening efficacy
has been estimated through a variety of sources,
Polyp between 6 and 9 mm in size
0.05
0.85
0.85
Polyp greater or equal to 10 mm in size
0.15
0.95
0.875
Cancer
0.75
0.95
0.99
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Specificity of the screening test
First screening round
0.95
0.90
Subsequent screening round
0.95
0.90
FIT=fecal immunochemical test
*FIT cut-off of 100 ng/ml
132
APPENDIX II: Data sources and methods
HPV/Cervical cancer simulations
CRMM HPV/Cervical cancer model consists of two
complementary components: Human Papillomavirus
Microsimulation Model (HPVMM) and CRMM.
Information in HPVMM communicates with the
subsequent CRMM to model a life-course HPV/
Cervical cancer-related event such as sexual debut, virus
infection/transmission, HPV natural history (cervical
intraepithelial neoplasia, warts), screening, cervical
cancer incidence, treatment, progression and death.
HPVMM
HPVMM is an interacting-agent model that simulates
lifetimes of hypothetical persons to model sexual
network, virus transmission and vaccination strategies.
HPVMM was developed based on a published model by
Van de Velde et al (2010).(79) The interacting nature of
the model allows males and females aged 10 years and
older to form relationships with variable durations over
time. HPV strains propagate within this population
through the sexual relationship, effectively taking
account of herd immunity associated with vaccinations.
HPVMM assumes that the population being simulated
is stationary (the population does not grow nor shrink
over time) and that the characteristics ruling
individual’s sexual behaviours (e.g., sexual debut,
partnership formation/separation, sexual acts) and
virus transmissions (e.g., virus infection, clearance) are
constant over time. Under these assumptions,
HPVMM generates HPV prevalence and incidence to
be constant over time at the steady-state level in the
absence of a vaccination program.
Six HPV serotypes are currently modelled: 6, 11, 16,
18, other carcinogenic types combined and other
non-carcinogenic combined. Bivalent and quadrivalent
vaccines are currently available for assessment.
HPVMM allows 100 years of projection to assess the
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effect of various vaccination strategies on HPV
prevalence and incidence.
HPVMM utilizes various data for building the model.
Information on demography is based on Canadian
Vital Statistics. Parameters associated with sexual
network and virus transmission are based on Van de
Velde et al (2010),(79) literature, clinical trials and
Statistics Canada surveys. Input parameters,
particularly those associated with sexual behaviour
and virus transmissions, are subject to a high degree of
uncertainty due to limited information available.
Therefore, extensive parameter estimation was
performed to find feasible parameters sets (solutions)
that are consistent with observed data on sexual
behaviours and HPV prevalence. The parameter
estimation was done by running thousands of
simulations repeatedly, each time with a different
combination of input parameters systematically drawn
from the range of pre-specified input parameter values
through Latin Hypercube Sampling. Projections from
HPVMM, therefore, can be presented as a range of
outputs (i.e., confidence intervals) that account for the
possible variations in outputs resulting from uncertain
input parameter values.
HPVMM was run with 250,000 interacting agents with
100-year burn-in to obtain equilibrium sexual network
and HPV prevalence levels. All HPVMM simulation
results are based on version 1.7.1.0., and results are
scaled to reflect the population size of Canadians aged
10 years and older in 2011.
CRMM
CRMM is a non-interacting agent model that simulates
the representative Canadian population dynamics and
models HPV natural history, screening, treatment of
abnormal lesions/warts, cervical cancer incidence and
progression, cancer treatment and cervical cancer
death. By communicating results from HPVMM, the
natural history of HPV is simulated through infection
status (susceptible / immune / infected) and cervical
abnormality (cervical intraepithelial neoplasia,
adenocarcinoma in situ, genital warts), which allows
the abnormal lesions to progress or regress. Eligible
women follow cervical cancer screening protocols,
which can detect abnormal lesions through various
screening/diagnostic modalities. A small proportion of
women with abnormal lesions could develop cervical
cancers. Upon the cancer detection (through screening
or clinical detection), a cancer stage is assigned and
women follow a detailed sequence of cancer treatments
based on their cancer stages. Cancers can be cured,
relapse and/or result in death from cervical cancer (or
from other causes).
The model is consistent with recent and past observed
practice/data with respect to the screening and followup strategies. A wide variety of future screening
strategies can be evaluated by altering primary screening
modalities (standard or liquid-based cytology, HPV
DNA or combinations) and follow-up protocols based
on target age, time and vaccination status.
Input data come from a variety of sources. Information
associated with natural history and screening is based
on literature. Incidence, staging and survival are based
on Canadian Cancer Registry of various years as well
as literature. Screening and treatment costs are based
on publicly available sources such as Ontario Case
Costing Initiative and provincial formularies.
The model was validated extensively so that the model
reflects observed data. Incidence of cervical cancer was
validated against age-specific incidence derived from
the Canadian Cancer Registry over time. Additional
model assessment was conducted so that model
outcomes associated with natural history and
screening are consistent with published data.
133
APPENDIX II: Data sources and methods
oo vaccines are perfect (i.e., 100% efficacious with
Scenarios
no waning over time)
Box 4 below summarizes scenario being evaluated.
• Cervical cancer screening
Default scenario
oo cytology as a primary screening modality
Default (status quo) scenario assumes the following:
(mixture of standard and liquid-based)
■■ reflects Canadian historical screening
behaviours (from 1955 to 2012)
■■ triennial screening for women aged 21–69
(2013 and onwards)
oo follow-up protocols based on current practice
• Vaccination
oo vaccinating 12-year-old girls annually with 70%
vaccination rate with quadrivalent vaccine
oo vaccination program beginning in 2007 without
a ramp-up in vaccination rates
Alternative scenarios
Alternative scenarios assessed in this analysis include
combinations of various vaccination and cervical
cancer screening strategies.
Alternative cervical cancer screening programs are
constructed by changing future screening patterns
(2013 and after) in terms of primary screening
modality and target population (vaccinated versus
unvaccinated).
Box 4 Scenario description for cervical cancer models
HPVMM*
Scenario #
Scenario name
CRMM description†
Target pop
Vaccination rate
Target pop
Primary screening
modality & frequency
1
Status quo (Cytology + HPV
Vaccination)
Girls
70%
Age 21–69
Cytology, every 3 years
2
Cytology + One-time HPV
DNA test + Vaccination
Girls
70%
Age 21–69
Cytology, every 3 years
Age 30
HPV DNA (one-time)‡§
Cytology for unvaccinated +
HPV DNA test for vaccinated
Girls
Age 21–69 who have
never been vaccinated
Cytology, every 3 years
Age 21–69 who have
been vaccinated
HPV DNA, every 10 years§
3
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70%
* Vaccination program starts in 2007.
†
Screening modalities specified here begin in year 2013. Default
historical practice patterns apply for years prior to 2013. Screening
participation rate is 70% for all screening strategies.
‡
One-time HPV DNA test is implemented when a woman’s initial or
next regular screening is scheduled between age 30 and 35. Each
eligible woman has only one chance of attempting to receive the
primary HPV DNA test.
§
Ontario follow-up protocol (i.e., a second HPV DNA test if the first
one was positive and the triage cytology was negative) applies as a
follow-up to the primary HPV DNA testing.(80)
134
APPENDIX II: Data sources and methods
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TABLE A10 Cancer definitions
ICD-O-3 names
(incidence)
ICD-O-3 Site/Type
(incidence)
ICD-10 names
(mortality)
ICD-10 Site/Type
(mortality)
Lip, base of tongue, other unspecified parts
of tongue, gum, floor of mouth, palate, other
and unspecified parts of mouth, parotid
gland, other and unspecified major salivary
glands, tonsil, oropharynx, pyriform sinus,
hypopharynx, other and ill-defined sites in lip,
oral cavity and pharynx
Esophagus Stomach
Colon, rectosigmoid junction, rectum, intestinal
tract NOS
C00–C14
Malignant neoplasms of lip, oral cavity and
pharynx
C00–C14
C15
C16
C18–C20, C26.0
C15
C16
C18–C20, C26.0
Liver
Pancreas
Larynx
Lung
Melanoma
Breast
Cervix
Body of uterus
Liver
Pancreas
Larynx
Bronchus and lung
Skin (melanoma)
Breast
Cervix uteri
Corpus uteri, uterus NOS
C22.0
C25
C32
C34
C44 (Type 8720–8790)
C50
C53
C54–C55
Ovary
Prostate
Testis
Bladder (including in situ for
incidence)
Kidney
Ovary
Prostate gland
Testis
C56.9
C61.9
C62
Malignant neoplasm of oesophagus Malignant neoplasm of stomach
Malignant neoplasm of colon, rectosigmoid
junction, rectum, and intestinal tract - part
unspecified
Malignant neoplasm of liver
Malignant neoplasm of pancreas
Malignant neoplasm of larynx
Malignant neoplasm of bronchus and lung
Malignant melanoma of skin
Malignant neoplasm of breast
Malignant neoplasm of cervix uteri
Malignant neoplasm of corpus uteri and
uterus - part unspecified
Malignant neoplasm of ovary
Malignant neoplasm of prostate
Malignant neoplasm of testis
Bladder
C67
Malignant neoplasm of bladder
C67
Kidney NOS, renal pelvis
C64.9, C65.9
C64–C65
Brain/CNS
Meninges, brain, spinal cord, cranial nerves
and other parts of central nervous system
C70–C72
Thyroid
Hodgkin lymphoma*
Non-Hodgkin lymphoma*
Thyroid gland
Hodgkin lymphoma Non-Hodgkin lymphoma
C73.9
Type 9650–9667
Type 9590–9597, 9670–9719,
9724–9729, 9735, 9737, 9738
Malignant neoplasm of kidney and of renal
pelvis
Malignant neoplasm of meninges, brain,
spinal cord, cranial nerves and other parts of
central nervous system
Malignant neoplasm of thyroid gland
Hodgkin lymphoma Follicular lymphoma, non-follicular
lymphoma, mature T/NK-cell lymphomas,
other and unspecified types of non-Hodgkin
lymphoma, and true histiocytic lymphoma
Multiple myeloma, extramedullary
plasmacytoma
C90.0, C90.2
Name used in the text
Oral
Esophagus
Stomach
Colorectal
C56
C61
C62
CNS=central nervous system
Multiple myeloma*
Canadian Cancer Society
C22.0, C22.2–C22.7
C25
C32
C34
C43
C50
C53
C54–C55
Myeloma, plasmacytoma
n
Canadian Cancer Statistics 2015
Type 9811-9818, 9823, 9827, 9837
all sites except C42.0, 42.1, 42.4
Type 9731, 9732, 9734
C70–C72
C73
C81
C82–C85, C96.3
* For incidence, histology types
9590–9992 (leukemia, lymphoma
and multiple myeloma),
9050–9055 (mesothelioma) and
9140 (Kaposi sarcoma) are
excluded from other specific organ
sites.
Note: ICD-O-3 refers to the
International Classification of
Diseases for Oncology, Third
Edition.(2) ICD-10 refers to the
International Statistical
Classification of Diseases and
Related Health Problems, Tenth
Revision.(4)
137
APPENDIX II: Data sources and methods
TABLE A10 Cancer definitions (continued)
Name used in the text
Leukemia*
ICD-O-3 names
(incidence)
ICD-O-3 Site/Type
(incidence)
ICD-10 names
(mortality)
ICD-10 Site/Type
(mortality)
Lymphoid leukaemia, myeloid leukaemia,
monocytic leukaemia, other leukaemias
of specified cell type, and leukaemia of
unspecified cell type
Type 9733, 9742, 9800–9801,
9805-9809, 9820, 9826, 9831–
9836, 9840, 9860–9861, 9863,
9865–9867, 9869–9876, 9891,
9895–9898, 9910, 9911, 9920,
9930–9931, 9940, 9945–9946,
9948, 9963–9964
Lymphoid leukaemia, myeloid leukaemia,
monocytic leukaemia, other leukaemias
of specified cell type, and leukaemia of
unspecified cell type
C91–C95, C90.1
All other cancers
All other and unspecified cancers
All cancers
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
Type 9811-9818, 9823, 9827, 9837
sites C42.0, 42.1, 42.4
All sites C00–C80, C97 not listed
above
Type 9140, 9740, 9741, 9750–9759, Malignant neoplasm: spleen, other
malignant neoplasms of skin, Kaposi
9760–9769, 9950–9962, 9966,
sarcoma, malignant neoplasms of ill9970–9989, 9991, 9992
defined, secondary and unspecified sites,
malignant immunoproliferative diseases,
C76.0–C76.8 (type 8000–9592)
multifocal and multisystemic (disseminated)
C80.9 (type 8000–9592)
Langerhans-cell histiocytosis [Letterer-Siwe
C42.0–C42.4 (type 8000–9592)
disease], malignant mast cell tumour,
C77.0–C77.9 (type 8000–9592)
C44.0–C44.9 excluding type 8050– other specified malignant neoplasms of
lymphoid, haematopoietic and related tissue,
8084, 8090–8110, 8720–8790,
histiocytic sarcoma, malignant neoplasm of
9590–9992
lymphoid, haematopoietic and related tissue,
unspecified
All invasive sites
All sites C00–C80,
C97 not listed above
C26.1, C44, C46,
C76–C80, C88,
C96.0–.2, C96.7–.9,
C97
All invasive sites
CNS=central nervous system
* For incidence, histology types
9590–9992 (leukemia, lymphoma
and multiple myeloma),
9050–9055 (mesothelioma) and
9140 (Kaposi sarcoma) are
excluded from other specific organ
sites.
Note: ICD-O-3 refers to the
International Classification of
Diseases for Oncology, Third
Edition.(2) ICD-10 refers to the
International Statistical
Classification of Diseases and
Related Health Problems, Tenth
Revision.(4)
138
APPENDIX II: Data sources and methods
TABLE A11-1 Recent cancer definition changes in incidence
New definitions
Bladder
Colorectal
Kidney
Lung
ICD-O-3 C67 (including in situ cancers, except
for Ontario since this province does not report
in situ bladder cancer)
ICD-O-3 C18–C20, C26.0
ICD-O-3 C64–C65
ICD-O-3 C34
Year changed
2006
ICD-O-3, C67 (not including in situ cancers)
2011
2008
ICD-O-3 C18–C21, C26.0
ICD-O-3 C64–C66, C68
ICD-O-3 C33-C34 (before 2006)
ICD-O-3 C34 (in 2006)
ICD-O-3 C33–C34 (in 2007)
ICD-O-3 C56, C57.0–C57.4
2008
Ovary
ICD-O-3 C56
Old definitions
2006
Note: According to ICD-O-3, incidence for bladder, colorectal, kidney, lung
and ovary cancers excludes histology types 9590–9992 (leukemia,
lymphoma and multiple myeloma), 9050–9055 (mesothelioma) and 9140
(Kaposi sarcoma). ICD-O-3 refers to the International Classification of
Diseases for Oncology, Third Edition.(2)
TABLE A11-2 Recent cancer definition changes in mortality
New definition
Colorectal
Kidney
Leukemia
Liver
ICD-10 C18–C20, C26.0
ICD-10 C64–C65
ICD-10 C91–C95, C90.1
ICD-10 C22.0, C22.2–C22.7
Lung
ICD-10 C34
Year changed
2012
2008
2008
2007
2008
Multiple myeloma
ICD-10 C90.0, C90.2
Ovary
All other and
unspecified cancers
ICD-10 C56
ICD-10 C44, C46, C76–C80, C88,C96.0–C96.2,
C96.7–C96.9, C97
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
2008
2006
2007
Old definitions
ICD-10 C18–C21, C26.0
ICD-10 C64–C66, C68
ICD-10 C91–C95
ICD-10 C22 (before 2006)
ICD-10 C22.0, C22.2–C22.9 (in 2006)
ICD-10 C33–C34 (before 2006)
ICD-10 C34 (in 2006)
ICD-10 C33–C34 (in 2007)
ICD-10 C88, C90 (before 2007)
ICD-10 C90 (in 2007)
ICD-10 C56, C57.0–C57.4
ICD-10 C44, C46, C76–C80,C96.0–C96.2,
C96.7–C96.9, C97
Note: ICD-10 refers to the International Statistical Classification of Diseases
and Related Health Problems, Tenth Revision.(4)
139
APPENDIX II: Data sources and methods
TABLE A12 Use of five-year average method* for incidence projection by cancer type, sex and province, 2015
BC
M
AB
F
M
SK
F
M
MB
F
M
ON
F
M
QC
F
M
NB
F
M
NS
F
M
All cancers
PE
F
M
NL
F
M
F
l
Lung
Breast
l
Colorectal
l
l
Prostate†
n
n
n
Bladder
Non-Hodgkin lymphoma
n
Melanoma
Kidney
l
Thyroid
n
l
n
n
n
n
l
n
l
n
l
n
l
n
Body of uterus
l
l
n
l
l
n
l
CNS=central nervous system
l
Leukemia
l
Pancreas
n
l
n
l
n
l
n
l
n
Oral
l
l
l
l
n
l
Stomach
l
l
l
l
n
l
l
n
Brain/CNS
n
l
n
l
n
l
n
Ovary
l
l
l
n
l
l
l
Multiple myeloma
n
l
n
l
n
l
n
l
n
l
n
l
Liver
n
l
n
l
n
l
n
l
n
l
n
l
Esophagus
n
l
n
l
n
l
n
l
n
l
n
Cervix
l
Larynx
l
l
Testis
n
l
n
Hodgkin lymphoma
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
* Nordpred Power5 regression
model is the default for all provinces
except when the average annual
cases for the most recent five years
is less than or equal to 50, when
the five-year average estimate is the
default.
†
An annual age-specific trend
Power5 projection model is the
default for prostate cancer. In place
of the five-year average as an
alternative, the last available year of
data was used for prostate cancer
to better capture recent changes
observed for this cancer.
Note: For territories (not shown),
five-year average method was used
for “All cancers” because of small
numbers.
M=males; F=females. BC=British Columbia; AB=Alberta; SK=Saskatchewan; MB=Manitoba; ON=Ontario; QC=Quebec; NB=New Brunswick; NS=Nova Scotia; PE=Prince Edward Island; NL=Newfoundland and Labrador.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
140
APPENDIX II: Data sources and methods
TABLE A13 Use of five-year average method* for mortality projection by cancer type, sex and province, 2015
BC
M
AB
F
M
SK
F
M
MB
F
M
ON
F
M
QC
F
M
NB
F
M
NS
F
M
PE
F
NL
M
F
M
F
Lung
n
l
Colorectal
n
l
l
n
l
All cancers
Breast
l
Pancreas
n
Prostate
n
Leukemia
l
Non-Hodgkin lymphoma
Bladder
l
Stomach
l
Esophagus
Brain/CNS
Kidney
l
l
n
l
n
l
n
n
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
CNS=central nervous system
l
* Nordpred Power5 regression
model is the default for all provinces
except when the average annual
deaths for the most recent five
years is less than or equal to 50,
when the five-year average estimate
is the default.
Ovary
l
Multiple myeloma
n
Oral
l
Liver
Melanoma
l
n
l
l
n
n
l
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
n
l
n
l
l
n
l
n
l
n
l
n
l
n
n
Body of uterus
l
n
n
l
Larynx
l
l
n
Cervix
l
l
l
l
n
l
l
l
l
n
l
l
l
n
l
l
l
n
l
l
l
l
n
l
l
Note: For territories (not shown),
five-year average method was used
for “All cancers” because of small
numbers.
M=males; F=females. BC=British Columbia; AB=Alberta; SK=Saskatchewan; MB=Manitoba; ON=Ontario; QC=Quebec; NB=New Brunswick; NS=Nova Scotia; PE=Prince Edward Island; NL=Newfoundland and Labrador.
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
141
APPENDIX III: Previous special topics, abbreviations and index
Previous special topics
Special topics are related to current or ongoing issues in cancer surveillance or cancer control. In particular, they aim to provide an in-depth look at the Canadian context.
The following previous special topics are available at cancer.ca/statistics:
2014
Skin cancers
2001 Colorectal cancer
2013
Liver cancer
2000 Progress in cancer control
2011
Colorectal cancer
2010 End-of-life care
Cancer in depth: esophagus cancer
Cancer in depth: kidney cancer
1999 Factors contributing to the population burden
of cancer incidence and mortality
A new national cancer surveillance system
for Canada
2009 Cancer in adolescents and young adults
(15–29 years)
2008 Childhood cancer (ages 0–14)
2007 Breast cancer
2006 Progress in cancer control: screening
2005 Progress in cancer prevention: modifiable risk factors
2004 International variation in cancer incidence, 1993–1997
Economic burden of cancer in Canada, 1998
2003 Non-Hodgkin’s lymphoma
2002 Cancer incidence in young adults
Five-year relative cancer survival in Canada, 1992
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
1998 International comparisons
1997 Ten years of Canadian cancer statistics
1996 Prostate cancer
Direct costs of cancer in Canada, 1993
Evaluation of cancer estimates: 1987–1991
1995 Prevalence of cancer
Colorectal cancer
1993 Female breast cancer
1991 Smoking and lung cancer
Cancer among the Inuit and Indians
1990 Cancer of the female breast and genital organs –
recent trends
Hodgkin’s disease and cancer of the testis
Cancer mortality by income quintile
Economic cost of illness in Canada
Cancer control
1989 Cancer incidence and mortality: an international
comparison
1988 Tobacco consumption from smoking and mortality
from lung cancer
Cancer mortality: an international comparison
142
APPENDIX III: Previous special topics, abbreviations and index
Abbreviations
AAPC
Average annual percent change
APC
Annual percent change
ASIR
Age-standardized incidence rate
ICD-O-3 International Classification of Diseases for Oncology,
Third Edition
ASMR
Age-standardized mortality rate
LDCT
CCR
Canadian Cancer Registry
NCIRS National Cancer Incidence Reporting System
CI
Confidence interval
NMSC
Non-melanoma skin cancer
CRMM Cancer Risk Management Model
OSP
Observed survival proportion
CNS
PSA
Prostate-specific antigen
CVS: D Canadian Vital Statistics – Death database
PYLL
Potential years of life lost
DCO
RSR
Relative survival ratio
SEER
Surveillance, Epidemiology, and End Results Program
Central nervous system
Death certificate only
HAART Highly active antiretroviral therapy
HIV
ICD-10 International Statistical Classification of Diseases and
Related Health Problems, Tenth Revision
Low-dose computed tomography
Human immunodeficiency virus
ICCC-3 International Classification of Childhood Cancer,
Third Edition
Canadian Cancer Society
n
Canadian Cancer Statistics 2015
143
APPENDIX III: Previous special topics, abbreviations and index
Index of tables and figures
Tables
1.1 Lifetime probability of developing cancer overall and
by age group, Canada, 2010 . . . . . . . . . . . . . . . . . 24
1.2 Estimated new cases and age-standardized incidence
rates (ASIR) for cancers by sex, Canada, 2015 . . . . . 25
1.3 Age-standardized incidence rates (ASIR) for selected
cancers, males, Canada, 1986–2015 . . . . . . . . . . . 26
1.4 Age-standardized incidence rates (ASIR) for selected
cancers, females, Canada, 1986–2015 . . . . . . . . . . 27
1.5 Annual percent change (APC) in age-standardized
incidence rates for selected cancers, by sex, Canada,
2001–2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.1 Estimated population and new cases for all cancers
by age group and sex, Canada, 2015 . . . . . . . . . . . 34
2.2 Estimated new cases for the most common cancers
by age group and sex, Canada, 2015 . . . . . . . . . . . 34
2.3 Estimated population and new cases for all cancers
by sex and geographic region, Canada, 2015 . . . . . 35
3.3 Age-standardized mortality rates (ASMR) for selected
cancers, males, Canada, 1986–2015 . . . . . . . . . . . 48
3.4 Age-standardized mortality rates (ASMR) for selected
cancers, females, Canada, 1986–2015 . . . . . . . . . . 49
3.5 Annual percent change (APC) in age-standardized
mortality rates (ASMR) for selected cancers, by sex,
Canada, 2001–2010 . . . . . . . . . . . . . . . . . . . . . . . 50
4.1 Estimated population and deaths for all cancers
by age group and sex, Canada, 2015 . . . . . . . . . . . 56
4.2 Estimated deaths for the most common cancers
by age group and sex, Canada, 2015 . . . . . . . . . . . 56
4.3 Estimated population and deaths for all cancers
by sex and geographic region, Canada, 2015 . . . . . 57
4.4 Estimated deaths for selected cancers by sex and
province, Canada, 2015 . . . . . . . . . . . . . . . . . . . . 58
4.5 Estimated age-standardized mortality rates (ASMR)
for selected cancers by sex and province, Canada,
2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
2.4 Estimated new cases for selected cancers by sex and
province, Canada, 2015 . . . . . . . . . . . . . . . . . . . . 36
5.1 Five-year relative and observed survival for selected
cancers by sex, ages 15–99 years at diagnosis,
Canada (excluding Quebec), 2006–2008 . . . . . . . . . . 66
2.5 Estimated age-standardized incidence rates (ASIR)
for selected cancers by sex and province, Canada,
2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
5.2 Age-standardized five-year relative survival ratios (RSRs)
for the most common cancers by province, Canada
(excluding Quebec), 2006–2008 . . . . . . . . . . . . . . . . 67
3.1 Lifetime probability of dying from cancer overall and
by age group, Canada, 2010 . . . . . . . . . . . . . . . . . 46
5.3 Five-year relative survival ratios (RSRs) for the most
common cancers by age group, Canada
(excluding Quebec), 2006–2008 . . . . . . . . . . . . . . 67
3.2 Estimated deaths and age-standardized mortality
rates (ASMR) for cancers by sex, Canada, 2015 . . . . 47
Canadian Cancer Society
n
5.4 Five-year relative survival ratios (RSRs) conditional
on having survived the specified number of years,
for selected cancers, ages 15–99 years at diagnosis,
Canada (excluding Quebec), 2006–2008 . . . . . . . . . . 68
5.5 Five-year observed survival proportions (OSP) by
diagnostic group and selected subgroup,
ages 0–14 years at diagnosis, Canada
(excluding Quebec), 2004–2008 . . . . . . . . . . . . . . 69
6.1 Tumour-based prevalence for selected cancers by
prevalence duration and sex, Canada, January 1,
2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
6.2 Age distribution for 10-year tumour-based prevalence
for the most common cancers by sex, Canada,
January 1, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . 75
6.3 Person-based prevalence for selected cancers by
prevalence duration and sex, Canada,
January 1, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . 76
6.4 Ten-year person-based prevalence proportions
for the most common cancers by sex, Canada,
January 1, 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . 77
7.1 Changes in average annual new cases and
age-standardized incidence rates (ASIRs) for cancers
in males, Canada, 2003–07 to 2028–32 . . . . . . . . . 98
7.2 Changes in average annual new cases and
age-standardized incidence rates (ASIRs) for cancers
in females, Canada, 2003–07 to 2028–32 . . . . . . . 99
7.3 Changes in average annual new cases for cancers
in both sexes, by province/territory, 2003–07 to
2028–32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
144
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
APPENDIX III: Previous special topics, abbreviations and index
7.4 Modifiable risk factors associated with selected
cancer types . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Appendix tables
7.5 Projections for selected measures for lung cancer
for status quo (no organized screening) versus
30% participation to LDCT screening and 22.5%
smoking cessation success rate, by province/
territory, Canada, 2015 and 2030 . . . . . . . . . . . . 105
A1
Actual data for new cases of cancer, Canada, 2010 107
A2
Actual data for cancer deaths, Canada, 2010 . . . . 108
A3
Actual data for new cases for the most common
cancers by sex and geographic region, Canada,
2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
7.6 Projections for selected measures for various
screening scenarios for colorectal cancer,
by province/territory, Canada, 2015 and 2030 . . . . 106
B
Selected causes of death and their associated
potential years of life lost (PYLL), Canada, 2010 . . . 11
C
Number of cancer deaths avoided since the cancer
mortality rate peaked in Canada for all cancers
combined, lung and female breast cancers . . . . . . . 12
D
A5
Actual data for cancer deaths for the most common
cancers by sex and geographic region, Canada,
2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Trends in new cases and deaths for all cancers and
ages, attributed to changes in cancer risk and cancer
control practices, population growth and aging of
the population, both sexes, Canada, 1986–2015 . . 14
A6
Actual age-standardized mortality rates (ASMR) for
the most common cancers by sex and geographic
region, Canada, 2010 . . . . . . . . . . . . . . . . . . . . . 112
1.1 Lifetime probability of developing cancer, Canada,
2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
A7
New cases and average annual age-standardized
incidence rates (ASIR) by diagnostic group,
in children (0–14 years), Canada, 2006–2010 . . . . 113
A8
New cases and average annual age-standardized
cancer incidence rates by sex and diagnostic group
in adolescents and young adults (15–29 years),
Canada, 2006–2010 . . . . . . . . . . . . . . . . . . . . . . 114
A11-1Recent cancer definition changes in incidence . . . . 139
A11-2Recent cancer definition changes in mortality . . . . 139
A12 Use of five-year average method for incidence
projection by cancer type, sex and province, 2015 . 140
A13 Use of five-year average method for mortality
projection by cancer type, sex and province, 2015 . 141
Canadian Cancer Statistics 2015
Proportion of deaths due to cancer and other causes,
Canada, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Actual age-standardized incidence rates (ASIR) for
the most common cancers by sex and geographic
region, Canada, 2010 . . . . . . . . . . . . . . . . . . . . . 110
A10 Cancer definitions . . . . . . . . . . . . . . . . . . . . . . . . 137
n
A
A4
A9 Deaths and average annual age-standardized
cancer mortality rates (ASMR) by sex and diagnostic
group in adolescents and young adults (15–29 years),
Canada, 2005–2009 . . . . . . . . . . . . . . . . . . . . . . 115
Canadian Cancer Society
Figures
1.2 Percent distribution of estimated new cancer cases,
by sex, Canada, 2015 . . . . . . . . . . . . . . . . . . . . . . 17
1.3 New cases and age-standardized incidence rates
(ASIR) for all cancers, Canada, 1986–2015 . . . . . . . 18
1.4 Age-standardized incidence rates (ASIR) for selected
cancers, males, Canada, 1986–2015 . . . . . . . . . . . 19
1.5 Age-standardized incidence rates (ASIR) for selected
cancers, females, Canada, 1986–2015 . . . . . . . . . . 20
2.1 Age-standardized incidence and mortality rates for
all cancers combined, by sex, Canada, 1986–2015 . 29
2.2 Distribution of new cancer cases for selected cancers
by age group, Canada, 2006–2010 . . . . . . . . . . . . 30
2.3 Age-standardized incidence rates (ASIR) for all
cancers, by age group, Canada, 1986–2015 . . . . . . 31
2.4 Geographic distribution of estimated new cancer
cases and age-standardized incidence rates (ASIR)
by province and territory, both sexes, Canada, 2015 . 32
145
APPENDIX III: Previous special topics, abbreviations and index
3.1 Lifetime probability of dying from cancer, Canada,
2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1 Current and projected population, by sex and age,
Canada, 2003–07 and 2028–32 . . . . . . . . . . . . . . 80
3.2 Percent distribution of estimated cancer deaths,
by sex, Canada, 2015 . . . . . . . . . . . . . . . . . . . . . . 39
7.2 Average annual new cases and age-standardized
incidence rates (ASIRs) for all cancers, Canada,
1983–2032 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
3.3 Deaths and age-standardized mortality rates (ASMR)
for all cancers, Canada, 1986–2015 . . . . . . . . . . . . 40
3.4 Age-standardized mortality rates (ASMR) for selected
cancers, males, Canada, 1986–2015 . . . . . . . . . . . 41
3.5 Age-standardized mortality rates (ASMR) for selected
cancers, females, Canada, 1986–2015 . . . . . . . . . . 42
4.1 Age-standardized incidence and mortality rates for
all cancers combined, by sex, Canada, 1986–2015 . 51
4.2 Distribution of cancer deaths for selected cancers
by age group, Canada, 2006–2010 . . . . . . . . . . . . 52
7.3 Current and projected distribution of average
annual new cancer cases, by sex and age, Canada,
2003–07 and 2028–32 . . . . . . . . . . . . . . . . . . . . 82
7.4 Trends in average annual new cases for all cancers
and ages, attributed to changes in cancer risk,
population growth, and aging population,
Canada, 2003–2032 . . . . . . . . . . . . . . . . . . . . . . 83
7.5 Average annual new cases by cancer type and
percentage change, Canada, 2028–32 versus
2003–07 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.3 Age-standardized mortality rates (ASMR) for all
cancers, by age group, Canada, 1986–2015 . . . . . . 53
7.6 Projected change in distribution of cancers in males
and females, Canada, 2003–07, 2018–22 and
2028–32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.4 Geographic distribution of estimated cancer deaths
and age-standardized mortality rates (ASMR) by
province and territory, both sexes, Canada, 2015 . . . 54
7.7 Age-standardized incidence rates (ASIRs) for
selected cancers, Canada, 1985–2030 . . . . . . . . . . 86
5.1 One-, three-, five- and ten-year relative survival ratios
(RSRs) for the most common cancers, ages 15–99
at diagnosis, Canada (excluding Quebec),
2006–2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
7.9 Projected number of new cases of lung cancer under
selected screening strategies, Canada, 2015–2030 . 90
5.2 Age-standardized five-year relative survival ratio (RSR)
for selected cancers, Canada (excluding Quebec),
2006–2008 versus 1992–1994 . . . . . . . . . . . . . . . 63
6.1 Distribution of 10-year tumour-based prevalence for
selected cancers, Canada, January 1, 2009 . . . . . . . 71
7.8 Age-standardized incidence rates (ASIRs) for all
cancers by age group, Canada, 1983–2032 . . . . . . 88
7.10 Projected number of new cases of colorectal cancer
under selected screening strategies and levels of
participation, Canada, 2015–2030 . . . . . . . . . . . . . 92
7.11 Projected incremental (relative to status quo
screening with vaccination) total healthcare costs
(vaccination, screening, pre-cancer and cancer
treatment) by year, Canada, 2015–2030 . . . . . . . . . 94
6.2 Tumour-based prevalence for the most common
cancers by duration, Canada, January 1, 2009 . . . . . 72
Canadian Cancer Society
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146
For further information
Partner organizations
Canadian Council of Cancer Registries
Statistics Canada
Cancer incidence data are supplied to Statistics Canada
by provincial and territorial cancer registries. Detailed
information regarding the statistics for each province
or territory is available from the relevant registry.
statcan.gc.ca (search “cancer”)
Public Health Agency of Canada
phac-aspc.gc.ca (select “surveillance”)
More detailed information on the methodology used
in this publication is available from the Chronic
Disease Surveillance and Monitoring Division,
CCDP, Public Health Agency of Canada,
785 Carling Avenue, Ottawa, Ontario, K1A 0K9.
Email: [email protected]
Chronic Disease Infobase Cubes (infobase.phac-aspc.
gc.ca) is an interactive online tool for easy access to
cancer surveillance data. It allows you to generate
tables, chart and maps according to a choice of
parameters, such as cancer type, geographic area and
time period.
More detailed information on the survival and/or
prevalence methodology used in this publication is
available from the Health Statistics Division, Statistics
Canada, National Enquiries Line (1-800-263-1136) or
through Client Services in the Health Statistics
Division (613-951-1746).
Custom tabulations are available on a cost-recovery
basis upon request. Analytical articles appear regularly
in Health Reports, Statistics Canada, Catalogue no.
82-003. Detailed standard tables are available on the
Statistics Canada website (statcan.gc.ca).
Canadian Cancer Society
cancer.ca
For general information about cancer (such as cancer
prevention, screening, diagnosis, treatment or care),
contact the Canadian Cancer Society’s Cancer
Information Service at 1-888-939-3333 or the
Canadian Cancer Society, National Office or divisional
offices.
For information about research funded by the
Canadian Cancer Society, visit cancer.ca/research or
contact the Canadian Cancer Society Research
Institute, National Office, at [email protected]
Canadian Cancer Society
n
147
Canadian Cancer Statistics 2015
All other
cancers
Prostate
21.0%
For further information
Canadian Council of Cancer Registries
NEW BRUNSWICK
NEWFOUNDLAND AND LABRADOR
Dr Eshwar Kumar
Co-Chief Executive Officer
New Brunswick Cancer Network
Department of Health
Place Carleton Place, 2nd floor
520 King Street, PO Box 5100
Fredericton, NB E3B 5G8
Elaine Warren
Director, Cancer Care Program
Eastern Health
Dr H. Bliss Murphy Cancer Centre
300 Prince Philip Drive
St John’s, NL A1B 3V6
Tel: 709-777-6521
Fax: 709-753-0927
easternhealth.ca
PRINCE EDWARD ISLAND
Kim Vriends
Manager, PEI Cancer Registry
PEI Cancer Treatment Centre
Riverside Drive
Charlottetown, PE C1A 8T5
Tel: 902-894-2167
Fax: 902-894-2187
Tel: 506-453-5521
Fax: 506-453-5522
Maureen MacIntyre
Director, Surveillance and Epidemiology Unit
Cancer Care Nova Scotia
1276 South Park Street
Bethune Building, Room 569
Halifax, NS B3H 2Y9
Tel: 902-473-6084
Fax: 902-425-9614
Gail Noonan
Manager, Manitoba Cancer Registry
CancerCare Manitoba
675 McDermot Avenue, Room ON4025
Winnipeg, MB R3E 0V9
Tel: 204-787-2573
Fax: 204-786-0629
cancercare.mb.ca
gnb.ca/0051/cancer/index-e.asp
SASKATCHEWAN
QUEBEC
Heather Stuart-Panko
Director, Cancer Registry
Saskatchewan Cancer Agency, 2nd Floor
#200-4545 Parliament Avenue
Regina, SK S4W 0G3
Rabiâ Louchini
Pilote d’orientation du Registre québécois du cancer
Ministère de la Santé et Services sociaux
1075, Chemin Ste-Foy, 7e étage
Québec, QC G1S 2M1
Tel: 418-266-6713
Fax: 418-266-5862
http://msssa4.msss.gouv.qc.ca/santpub/tumeurs.nsf/
cat?OpenView
NOVA SCOTIA
MANITOBA
ONTARIO
Mary Jane King
Manager, Ontario Cancer Registry
Analytics and Informatics
Cancer Care Ontario
620 University Avenue
Toronto, ON M5G 2L7
Tel: 639-625-2042
Fax: 639-625-2191
saskcancer.ca
ALBERTA
Cindy Nikiforuk
Director, Alberta Cancer Registry
Cross Cancer Institute, Room 2133
11560 University Avenue
Edmonton, AB T6G 1Z2
Tel: 780-432-8781
Fax: 780-432-8659
albertahealthservices.ca
Tel: 416-217-1260
Fax: 416-217-1304
cancercare.ns.ca
cancercare.on.ca
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For further information
YUKON
NORTHWEST TERRITORIES
Marguerite Fenske
Manager Health Informatics
Insured Health and Hearing Services
Box 2703 (H-2)
Whitehorse, YK Y1A 2C6
Heather Hannah
Territorial Epidemiologist
Epidemiology & Disease Registries
Office of the Chief Public Health Officer
Department of Health and Social Services
Government of the NWT
Box 1320, 5022 49th Street
Centre Square Tower, 6th Floor
Yellowknife, NT X1A 2L9
Tel: 867-393-6925
Fax: 867- 393-6486
hss.gov.yk.ca/insured_services.php
BRITISH COLUMBIA
Ryan Woods
Scientific Director, BC Cancer Registry
BC Cancer Agency
Cancer Control Research Unit
675 West 10th Avenue, Room #2-116
Vancouver, BC V5Z 1L3
Tel: 604-675-8070
Fax: 604-675-8180
bccancer.bc.ca
Tel: 867-920-3241
Fax: 867-873-0442
hss.gov.nt.ca
STATISTICS CANADA
Josée Bégin
Director, Health Statistics Division
RH Coats Building, 12th Floor
100 Tunney’s Pasture Driveway
Ottawa, ON K1A 0T6
Tel: 613-951-4041
Fax: 613-951-0792
NUNAVUT
Mike Ruta
Manager, Population Health Information
Department of Health
Government of Nunavut
Box 1000, Station 1033
Iqaluit, NU X0A 0H0
statcan.gc.ca
Tel: 867-975-5917
Fax: 867-975-5946
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149
For further information
Canadian Cancer Society offices
NATIONAL
MANITOBA
ONTARIO
55 St Clair Avenue West, Suite 300
Toronto, ON M4V 2Y7
193 Sherbrook Street
Winnipeg, MB R3C 2B7
55 St Clair Avenue West, Suite 500
Toronto, ON M4V 2Y7
Tel: 416-961-7223
Fax: 416-961-4189
[email protected]
Toll-free: 1-888-532-6982
Tel: 204-774-7483
Fax: 204-774-7500
[email protected]
Toll-free: 1-800-268-8874
Tel: 416-488-5400
Fax: 416-488-2872
[email protected]
NEW BRUNSWICK
PRINCE EDWARD ISLAND
PO Box 2089
133 Prince William Street
Saint John, NB E2L 3T5
1 Rochford Street, Suite 1
Charlottetown, PE C1A 9L2
For more information about cancer:
[email protected] 1 888 939-3333
ALBERTA AND NORTHWEST TERRITORIES
325 Manning Road NE, Suite 200
Calgary, AB T2E 2P5
[email protected]
Toll-free: 1-866-566-4007
Tel: 902-566-4007
Fax: 902-628-8281
[email protected]
NEWFOUNDLAND AND LABRADOR
QUEBEC
PO Box 8921
Daffodil Place
70 Ropewalk Lane
St John’s, NL A1B 3R9
5151 de l’Assomption Blvd
Montreal, QC H1T 4A9
Toll-free: 1-800-661-2262
Tel: 403-205-3966
Fax: 403-205-3979
[email protected]
Tel: 506-634-6272
Fax: 506-634-3808
BRITISH COLUMBIA AND YUKON
565 West 10th Avenue
Vancouver, BC V5Z 4J4
Toll-free: 1-800-663-2524
Tel: 604-872-4400
Fax: 604-872-4113
[email protected]
Toll-free: 1-888-753-6520
Tel: 709-753-6520
Fax: 709-753-9314
[email protected]
NOVA SCOTIA
5826 South Street, Suite 1
Halifax, NS B3H 1S6
Toll-free: 1-800-639-0222
Tel: 902-423-6183
Fax: 902-429-6563
[email protected]ns.cancer.ca
Canadian Cancer Society
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Canadian Cancer Statistics 2015
Tel: 514-255-5151
Fax: 514-255-2808
[email protected]
SASKATCHEWAN
1910 McIntyre Street
Regina, SK S4P 2R3
Toll-free: 1-877-977-4673
Tel: 306-790-5822
Fax: 306-569-2133
[email protected]
150
Questions about cancer?
When you want to know more about cancer, call
the Canadian Cancer Society’s Cancer Information Service.
1-888-939-3333 Monday to Friday
cancer.ca

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