• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Cancer in Ontario

 

Key findings

As the incidence of cancer increases and deaths from cancer decrease, the number of people living with cancer in Ontario is expected to rise. Evidence shows that the 5-year relative survival ratio for most of the common cancers has improved over time.

How do incidence, mortality, survival and prevalence relate to one another?

  • Incidence is a measure of cancer burden in a population. It describes the number of new cases of cancer diagnosed in a given time period and often is expressed as a rate per 100,000 population.
  • Mortality describes the number of cancer deaths in a given time period; as with incidence, it often is expressed as a rate per 100,000 population. Mortality is determined by both incidence and survival.
  • Cancer survival in a population describes the average prognosis after a cancer diagnosis, and it is usually compared to that of the general population. It is typically expressed as a 5-year relative survival ratio.
  • Prevalence describes both the number of people in a population who have been diagnosed with cancer in a given time period and those who are still alive on a given date. It includes both new (incident) and existing cases, and it is determined by both incidence and survival.

Rates and ratios for the measures highlighted above are age-adjusted to allow comparison over time.

The standard population used for age adjustment of the rates is the 2011 Canadian census population. Using the 2011 standard population for age standardization results in rates that are closer to the crude rate. For example, the 2012 age-standardized incidence rate (ASIRs) for prostate cancer using the 1991 population was 102.7 per 100,000; it was 136.2 per 100,000 using the 2011 standard population. The crude rate was 129.0 per 100,000.

See Technical information for more details on our analysis, as well as definitions of cancer.

Incidence

  • The number of new cancer cases diagnosed each year (the incidence) in Ontario has increased annually since 1981. Aging of the population and population growth have contributed proportionally more new cases of cancer over the last 3 decades than any changes in the risk of developing cancer (also referred to as the change in the cancer rate) (Figure 1). In 2016, approximately 85,648 new cancer cases are projected to occur, an 189% increase over the 29,649 new cancer cases reported in 1981. Of those additional cases, 89.2% will be due to population growth, 80.3% will be due to aging of the population and 19.5% will be due to changes in the cancer rate.
  • Cancer risk in a population is related to many things in addition to age, such as the following:
    • prevalence of important risk factors that are both modifiable (e.g. tobacco use, obesity or sexual behaviours) and non-modifiable (e.g. reproductive and hormonal factors, or genetics);
    • prevalence of protective behaviours, including uptake of human papillomavirus (HPV) vaccines;
    • screening patterns (availability, type and uptake); and
    • exposure to environmental or occupational carcinogens (such as asbestos).
  • Changes over time in some of these underlying factors result in changes to incidence rates. It can be difficult to make direct connections between exposure to risk factors and the burden of cancer in the population, however, because cancer can develop quickly or slowly after exposure. Lung cancer rates, for example, typically take upwards of 20 years to reflect changes in provincial smoking rates, while rapid uptake of screening can result in an apparent sudden rise in cancer diagnoses because cancers are discovered earlier than they otherwise would have been.
  • In 2012, the most commonly diagnosed cancers in Ontario for males were prostate (22%), lung (13%) and colorectal (13%). For females, the most common cancers were breast (27%), lung (13%) and colorectal (11%) (Figures 2 and 3).
  • Starting with 2010 diagnoses, the Ontario Cancer Registry rules for counting multiple primary cancers were changed to align the registry with the North American standard. This change has resulted in more cancer cases being counted for certain cancer types, but it does not reflect an increase in the number of people being diagnosed with cancer in the province. The impact of this change differs by cancer type, with some cancers (such as female breast) showing a particularly large increase in incidence rates, while others (such as colorectal and lung) show more modest increases (Figures 4–6).
  • Incidence rates for all cancers combined in males increased significantly by 0.9% per year from 1981 to 1992 and declined significantly by 0.2% per year from 1992 to 2012. For females, incidence rates for all cancers combined increased significantly by 0.4% per year from 1981 to 2008 and by 1.2% per year from 2008 to 2012 (Figure 4).
  • Incidence rates for 3 of the most common cancers diagnosed in males in Ontario—prostate, lung and colorectal—are stable (i.e. there is no statistically upward or downward trend) or declining (Figure 5).
    • Prostate cancer incidence rates rose at a rate of 1% per year from 1992 to 2007; they then fell by approximately 5% annually from 2007 to 2012. The incidence rate peaked twice: in 1993 and 2001. The first peak likely coincided with the introduction of prostate-specific antigen (PSA) testing in 1988 (an abrupt rise and fall in incidence is common when a new method of early diagnosis is introduced).
    • Lung cancer incidence decreased 2.1% per year from 1989 to 2008 and then stabilized.
    • Colorectal cancer incidence declined steadily from the early 1980s at 0.3% per year, although the trend line visually suggests a slight rise from the late 1990s, followed by a fall after 2001. This also reflects the rectal cancer trend in males. The colon cancer incidence rates for males declined throughout the period.
  • Incidence rates for 3 of the most common cancers diagnosed in females in Ontario—breast, lung and colorectal—are increasing or declining in Ontario (Figure 6).
    • Breast cancer incidence rates increased at 2% per year from the 1980s to the early 1990s. They then decreased by 0.2% per year from 1992 to 2012.
    • Lung cancer incidence rates have been increasing since the 1980s, but the upward trend has been slowing: the rates increased by 6.4% per year from 1981 to 1985, by 2.1% per year from 1985 to 1996, and by only 0.8% per year from 1996 to 2012.
    • Colorectal cancer incidence in females is complex: rates fell by 1.2% per year from 1982 to 1996, rose (non-significantly) from 1996 to 1999, and fell again from 1999 onwards (0.6% annually). This reflects the rectal cancer trend in females of a rise in the number of incidences from 1996 to 1999. The colon cancer incidence rates declined steadily throughout the period.

Mortality

  • Mortality is a function of both incidence and survival. Mortality rates therefore reflect the impact both of factors that influence cancer risk and of population-level interventions (such as screening and treatment).
  • Mortality rates for all cancers combined in males increased significantly by 0.5% per year from 1981 to 1988. They declined significantly by 0.9% per year from 1988 to 2001, and by 1.8% from 2001 to 2012. For females, mortality rates for all cancers combined steadily declined by 0.3% per year from 1985 to 2002 and by 1.4% per year from 2002 to 2012 (Figure 7).
  • Mortality rates for 3 of the most common cancers diagnosed in males in Ontario—prostate, lung and colorectal—are declining in Ontario (Figure 8).
    • Prostate cancer mortality rates rose at a rate of 1.6% per year from 1981 to 1994. They then fell by 2.8% annually from 1994 to 2012.
    • Lung cancer mortality rates began to level off in the late 1980s and have been declining ever since by 2.1% per year.
    • Colorectal cancer mortality rates have declined steadily since the early 1980s by 1.2% per year from 1981 to 2003, and by 2.8% per year from 2003 to 2012.
  • Mortality rates for 3 of the most common cancers diagnosed in females in Ontario—breast, lung and colorectal—are stable or declining in Ontario (Figure 9).
    • Breast cancer mortality rates have been declining since 1986 by 1.1% per year from 1986 to 1995, and by 2.5% per year from 1995 to 2012.
    • Lung cancer mortality rates increased by 7.4% from 1981 to 1985, and by 1.9% from 1985 to 2000. The rates, however, have been stable since 2000.
    • Colorectal cancer mortality rates have been steadily declining by 1.9% per year since 1981.

How Ontario Compares

  • For more information comparing Ontario’s Mortality rates to other jurisdictions, please see International Comparisons: Mortality & Survival.

Survival

  • Relative survival is a ratio that compares the survival experience of individuals with cancer to that of people of the same age and sex in the general population. It shows the extent to which cancer shortens life, and it is often age-adjusted when comparing survival ratios from different time periods. This is done to account for the fact that the risk of death increases as we age—and the population of Ontario is aging.
  • As a result of advances in treatment and detection (including improvements in diagnostic technologies and the implementation of organized screening programs for some cancers), the 5-year relative survival ratio for most common cancers improved in Ontario from 1998 to 2002 and from 2008 to 2012 (Figure 10).
  • The exceptions to this improvement are uterus and bladder cancer, for which survival declined slightly but not significantly. It is worth noting the following:
    • Other jurisdictions—including the United States of America1,2, Europe3 and South Australia4—have recorded stable or decreasing trends for bladder cancer survival over similar time frames.
    • Beginning in 2005, the increase in volume of more complete pathology reports led to more accurate identification of in situ bladder cases. These subsequently are removed from survival analyses, and survival for the remaining malignant cases is lower. Changes in the distribution of histologic subtypes for bladder cancer, which differ in their survival, also may be a contributor to the slight decline in the 5-year relative survival ratio for this cancer.
  • In spite of improvements, relative survival for certain cancers remains low. Most notable are the 5-year relative survival ratios for cancers of the pancreas, lung and stomach, which are all less than 30%. This means that, compared to Ontarians of the same age and sex, the probability of surviving at least 5 years after a diagnosis of one of these cancers is reduced by more than 70%.
  • It is important to note, however, that the 5-year relative survival ratios for prostate, thyroid, melanoma and female breast cancers are high: 85% or higher. In particular, the 5-year relative survival ratios for prostate and thyroid cancers are 93% or higher.

How Ontario Compares

  • For more information comparing Ontario’s Survival rates to other jurisdictions, please see International Comparisons: Mortality & Survival.

Prevalence

  • For prostate and breast cancers, 10-year prevalence is high (Figure 11). As of January 1, 2013, 75,980 men living in Ontario had been diagnosed with prostate cancer within the previous 10 years. During that same period, 69,209 women living in Ontario had been diagnosed with breast cancer. The prevalence for both of these cancers is high because of their high incidence and good survival rates.
  • Although colorectal cancer is one of the most common cancers in Ontario, the 10-year prevalence for this cancer was only about 44,800 (as of January 1, 2013). This is substantially lower than prevalence for prostate and breast cancer, reflecting the fact that colorectal cancer has lower survival than breast and prostate cancers.
  • Although lung cancer is one of the most common cancers diagnosed in Ontario, it ranks lower for prevalence than the less common cancers of thyroid and melanoma. This is due to the very poor survival for lung cancer (compared with the high survival for thyroid and melanoma).
  • In spite of increasing cancer incidence, more effective treatments and early detection have resulted in more Ontarians surviving cancer with each passing year. As a result, many cancers are now being managed as chronic conditions.
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View Notes

  1. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al., editors. SEER cancer statistics review, 1975–2011. National Cancer Institute [Internet]. 2014 Dec 17 [cited 2015 Mar 18]. Available from: http://seer.cancer.gov/csr/1975_2011/.
  2. David K, Mallin K, Milowsky M, Ritchey J, Carroll P, Nanus D. Surveillance of urothelial carcinoma: stage and grade migration, 1993–2005 and survival trends, 1993–2000. Cancer. 2009; 115(7):1435–47.
  3. Karim-Kos H, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh J. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. European Journal of Cancer. 2008; 44(10):1345–89.
  4. Luke C, Tracey E, Stapleton A, Roder D. Exploring contrary trends in bladder cancer incidence, mortality and survival: implications for research and cancer control. Journal of Internal Medicine. 2010; 40(5):357–62.