• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Cancer in Ontario

 

Key findings

As the incidence rate of cancer increases and death rate from cancer decreases, the number of people living with cancer in Ontario is expected to rise. Statistics show 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 over a given period of time after a cancer diagnosis, and it can be compared to the survival of the general population. It is typically expressed as a 5-year relative survival ratio.
  • Prevalence describes the number of people in a population who are still alive on a given date and includes those who were diagnosed within a given period of time (such as within the past 10 years), and includes those who have been recently diagnosed. Prevalence is determined by both incidence and survival.

Rates and ratios for the measures highlighted above are age-adjusted to allow comparison over time while accounting for changes in the age structure of the population.

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 (i.e. unadjusted rate) than the previously used 1991 Canadian Standard population, which had a different age distribution. For example, the 2013 age-standardized incidence rate (ASIRs) for prostate cancer using the 1991 population was 89.5 per 100,000; it was 118.4 per 100,000 using the 2011 standard population. The crude rate was 114.9 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. An aging population and population growth have contributed proportionally more new cases of cancer over the last 32 years than any changes in the risk of developing cancer (also referred to as the change in the cancer rate) (Figure 1). In 2017, approximately 88,045 new cancer cases are projected to occur, a 196.9% increase over the 29,650 new cancer cases reported in 1981. Of those additional cases, 105.1% will be due to an aging population, 72.3% will be due to population growth and 19.7% 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 risk factors that include those that are modifiable (e.g. tobacco use, obesity, vaccine preventable infections such as hepatitis B) and non-modifiable (e.g. reproductive and hormonal factors, or genetics);
    • prevalence of protective behaviours, including uptake of human papillomavirus (HPV) vaccine;
    • cancer 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 attribute exposure to risk factors and cancer in the population, partly 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 2013, the most commonly diagnosed cancers in Ontario for males were prostate (20%), lung (13%) and colorectal (12%). For females, the most common cancers were breast (27%), lung (12%) and colorectal (10%) (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 rate for all cancers combined in males increased significantly by 0.43% per year from 1981 to 2001 and declined significantly by 0.76% per year from 2001 to 2013. For females, incidence rates for all cancers combined increased significantly by 0.4% per year from 1981 to 2013 (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 rate rose at a rate of 1.2% per year from 1993 to 2007; it then fell by approximately 6% annually from 2007 to 2013. 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 rate decreased by 2.1% per year from 1989 to 2008 and then stabilized.
    • Colorectal cancer incidence rate declined by 0.25% per year from 1981 to 2007; it then further declined at a rate of 1.9% per year from 2007-2013. 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. It 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 rate increased by 6.5% per year from 1981 to 1985, by 2.0% per year from 1985 to 1997 and by only 0.7% per year from 1997 to 2013.
    • Colorectal cancer incidence in females is complex: the rate fell by 1.2% per year from 1982 to 1996, and remained stable (non-significantly) from 1996 to 1999 and fell again from 1999 onwards (1.1% annually). This reflects the rectal cancer trend in females of a rise in the incidence rate from 1996 to 1999. The colon cancer incidence rates declined steadily throughout the period.

Mortality

  • Mortality is a function of both incidence and survival. Therefore, mortality rates reflect the impact of factors that influence cancer risk and of interventions (such as screening and treatment).
  • Mortality rate for all cancers combined in males increased significantly by 0.5% per year from 1981 to 1988. It declined significantly by 0.9% per year from 1988 to 2001, and by 1.8% from 2001 to 2013. For females, the mortality rate for all cancers combined increased significantly by 1.0% per year from 1981 to 1985; it then steadily declined by 0.3% per year from 1985 to 2002 and by 1.4% per year from 2002 to 2013 (Figure 7).
  • Mortality rates for 3 of the most common cancers diagnosed in males in Ontario—prostate, lung and colorectal—are declining (Figure 8).
    • Prostate cancer mortality rate rose at a rate of 1.6% per year from 1981 to 1994. It then fell by 2.8% annually from 1994 to 2013.
    • Lung cancer mortality rates began to level off in the late 1980s and have been declining ever since by 2.2% per year.
    • Colorectal cancer mortality rate declined steadily since the early 1980s by 1.3% per year from 1981 to 2003, and by 3.6% per year from 2003 to 2013.
  • 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 rate has been declining since 1986 by 1.1% per year from 1986 to 1995, and by 2.6% per year from 1995 to 2013.
    • Lung cancer mortality rate increased by 7.4% from 1981 to 1985, and by 1.9% from 1985 to 2000. The rate, however, has been declining ever since by 0.4% per year.
    • Colorectal cancer mortality rate has declined steadily by 1.8% per year from 1981 to 2004, and by 2.7% per year from 2004 to 2013.

How Ontario compares

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 Ontario population 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 1999 to 2003 and from 2009 to 2013 (Figure 10).
  • The exceptions to this improvement are uterus and bladder cancers, for which survival declined slightly but not significantly. It is worth noting the following:
    • Other jurisdictions—including the United States of America, Europe and South Australia-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, may also 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 32%. 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 68%.
  • It is important to note, however, that the 5-year relative survival ratios for thyroid, prostate, female breast and melanoma cancers are high: 85% or higher. In particular, the 5-year relative survival ratios for thyroid and prostate cancers are 93% or higher.

Prevalence

  • For prostate and breast cancers, 10-year prevalence is high (Figure 11). As of January 1, 2014, 75,634 men living in Ontario had been diagnosed with prostate cancer within the previous 10 years. During that same period, 71,355 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 45,617 (as of January 1, 2014). This is substantially lower than prevalence for prostate and breast cancer, reflecting 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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Age-standardized incidence rates of all cancers by sex,
 Age-standardized incidence rates for colorectal, prostate and lung cancer, males, Ontario
Age-standardized incidence rates for colorectal, breast and lung cancer, females, Ontario
Figure 7. Age-standardized mortality rates for all cancers by sex, Ontario, 1981 to 2013
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Age-standardized mortality rates for colorectal, prostate and lung cancer, male, Ontario
Age-standardized mortality rates for colorectal, breast and lung cancer, females, Ontario