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Cancer Incidence

Key findings

From 2012 to 2016, the age-standardized incidence rates for colorectal and lung cancers have decreased for both men and women. Female breast cancer incidence rates have remained stable during this period. There appears to be a slight upward trend in the prostate cancer incidence rate in 2016.

Why is this important to Ontarians?

Incidence is one measure of cancer burden in a population. It describes the number of new cases of cancer diagnosed in a given period. Incidence is often reported as a rate per 100,000 people.

The cancer incidence rate for a population is generally affected by the age of the population. Other factors that contribute to incidence rates include:

  • Prevalence of risk factors for cancer:
    • modifiable risk factors include tobacco use, air pollution, or cancer-causing infections such as hepatitis B
    • non-modifiable risk factors include reproductive and hormonal factors or genetic predisposition to cancer
  • Availability of interventions and policies to prevent cancer, including:
    • vaccination against cancer-causing infections (e.g., human papillomavirus [HPV])
    • programs aimed at reducing risk behaviour (e.g., sun safety campaigns)
    • screening for certain cancers
  • Exposure to carcinogens, and availability of interventions to reduce exposure at home or in the workplace (e.g., asbestos mitigation)
Table 1: Number of new cases for the 4 most common cancers diagnosed in Ontario, 2016
Disease sites New cases in 2016
Female Breast 11,192
Colorectal Both sexes: 8,797
Males: 4,822
Females: 3,975
Lung Both sexes: 9,958
Males: 4,922
Females: 5,036
Prostate 8,414

Note: Number of new cases is based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) data standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.

See Cancer Incidence Methodology for technical information.

Notes:  

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population. 
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
Data Table 1: Age-standardized incidence rates for female breast cancer, 2012 to 2016
Year of Diagnosis Age-standardized rate;
2012 142.7
2013 142.2
2014 146.1
2015 145.0
2016 145.2

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population. 
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
     
Data Table 2: Age-standardized incidence rates for colorectal cancer, 2012 to 2016
Year of diagnosis Age-standardized rate both sexes Age-standardized rate males Age-standardized rate females
2012 61.9 73 52.8
2013 60.7 73.2 50.6
2014 60.2 70.6 51.4
2015 60.6 72.8 50.3
2016 58.5 69.6 48.7

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
Data Table 3: Age-standardized incidence rates for lung cancer, 2012 to 2016
Year of Diagnosis Age-standardized rate both sexes Age-standardized rate males Age-standardized rate females
2012 71.9 83.2 64
2013 68.7 76.9 62.9
2014 67.7 75.6 62.4
2015 66.5 73.2 61.8
2016 65.1 70.8 61.2

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
Data Table 4: Age-standardized incidence rates for prostate cancer, 2012 to 2016
Year of diagnosis Age-standardized rate
2012 135.2
2013 118.8
2014 113.1
2015 113.8
2016 118

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. Observed incidence rates are based on the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) standards for counting multiple primary cancers, adopted by the Ontario Cancer Registry for cases diagnosed in 2010 and beyond.
Table 2: Estimated age-standardized incidence rates, 2018, by jurisdiction and type of cancer
Jurisdiction Female Breast
Age-standardized incidence rate
Prostate
Age-standardized incidence rate
Colorectal
Age-standardized incidence rate
Lung
Age-standardized incidence rate
Ontarioϴ 89.0 64.3 Male: 38.2
Female: 27.2
Both: 32.4

Male: 35.0
Female: 32.1
Both: 33.3

Canada 83.8 58.2 Male: 35.2
Female: 28.0
Both: 31.5 
Male: 31.1
Female: 29.3
Both: 30.0
Finland 89.5 71.6 Male: 28.7
Female: 21.2
Both: 24.6
Male: 24.8
Female: 14.7
Both: 19.3
France 99.1 99.0 Male: 36.9
Female: 24.8
Both: 30.4
Male: 51.3
Female: 22.5
Both: 36.1
Japan 57.6 35.4 Male: 49.1
Female: 29.6
Both: 38.9
Male: 41.4
Female: 15.6
Both: 27.5
Netherlands 105.9 68.9 Male: 45.3
Female: 31.1
Both: 37.8 
Male: 34.5
Female: 32.7
Both: 33.3
New Zealand 92.6  90.8 Male: 40.2
Female: 30.8
Both: 35.3
Male: 24.2
Female: 26.4
Both: 25.3 
Norway 87.5 106.5 M: 46.9
Female: 39.3
Both: 42.9
Male: 30.9
Female: 29.2
Both: 29.9
Sweden 89.8 103 Male: 29.7
Female: 24.3
Both: 26.9
Male: 16.9
Female: 18.1
Both: 17.4
United Kingdom 93.6 80.7 Male: 37.8
Female: 27.0
Both: 32.1
Male: 35.5
Female: 30.2
Both: 32.5
United States 84.9 75.7 Male: 28.8
Female: 22.6
Both: 25.6
Male: 40.1
Female: 30.8
Both: 35.1

Data source: World Health Organization [Internet]. Geneva: World Health Organization; c2019. GLOBOCAN 2018: estimated cancer incidence, mortality and prevalence worldwide in 2018; [cited on 2019 Apr 10]. Available from: http://globocan.iarc.fr

Notes:

  1. ϴ Ontario incidence rates are per 100,000 and are standardized to the age distribution of the 1960 World Standard Population.
  2. Colorectal cancers included colon, rectal and anal cancers.
  3. Ontario data is from 2016.
  4. †Incidence rates for France are based on data from the metropolitan region.

Results

  • In Ontario, age-standardized incidence rates for colorectal and lung cancers declined from 2012 to 2016.
  • Age-standardized incidence rates for breast cancer remained stable from 2012 to 2016. The prostate cancer incidence rate increased slightly, from 113.8 per 100,000 in 2015, to 118 per 100,000 in 2016.
  • Prostate cancer incidence increased from 1983 to 1993. The increase in the later years is most likely due to the introduction of prostate-specific antigen (PSA) testing in 1988. A sudden rise and fall in the incidence rate is common when a new method of early diagnosis is introduced. However, in 2011 the U.S. Preventive Services Task Force recommended against PSA testing for prostate cancer, as evidence suggests the expected harms of screening are greater than the small potential benefit. The U.S. recommendations likely resulted in less opportunistic screening in Ontario. This may be reflected in the declining incidence rates, which started in 2011 and continued into 2012[1].

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

Use caution when comparing data

  • Cancer burden in Ontario is compared with cancer burden in jurisdictions with healthcare and data systems similar to those in Ontario. However, we acknowledge that jurisdictions have different prevention programs and practices that can affect the disease burden rates. Differences in biological, demographical and modifiable risk factors across jurisdictions also affect the observed differences in cancer burden.
  • In developed countries, incidence data are collected within organized government systems, and coded using an international classification system, the International Classification of Diseases,[2] ICD-O-3 specific to oncology. This enables meaningful international comparisons of the effectiveness of cancer control.

Cancer incidence comparisons

  • Age-standardized incidence rates from the following jurisdictions are being compared with Ontario: Canada, Finland, France, Japan, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the United States. These age-standardized rates are meant only to allow comparisons. They do not represent the true rates of disease in the jurisdictions.

GLOBOCAN 2018 Database (see Table 2)

  • Female breast cancer incidence: Of the 11 jurisdictions compared in the analysis, Ontario performed better (i.e., had lower incidence rates) than the Netherlands, the United Kingdom, France, New Zealand, Sweden and Finland. However, Ontario performed worse (i.e. had higher incidence rates) than the United States, Canada, Norway and Japan. Of all the jurisdictions compared, Japan had the lowest incidence rate (57.6 per 100,000).
  • Prostate cancer incidence: Ontario ranked third best out of 11 jurisdictions, with a reported incidence rate for prostate cancer of 64.3 per 100,000. Of all the jurisdictions compared, Japan had the lowest incidence rate for prostate cancer of 35.4 per 100,000.
  • Colorectal cancer incidence: With respect to the combined male and female incidence rate, Ontario outperformed the Netherlands, Norway, New Zealand and Japan, but not the United Kingdom, France, Sweden, Canada, United States and Finland. Finland is the best-performing jurisdiction, as it had the lowest incidence rates for colorectal cancer (males and females).
  • Lung cancer incidence: Among males in the 11 jurisdictions examined, the incidence rate in Ontario was lower than in France, Japan and the United States, but higher than the United Kingdom, Netherlands, Norway, Finland, New Zealand, Sweden and Canada. Ontario and the Netherlands had the highest rates of female lung cancer, with reported incidence rates of 32.1 per 100,000 and 32.7 per 100,000 respectively.

For more information

Find more information on cancer incidence, mortality, survival and prevalence in Ontario in the Ontario Cancer Statistics 2018 Report.

Find information on cancer statistics across Canada in Canadian Cancer Statistics.

References

  1. U.S. Preventive Services Task Force. Evidence Summary: Prostate Cancer: Screening [Internet]. April 2019 [cited April 2019]. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/final-evidence-summary43/prostate-cancer-screening
  2. World Health Organization [Internet]. Geneva: World Health Organization; c2019. GLOBOCAN 2018: estimated cancer incidence, mortality and prevalence worldwide in 2018; [cited 2019 Apr 10]. Available from: http://globocan.iarc.fr