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. The rates for all 4 malignant hematology sub-groups remained stable between 2014 and 2018: acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), diffuse large B-cell lymphoma (DLBCL) and multiple myeloma (MM).
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)
| Disease sites | New cases in 2016 |
|---|---|
| Female Breast | 11,192 |
| Colorectal |
Male: 4,822 |
| Lung |
Male: 4,922 |
| 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.
| Disease Sub-Groups | New cases in 2018 |
|---|---|
| Acute Lymphocytic Leukemia (ALL) | Male: 132 Female: 98 Both: 230 |
| Acute Myeloid Leukemia (AML) | Male: 377 Female: 333 Both: 710 |
| Diffuse Large B-Cell Lymphoma (DLBCL) |
Male: 727 |
| Multiple Myeloma (MM) | Male: 809 Female: 606 Both: 1,415 |
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.
| Jurisdiction | Female Breast Age-standardized incidence rate |
Prostate Age-standardized incidence rate |
Colorectal Age-standardized incidence rate |
Lung Age-standardized incidence rate |
Multiple Myeloma Age-standardized incidence rate |
|---|---|---|---|---|---|
| Ontarioϴ | 89.0 | 64.3 | Male: 38.2 Female: 27.2 Both: 32.4 |
Male: 35.0 |
Male: 5.1 |
| Canada | 83.8 | 58.2 | Male: 35.2 Female: 28.0 Both: 31.5 |
Male: 31.1 Female: 29.3 Both: 30.0 |
Male: 5.0 |
| Finland | 89.5 | 71.6 | Male: 28.7 Female: 21.2 Both: 24.6 |
Male: 24.8 Female: 14.7 Both: 19.3 |
Male: 3.8 |
| France† | 99.1 | 99.0 | Male: 36.9 Female: 24.8 Both: 30.4 |
Male: 51.3 Female: 22.5 Both: 36.1 |
Male: 5.0 |
| Japan | 57.6 | 35.4 | Male: 49.1 Female: 29.6 Both: 38.9 |
Male: 41.4 Female: 15.6 Both: 27.5 |
Male: 1.8 |
| Netherlands | 105.9 | 68.9 | Male: 45.3 Female: 31.1 Both: 37.8 |
Male: 34.5 Female: 32.7 Both: 33.3 |
Male: 3.8 |
| New Zealand | 92.6 | 90.8 | Male: 40.2 Female: 30.8 Both: 35.3 |
Male: 24.2 Female: 26.4 Both: 25.3 |
Male: 7.8 |
| Norway | 87.5 | 106.5 | M: 46.9 Female: 39.3 Both: 42.9 |
Male: 30.9 Female: 29.2 Both: 29.9 |
Male: 4.5 |
| Sweden | 89.8 | 103 | Male: 29.7 Female: 24.3 Both: 26.9 |
Male: 16.9 Female: 18.1 Both: 17.4 |
Male: 4.3 |
| United Kingdom | 93.6 | 80.7 | Male: 37.8 Female: 27.0 Both: 32.1 |
Male: 35.5 Female: 30.2 Both: 32.5 |
Male: 5.4 |
| United States | 84.9 | 75.7 | Male: 28.8 Female: 22.6 Both: 25.6 |
Male: 40.1 Female: 30.8 Both: 35.1 |
Male: 5.0 |
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:
- ϴ Ontario incidence rates are per 100,000 and are standardized to the age distribution of the 1960 World Standard Population.
- Colorectal cancers included colon, rectal and anal cancers.
- Ontario data is from 2016 for solid tumours and from 2018 for hematologic cancers.
- †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].
- Age-standardized incidence rates for acute lymphoblastic leukemia and acute myeloid leukemia remained stable from 2014 to 2018.
- Age-standardized incidence rates for diffuse large B-cell lymphoma remained stable, with rates ranging from 9.1 per 100,000 in 2014 to 8.2 per 100,000 in 2018.
- The incidence of multiple myeloma also remained stable, with rates ranging from 8.7 per 100,000 in 2014 to 10.2 per 100,000 in 2017.
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.
- Jurisdictional data are included to provide a high-level snapshot of how Ontario is performing against comparable nations. When reviewing data, it is important to consider that comparisons are inexact due to differences in disease definitions and indicator methodology across jurisdictions.
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.
- Leukemia incidence: Jurisdictional comparisons have not been made for this disease sub-group because Ontario defines leukemia cases differently than other jurisdictions. Specifically, other jurisdictions use a broader definition of leukemia than that used in the Cancer System Quality Index, which limits the sub-types to acute lymphocytic leukemia and acute myeloid leukemia.
- Diffuse large B-cell lymphoma incidence: Jurisdictional comparisons have not been made for this disease sub-group because comparators are not available.
- Multiple myeloma incidence: The combined incidence rate in Ontario was lower than New Zealand, Norway and the United Kingdom, higher than France, Japan, Netherlands and Sweden, and similar to the United States. The incidence of multiple myeloma among all Canadians (4.0 per 100,000) was slightly lower than the rate among Ontarians (4.1 per 100,000). Of all the jurisdictions compared, Japan had the lowest incidence rate for multiple myeloma of 1.5 per 100,000.
For more information
Find more information on cancer incidence, mortality, survival and prevalence in Ontario in Ontario Cancer Statistics 2020.
Find information on cancer statistics across Canada in Canadian Cancer Statistics.