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Statistical Reports

Ch 5: Cancer incidence rates and trends

Data Type:
Publication Series: Under Review
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Ontario Cancer Statistics 2020 Ch 5: Cancer Incidence Rates and Trends

Cancer incidence refers to the number of new cases of cancer diagnosed within a specific period. This chapter presents actual (non-projected) incidence rates and trends based on counts considered complete as of 2016 – the latest available year.

What's on this page

Over the past 3 decades, population aging and growth contributed far more to the number of new cancer cases than actual changes in cancer risk and cancer control practices (Figure 5.1).

In 2016, 81,409 new cases of cancer were diagnosed in Ontario, representing a 175% increase since 1981 (29,649 cases). Breaking down this 175% increase, approximately 94% is attributable to aging of the population, 67% to population growth and only 14% to changes in cancer risk and cancer control practices.

Note: Number of new cancer cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Direct comparisons with rates for 2009 and prior years are shown here to highlight the impact of this change in counting standards for multiple primary cancers but should generally not be made.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.1 Incidence attributed to changes in cancer risk, population growth and aging, Ontario, 1981 to 2016
Year Additional cases due to aging Additional cases due to population growth Change in cancer risk Baseline cancer incidence in 1981
1981 29649 29649 29649 29649
1982 30346 29942 29579 29649
1983 31885 31110 30328 29649
1984 33003 31833 30600 29649
1985 34267 32708 31010 29649
1986 34660 32745 30576 29649
1987 36469 34135 31211 29649
1988 38054 35423 31728 29649
1989 38269 35506 30969 29649
1990 40264 37020 31686 29649
1991 42462 38634 32638 29649
1992 43421 39107 32597 29649
1993 44447 39567 32617 29649
1994 45164 39822 32435 29649
1995 45021 39351 31668 29649
1996 46388 40116 31897 29649
1997 48106 41285 32404 29649
1998 49756 42229 32741 29649
1999 51483 43363 33215 29649
2000 53131 44372 33468 29649
2001 54795 45520 33717 29649
2002 55428 45653 33267 29649
2003 56055 45440 32705 29649
2004 58269 46622 33159 29649
2005 59716 47110 33138 29649
2006 61299 47799 33267 29649
2007 63816 48827 33710 29649
2008 63893 48002 32836 29649
2009 65515 48493 32878 29649
2010 72933 52908 35496 29649
2011 75659 53999 35877 29649
2012 75415 53044 34848 29649
2013 76424 52669 34239 29649
2014 77439 52633 33904 29649
2015 79653 53211 34004 29649
2016 81409 53724 33874 29649

Note: Number of new cancer cases diagnosed in 2010 and afterwards are based on the NCI SEER standards for counting multiple primary cancers. Direct comparisons with rates for 2009 and prior years are shown here to highlight the impact of this change in counting standards for multiple primary cancers but should generally not be made.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario).

Probability of Developing Cancer

The probability of developing cancer refers to the average chance of being diagnosed with cancer over the course of a lifetime.

The probability of developing a specific type of cancer depends on many factors, including:

  • the population’s characteristics (e.g., demographics)
  • the prevalence of risk factors (e.g., age, family history of cancer, smoking, obesity)
  • current life expectancy

In addition, the probabilities in this report reflect the average risks for the overall population and do not take into account personal risk factors. In other words, an individual’s risk may be higher or lower than the numbers reported here.

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In Ontario, 1 in 2 people, or 45.3%, will develop cancer in their lifetime (not including non-melanoma skin cancer) (Table 5.1). The probability of developing cancer was nearly the same for both males and females, although it varies based on cancer type:

  • Among males, the probability is highest for prostate (1 in 8), lung (1 in 12) and colorectal (1 in 14) cancers.
  • Among females, the probability is highest for breast (1 in 8), lung (1 in 14) and colorectal (1 in 17) cancers.
Table 5.1 Lifetime probability of developing cancer by cancer type and sex, Ontario, 2013 to 2016
Cancer type Both sexes Males Females
% 1 in % 1 in % 1 in
All cancers 45.3% 2 45.9% 2 45.0% 2
Bladder 1.9% 52 3.0% 33 1.0% 103
Brain 0.7% 138 0.8% 122 0.6% 156
Breast (female) 12.8% 8 n/a n/a 12.8% 8
Cervix 0.6% 157 n/a n/a 0.6% 157
Colorectal 6.5% 15 7.0% 14 6.0% 17
Esophagus 0.6% 168 0.9% 113 0.3% 310
Hodgkin lymphoma 0.2% 421 0.3% 397 0.2% 448
Kidney 1.5% 66 2.0% 51 1.1% 92
Larynx 0.3% 341 0.5% 198 0.1% 1052
Leukemia 1.9% 53 2.3% 44 1.5% 65
Liver 1.0% 101 1.3% 75 0.7% 150
Lung 7.6% 13 8.0% 12 7.3% 14
Melanoma 2.4% 42 2.8% 35 2.0% 51
Myeloma 1.1% 95 1.2% 80 0.9% 112
Non-Hodgkin lymphoma 3.0% 33 3.5% 29 2.7% 38
Oral cavity & pharynx 1.3% 79 1.8% 57 0.8% 123
Ovary 1.6% 62 n/a n/a 1.6% 62
Pancreas 1.7% 60 1.7% 59 1.6% 62
Prostate 11.9% 8 11.9% 8 n/a n/a
Stomach 1.2% 83 1.5% 65 0.9% 113
Testis 0.4% 230 0.4% 230 n/a n/a
Thyroid 1.8% 57 0.9% 110 2.6% 38
Uterus 3.4% 30 n/a n/a 3.4% 30

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario). Statistics Canada, Canadian Vital Statistics, Birth and Death Databases and population estimates (formerly CANSIM 102-0504)

Incidence by Sex and Cancer Type

In 2016, 81,409 new cases of cancer were diagnosed in Ontario, for an age-standardized incidence rate (ASIR) of 544.0 per 100,000 (Table 5.2).

Table 5.2 Age-standardized incidence rates and counts by cancer type and sex, Ontario, 2016
Cancer group Cancer type Both sexes Males Females
New cases % of cases ASIR ASIR 95% CI New cases % of cases ASIR ASIR 95% CI New cases % of cases ASIR ASIR 95% CI
All All cancers 81,409 100% 544.0 540.2 - 547.7 40,628 100% 584.3 578.6 - 590.0 40,781 100% 517.7 512.7 - 522.8
Brain & nervous system Brain and other nervous system - malignant 1,105 1.4% 7.6 7.1 - 8.0 620 1.5% 8.9 8.3 - 9.7 485 1.2% 6.4 5.8 - 7.0
Glioblastoma 580 0.7% 3.9 3.6 - 4.2 332 0.8% 4.7 4.2 - 5.3 248 0.6% 3.2 2.8 - 3.6
Meninges - malignant 13 0.0% 0.1 0.0 - 0.1 ** ** ** ** ** ** ** **
Brain and other nervous system - non-malignant 2,309 2.8% 15.8 15.2 - 16.5 938 2.3% 13.6 12.8 - 14.6 1,371 3.4% 17.9 16.9 - 18.9
Meninges - non-malignant 947 1.2% 6.4 6.0 - 6.8 300 0.7% 4.4 3.9 - 4.9 647 1.6% 8.2 7.6 - 8.9
Pituitary, pineal and craniopharyngeal duct 512 0.6% 3.5 3.2 - 3.9 253 0.6% 3.6 3.2 - 4.1 259 0.6% 3.5 3.1 - 4.0
Breast & genital system Breast (female) n/a n/a n/a n/a n/a n/a n/a n/a 11,192 27.4% 145.2 142.5 - 148.0
Cervix n/a n/a n/a n/a n/a n/a n/a n/a 600 1.5% 8.3 7.6 - 9.0
Ovary n/a n/a n/a n/a n/a n/a n/a n/a 1,243 3.0% 16.1 15.3 - 17.1
Prostate n/a n/a n/a n/a 8,414 20.7% 118.0 115.5 - 120.5 n/a n/a n/a n/a
Testis n/a n/a n/a n/a 467 1.1% 6.9 6.3 - 7.5 n/a n/a n/a n/a
Uterus n/a n/a n/a n/a n/a n/a n/a n/a 2,824 6.9% 36.3 34.9 - 37.6
Uterus - endometrial n/a n/a n/a n/a n/a n/a n/a n/a 2,577 6.3% 33.1 31.8 - 34.4
Uterus - uterine sarcoma n/a n/a n/a n/a n/a n/a n/a n/a 84 0.2% 1.2 0.9 - 1.4
Digestive system Colorectal 8,525 10.5% 56.6 55.4 - 57.8 4,706 11.6% 68.0 66.0 - 69.9 3,819 9.4% 46.6 45.1 - 48.1
Colon excluding rectum 5,840 7.2% 38.5 37.6 - 39.5 3,069 7.6% 44.5 42.9 - 46.1 2,771 6.8% 33.4 32.2 - 34.7
Colon - left sided 2,119 2.6% 14.1 13.5 - 14.7 1,247 3.1% 18.0 17.0 - 19.0 872 2.1% 10.9 10.2 - 11.6
Colon - right sided 3,268 4.0% 21.4 20.7 - 22.2 1,604 3.9% 23.3 22.1 - 24.4 1,664 4.1% 19.8 18.8 - 20.8
Rectum and rectosigmoid junction 2,663 3.3% 17.9 17.2 - 18.6 1,631 4.0% 23.4 22.3 - 24.6 1,032 2.5% 13.0 12.2 - 13.8
Rectosigmoid junction 599 0.7% 4.0 3.7 - 4.3 355 0.9% 5.1 4.6 - 5.7 244 0.6% 3.0 2.6 - 3.4
Rectum 2,064 2.5% 13.9 13.3 - 14.5 1,276 3.1% 18.3 17.3 - 19.3 788 1.9% 10.0 9.3 - 10.8
Esophagus 808 1.0% 5.3 5.0 - 5.7 606 1.5% 8.7 8.0 - 9.4 202 0.5% 2.5 2.1 - 2.8
Esophagus - adenocarcinoma 494 0.6% 3.3 3.0 - 3.6 407 1.0% 5.8 5.3 - 6.4 87 0.2% 1.1 0.9 - 1.3
Esophagus - squamous cell carcinoma 226 0.3% 1.5 1.3 - 1.7 137 0.3% 1.9 1.6 - 2.3 89 0.2% 1.1 0.9 - 1.3
Liver 1,270 1.6% 8.4 7.9 - 8.9 889 2.2% 12.7 11.9 - 13.5 381 0.9% 4.6 4.1 - 5.1
Pancreas 2,056 2.5% 13.5 12.9 - 14.1 1,096 2.7% 15.9 14.9 - 16.8 960 2.4% 11.5 10.8 - 12.3
Stomach 1,529 1.9% 10.1 9.6 - 10.7 978 2.4% 14.2 13.3 - 15.1 551 1.4% 6.8 6.2 - 7.4
Head and neck Larynx 414 0.5% 2.7 2.5 - 3.0 346 0.9% 4.9 4.4 - 5.4 68 0.2% 0.8 0.7 - 1.1
Oral cavity & pharynx 1,690 2.1% 11.4 10.8 - 11.9 1,163 2.9% 16.6 15.6 - 17.6 527 1.3% 6.6 6.1 - 7.2
Lip and oral cavity 776 1.0% 5.2 4.8 - 5.6 450 1.1% 6.5 5.9 - 7.1 326 0.8% 4.0 3.6 - 4.5
Hypopharynx 93 0.1% 0.6 0.5 - 0.8 73 0.2% 1.1 0.8 - 1.3 20 0.0% 0.3 0.2 - 0.4
Nasopharynx 128 0.2% 0.9 0.8 - 1.1 95 0.2% 1.4 1.1 - 1.7 33 0.1% 0.5 0.3 - 0.6
Oropharynx 629 0.8% 4.2 3.9 - 4.6 503 1.2% 7.1 6.5 - 7.7 126 0.3% 1.6 1.3 - 1.9
Thyroid 3,013 3.7% 21.4 20.7 - 22.2 780 1.9% 11.3 10.5 - 12.1 2,233 5.5% 31.2 29.9 - 32.5
Thyroid - anaplastic 15 0.0% 0.1 0.1 - 0.2 8 0.0% 0.1 0.1 - 0.2 7 0.0% 0.1 0.0 - 0.2
Thyroid - follicular 96 0.1% 0.7 0.5 - 0.8 22 0.1% 0.3 0.2 - 0.5 74 0.2% 1.0 0.8 - 1.3
Thyroid - medullary 39 0.0% 0.3 0.2 - 0.4 16 0.0% 0.2 0.1 - 0.4 23 0.1% 0.3 0.2 - 0.5
Thyroid - papillary 2,790 3.4% 19.9 19.2 - 20.6 708 1.7% 10.3 9.5 - 11.1 2,082 5.1% 29.2 27.9 - 30.4
Hematological Leukemia 2,396 2.9% 16.1 15.4 - 16.7 1,447 3.6% 21.0 20.0 - 22.2 949 2.3% 11.9 11.2 - 12.7
Acute lymphocytic leukemia 205 0.3% 1.5 1.3 - 1.7 123 0.3% 1.8 1.5 - 2.1 82 0.2% 1.2 0.9 - 1.5
Acute monocytic leukemia 81 0.1% 0.6 0.4 - 0.7 52 0.1% 0.8 0.6 - 1.0 29 0.1% 0.4 0.3 - 0.5
Acute myeloid leukemia 651 0.8% 4.4 4.0 - 4.7 372 0.9% 5.5 4.9 - 6.1 279 0.7% 3.5 3.1 - 3.9
Chronic lymphocytic leukemia 811 1.0% 5.3 5.0 - 5.7 512 1.3% 7.3 6.7 - 8.0 299 0.7% 3.6 3.2 - 4.1
Chronic myeloid leukemia 350 0.4% 2.4 2.1 - 2.6 214 0.5% 3.1 2.7 - 3.6 136 0.3% 1.7 1.4 - 2.0
Lymphoma 4,772 5.9% 32.2 31.3 - 33.1 2,622 6.5% 38.1 36.6 - 39.6 2,150 5.3% 27.2 26.1 - 28.4
Hodgkin lymphoma 412 0.5% 2.9 2.7 - 3.2 222 0.5% 3.2 2.8 - 3.7 190 0.5% 2.7 2.3 - 3.1
Non-Hodgkin lymphoma 4,360 5.4% 29.2 28.4 - 30.1 2,400 5.9% 34.8 33.4 - 36.3 1,960 4.8% 24.6 23.5 - 25.7
Non-Hodgkin lymphoma - extranodal 2,319 2.8% 15.5 14.9 - 16.2 1,276 3.1% 18.6 17.5 - 19.6 1,043 2.6% 13.0 12.2 - 13.8
Non-Hodgkin lymphoma - nodal 2,041 2.5% 13.7 13.1 - 14.3 1,124 2.8% 16.3 15.3 - 17.3 917 2.2% 11.5 10.8 - 12.3
Myeloma 1,387 1.7% 9.1 8.7 - 9.6 762 1.9% 11.1 10.3 - 11.9 625 1.5% 7.6 7.0 - 8.3
Melanoma Melanoma of the skin 3,851 4.7% 25.9 25.0 - 26.7 2,230 5.5% 32.5 31.1 - 33.9 1,621 4.0% 20.8 19.8 - 21.9
Melanoma (non-cutaneous) 191 0.2% 1.3 1.1 - 1.5 93 0.2% 1.3 1.1 - 1.6 98 0.2% 1.3 1.0 - 1.5
Melanoma - mucosal 44 0.1% 0.3 0.2 - 0.4 14 0.0% 0.2 0.1 - 0.3 30 0.1% 0.4 0.2 - 0.5
Melanoma - ocular 147 0.2% 1.0 0.8 - 1.2 79 0.2% 1.1 0.9 - 1.4 68 0.2% 0.9 0.7 - 1.1
Thoracic system Lung 9,958 12.2% 65.1 63.8 - 66.4 4,922 12.1% 70.8 68.8 - 72.8 5,036 12.3% 61.2 59.5 - 62.9
Lung - adenocarcinoma 4,308 5.3% 28.3 27.5 - 29.2 1,883 4.6% 26.9 25.7 - 28.1 2,425 5.9% 29.9 28.7 - 31.1
Lung - large cell 130 0.2% 0.9 0.7 - 1.0 67 0.2% 0.9 0.7 - 1.2 63 0.2% 0.8 0.6 - 1.0
Lung - small cell 943 1.2% 6.2 5.8 - 6.6 495 1.2% 7.0 6.4 - 7.6 448 1.1% 5.5 5.0 - 6.1
Lung - squamous cell 1,688 2.1% 10.9 10.4 - 11.5 1,063 2.6% 15.2 14.3 - 16.1 625 1.5% 7.5 6.9 - 8.1
Urinary system Bladder 4,237 5.2% 27.7 26.9 - 28.6 3,195 7.9% 46.7 45.0 - 48.3 1,042 2.6% 12.5 11.8 - 13.3
Kidney 2,438 3.0% 16.5 15.8 - 17.2 1,590 3.9% 22.7 21.6 - 23.9 848 2.1% 10.9 10.1 - 11.6

Abbreviations: ASIR means age-standardized incidence rate; CI means confidence interval.

Notes:

  1. Rates are per 100,000 and are age-standardized to the 2011 Canadian population.
  2. Only selected subsites and histological subtypes of major cancers are shown. As a result, counts for these may not sum to the total for the cancer type.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Distribution of new cases for selected cancers, 2016: bladder at 6.1%, brain at 1.4%, female breast at 13.7%, colorectal at 10.5%, lung at 12.2%, non-Hodgkin lymphoma at 5.4%, prostate at 10.3%, thyroid at 3.7%

The 4 most commonly diagnosed cancers (lung, colorectal, breast and prostate) were responsible for almost 50% of all new cancer cases in 2016. By sex, lung, colorectal and prostate cancers accounted for 44% new cases among males, while lung, breast and colorectal cancers accounted for 49% of new cases among females (Figure 5.2).

Non-melanoma skin cancers represent the most common type of cancer in most jurisdictions, but they are not included in this report because Ontario does not routinely collect data about them. Other countries have reported an increasing trend in non-melanoma skin cancers.[1-3]

In 2016, the highest ASIRs for cancers occurring in both sexes were lung (65.1 per 100,000), colorectal (56.6 per 100,000) and lymphoma (32.2 per 100,000).

The ASIR for all cancers combined was significantly higher in males (584.3 per 100,000) than in females (517.7 per 100,000) (Table 5.2).

  • In males, the most commonly diagnosed cancers were prostate (8,414, or 20.7% of all new male cases), lung (4,922, or 12.1%) and colorectal (4,706, or 11.6%).
  • In females, the leading cancer types were breast (11,192, or 27.4% of all new female cases), lung (5,036, or 12.3%) and colorectal (3,819, or 9.4%).

Note: Incidence counts based on IARC/IACR multiple primary rules.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.2 Proportion of new cases by sex and cancer type, Ontario, 2016
Cancer Type Males (%) Females (%)
Breast (female) n/a 27.4
Prostate 20.7 n/a
Lung 12.1 12.3
Colorectal 11.6 9.4
Bladder 7.9 2.6
Uterus n/a 6.9
Non-Hodgkin lymphoma 5.9 4.8
Melanoma 5.5 4
Kidney 3.9 2.1
Leukemia 3.6 2.3
Oral cavity & pharynx 2.9 1.3
Pancreas 2.7 2.4
Ovary n/a 3
Stomach 2.4 1.4
Liver 2.2 0.9
Thyroid 1.9 5.5
Myeloma 1.9 1.5
Brain 1.5 1.2
Esophagus 1.5 0.5
Testis 1.1 n/a
Cervix n/a 1.5
Larynx 0.9 0.2
Hodgkin lymphoma 0.5 0.5
All other types 9.3 8.4

Note: Incidence counts based on IARC/IACR multiple primary rules.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

The greatest difference in incidence between males and females was for the following cancers: laryngeal, bladder, esophageal, liver and intrahepatic bile duct, oral cavity and pharynx, stomach and kidney. Notably, the risk of each of these cancer types is associated with the use of either tobacco or alcohol,[4,5] and in Ontario, tobacco and alcohol use are more prevalent among men.[6]

  • Laryngeal cancer: The male rate was over 6 times the female rate. Smokers are 7 times more likely to develop laryngeal cancers,[7] while heavy alcohol use more than doubles the risk.[4]
  • Bladder cancer: The male rate was nearly 4 times the female rate. One of the main risk factors for bladder cancer is smoking, with smokers being 2 to 3 times more likely to develop bladder cancer than non-smokers.[8,9]
  • Esophageal cancer: The overall male rate was more than 3 times the female rate, with the rate of adenocarcinoma of the esophagus more than 5 times greater in males than in females. Smoking more than doubles the risk of esophageal cancer.[7] Alcohol use and obesity — also more common in males — are other risk factors for esophageal cancer.[10]
  • Liver cancer: The male rate was nearly 3 times greater than the female rate. Tobacco and alcohol use are both linked to increased risk of liver cancer.[4] Chronic viral hepatitis is another important risk factor for liver cancer.[11]
  • Stomach cancer: The male rate was double the female rate. Heavy alcohol use is associated with a 20% increase in risk of stomach cancer. [4]
  • Oral cavity and pharynx cancer: The male rate was more than twice the female rate, with the rate of oropharynx cancers in males over 4 times the female rate. Tobacco and alcohol use are important risk factors for oral cavity and pharynx cancer.[12] Alcohol use increases the risk by more than 5 times.[4]
  • Kidney cancer: The male rate was double the female rate. Heavy alcohol use is associated with increased risk of kidney cancer.[4]

The incidence rate was higher in males than females for almost all cancers. An exception was thyroid cancer, for which the ASIR for females was 31.2 per 100,000 compared with just 11.3 per 100,000 in males. A number of possible reasons for the higher incidence of thyroid cancer in females have been proposed, including:

  • a greater likelihood of diagnostic investigation among females because they are more likely to have thyroid disease,[13] as well as a greater tendency to seek medical attention and participate more actively in medical visits[14-16]
  • the biological differences that exist in the hormone levels of males and females (such as thyroid stimulated hormone and sex steroids)[17-19]

While the incidence of less aggressive types of thyroid cancer, such as papillary carcinoma, is higher for females than males (Table 5.2), the rate of more aggressive types (such as anaplastic and medullary thyroid cancers) are generally similar between the sexes. The same is seen in other jurisdictions.[13,20] The result is similar for thyroid mortality rates between the sexes (see Chapter 6: Cancer Mortality Rates and Trends).

The incidence rates of non-malignant tumours of the brain and nervous system as well as lung adenocarcinoma were higher in females than males. Although the higher rate of non-malignant brain tumours in females also has been seen in many other jurisdictions,[21-24] the reason for these sex differences is not clear.

Incidence by Age

Between 2014 and 2016, the median age at cancer diagnosis was 67 years for both males and females (Table 5.3). The median age at diagnosis varied by cancer type. Of the 23 cancer types, cancers with the lowest median age (all under age 50 years) were testis, Hodgkin lymphoma and cervix. However, these cancer types are rare in children 0 to 14 years of age.

Childhood cancer types are unique. The childhood cancer types with the lowest median age at diagnosis include neuroblastoma, retinoblastoma and hepatic tumours. In addition, neuroblastoma, leukemias and central nervous system tumours are the most common types of cancer in children under 1 year of age.

For details about childhood cancer incidence, see Spotlight: Childhood Cancer Incidence, Table S1 or visit the POGO Surveillance Report.

With the exception of thyroid cancer, the median ages for all other cancer types were above age 60.

Table 5.3 Median age at diagnosis by cancer type and sex, Ontario, 2014 to 2016
Cancer type Age (years)
Both sexes Males Females
All cancers 67 68 66
Bladder 73 73 73
Brain 61 60 62
Breast (female) 63 n/a 63
Cervix 49 n/a 49
Colorectal 70 69 72
Esophagus 69 68 72
Hodgkin lymphoma 38 37.5 38
Kidney 64 64 65
Larynx 68 68 69
Leukemia 68 68 68
Liver 68 67 72
Lung 71 72 71
Melanoma 66 68 63
Myeloma 71 71 72
Non-Hodgkin lymphoma 68 67 69
Oral cavity & pharynx 64 63 66
Ovary 63 n/a 63
Pancreas 71 70 74
Prostate 68 68 n/a
Stomach 70 70 70
Testis 34 34 n/a
Thyroid 51 55 50
Uterus 64 n/a 64

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

In 2016, more than half of all newly diagnosed cancer cases were in people ages 60 to 79 (Table 5.4). The distribution of cancer types by age group varied widely.

Table 5.4 Incidence counts and rates by cancer type and age group, Ontario, 2016
Cancer group Cancer type Ages 0 - 39 years Ages 40 - 59 years Ages 60 - 79 years 80 years or older
New cases Age-specific rate 95 % CI New cases Age-specific rate 95 % CI New cases Age-specific rate 95 % CI New cases Age-specific rate 95 % CI
All All cancers 4,091 59.6 57.7 - 61.4 19,496 493.1 486.2 - 500.1 42,396 1,662.6 1,646.8 - 1,678.5 15,426 2,559.7 2,519.4 - 2,600.4
Brain & nervous system Brain and other nervous system - Malignant* 210 3.1 2.7 - 3.5 308 7.8 6.9 - 8.7 441 17.3 15.7 - 19.0 146 24.2 20.5 - 28.5
Glioblastoma 34 0.5 0.3 - 0.7 173 4.4 3.7 - 5.1 307 12.0 10.7 - 13.5 66 11.0 8.5 - 13.9
Meninges - malignant ** ** ** ** ** ** 7 0.3 0.1 - 0.6 ** ** **
Brain and other nervous system - Non-malignant 372 5.4 4.9 - 6.0 742 18.8 17.4 - 20.2 824 32.3 30.1 - 34.6 371 61.6 55.5 - 68.2
Meninges - non-malignant 55 0.8 0.6 - 1.0 298 7.5 6.7 - 8.4 395 15.5 14.0 - 17.1 199 33.0 28.6 - 37.9
Pituitary, pineal and craniopharyngeal duct 127 1.8 1.5 - 2.2 177 4.5 3.8 - 5.2 170 6.7 5.7 - 7.7 38 6.3 4.5 - 8.7
Breast & genital system Breast (female) 463 13.6 12.4 - 14.9 4,103 205.4 199.1 - 211.8 5,143 384.5 374.1 - 395.2 1,483 404.7 384.4 - 425.9
Cervix 176 5.2 4.4 - 6.0 251 12.6 11.1 - 14.2 135 10.1 8.5 - 11.9 38 10.4 7.3 - 14.2
Ovary 87 2.6 2.0 - 3.2 423 21.2 19.2 - 23.3 555 41.5 38.1 - 45.1 178 48.6 41.7 - 56.3
Prostate ** ** ** 1,425† 72.9 69.1 - 76.7 5,845 482.1 469.8 - 494.6 1,140 482.5 454.9 - 511.4
Testis 300 8.7 7.7 - 9.7 133 6.8 5.7 - 8.1 26 2.1 1.4 - 3.1 8 3.4 1.5 - 6.7
Uterus 62 1.8 1.4 - 2.3 901 45.1 42.2 - 48.1 1,600 119.6 113.8 - 125.6 261 71.2 62.9 - 80.4
Uterus - endometrial 46 1.4 1.0 - 1.8 820 41.0 38.3 - 44.0 1,501 112.2 106.6 - 118.0 210 57.3 49.8 - 65.6
Uterus - uterine sarcoma ** ** ** 50 2.5 1.9 - 3.3 25 1.9 1.2 - 2.8 ** ** **
Digestive system Colorectal 168 2.4 2.1 - 2.8 1,856 46.9 44.8 - 49.1 4,353 170.7 165.7 - 175.9 2,148 356.4 341.5 - 371.8
Colon excluding rectum* 99 1.4 1.2 - 1.8 1,049 26.5 24.9 - 28.2 3,035 119.0 114.8 - 123.3 1,657 274.9 261.9 - 288.5
Colon - left sided 55 0.8 0.6 - 1.0 506 12.8 11.7 - 14.0 1,114 43.7 41.2 - 46.3 444 73.7 67.0 - 80.9
Colon - right sided* 36 0.5 0.4 - 0.7 451 11.4 10.4 - 12.5 1,756 68.9 65.7 - 72.2 1,025 170.1 159.8 - 180.8
Rectum and rectosigmoid junction 69 1.0 0.8 - 1.3 806 20.4 19.0 - 21.8 1,316 51.6 48.9 - 54.5 472 78.3 71.4 - 85.7
Rectosigmoid junction 13 0.2 0.1 - 0.3 166 4.2 3.6 - 4.9 286 11.2 10.0 - 12.6 134 22.2 18.6 - 26.3
Rectum 56 0.8 0.6 - 1.1 640 16.2 15.0 - 17.5 1,030 40.4 38.0 - 42.9 338 56.1 50.3 - 62.4
Esophagus 8 0.1 0.1 - 0.2 160 4.0 3.4 - 4.7 484 19.0 17.3 - 20.7 156 25.9 22.0 - 30.3
Esophagus - adenocarcinoma ** ** ** 110† 2.8 2.3 - 3.4 293 11.5 10.2 - 12.9 85 14.1 11.3 - 17.4
Esophagus - squamous cell carcinoma ** ** ** 40† 1.0 0.7 - 1.4 145 5.7 4.8 - 6.7 39 6.5 4.6 - 8.8
Liver 22 0.3 0.2 - 0.5 242 6.1 5.4 - 6.9 732 28.7 26.7 - 30.9 274 45.5 40.2 - 51.2
Pancreas 26 0.4 0.2 - 0.6 358 9.1 8.1 - 10.0 1,101 43.2 40.7 - 45.8 571 94.7 87.1 - 102.8
Stomach 34 0.5 0.3 - 0.7 320 8.1 7.2 - 9.0 808 31.7 29.5 - 33.9 367 60.9 54.8 - 67.5
Head and neck Larynx ** ** ** 80† 2 1.6 - 2.5 276 10.8 9.6 - 12.2 55 9.1 6.9 - 11.9
Oral cavity & pharynx 40 0.6 0.4 - 0.8 535 13.5 12.4 - 14.7 885 34.7 32.5 - 37.1 230 38.2 33.4 - 43.4
Hypopharynx ** ** ** 20 0.5 0.3 - 0.8 60 2.4 1.8 - 3.0 10† 1.7 0.8 - 3.1
Lip and oral cavity 25 0.4 0.2 - 0.5 200 5.1 4.4 - 5.8 389 15.3 13.8 - 16.8 162 26.9 22.9 - 31.4
Nasopharynx 11 0.2 0.1 - 0.3 71 1.8 1.4 - 2.3 39 1.5 1.1 - 2.1 7 1.2 0.5 - 2.4
Oropharynx ** ** ** 230† 5.8 5.1 - 6.6 361 14.2 12.7 - 15.7 36 6.0 4.2 - 8.3
Thyroid 737 10.7 10.0 - 11.5 1,363 34.5 32.7 - 36.4 832 32.6 30.4 - 34.9 81 13.4 10.7 - 16.7
Thyroid - anaplastic ** ** ** ** ** ** 9 0.4 0.2 - 0.7 ** ** **
Thyroid - follicular 30 0.4 0.3 - 0.6 29 0.7 0.5 - 1.1 30† 1.2 0.8 - 1.7 ** ** **
Thyroid - medullary 10† 0.1 0.1 - 0.3 15 0.4 0.2 - 0.6 15 0.6 0.3 - 1.0 ** ** **
Thyroid - papillary 691 10.1 9.3 - 10.8 1,293 32.7 30.9 - 34.5 744 29.2 27.1 - 31.4 62 10.3 7.9 - 13.2
Hematological Leukemia* 265 3.9 3.4 - 4.4 470 11.9 10.8 - 13.0 1,138 44.6 42.1 - 47.3 523 86.8 79.5 - 94.5
Acute lymphocytic leukemia 127 1.8 1.5 - 2.2 34 0.9 0.6 - 1.2 32 1.3 0.9 - 1.8 12 2.0 1.0 - 3.5
Acute monocytic leukemia* 11 0.2 0.1 - 0.3 18 0.5 0.3 - 0.7 40 1.6 1.1 - 2.1 12 2.0 1.0 - 3.5
Acute myeloid leukemia* 65 0.9 0.7 - 1.2 126 3.2 2.7 - 3.8 307 12.0 10.7 - 13.5 153 25.4 21.5 - 29.7
Chronic lymphocytic leukemia 7 0.1 0.0 - 0.2 149 3.8 3.2 - 4.4 489 19.2 17.5 - 21.0 166 27.5 23.5 - 32.1
Chronic myeloid leukemia* 38 0.6 0.4 - 0.8 75 1.9 1.5 - 2.4 148 5.8 4.9 - 6.8 89 14.8 11.9 - 18.2
Lymphoma* 499 7.3 6.6 - 7.9 1,090 27.6 26.0 - 29.3 2,255 88.4 84.8 - 92.2 928 154.0 144.2 - 164.2
Hodgkin lymphoma 221 3.2 2.8 - 3.7 98 2.5 2.0 - 3.0 70 2.7 2.1 - 3.5 23 3.8 2.4 - 5.7
Non-hodgkin lymphoma* 278 4.0 3.6 - 4.6 992 25.1 23.6 - 26.7 2,185 85.7 82.1 - 89.4 905 150.2 140.5 - 160.3
NHL - extranodal* 169 2.5 2.1 - 2.9 497 12.6 11.5 - 13.7 1,118 43.8 41.3 - 46.5 535 88.8 81.4 - 96.6
NHL - nodal 109 1.6 1.3 - 1.9 495 12.5 11.4 - 13.7 1,067 41.8 39.4 - 44.4 370 61.4 55.3 - 68.0
Myeloma 11 0.2 0.1 - 0.3 243 6.1 5.4 - 7.0 757 29.7 27.6 - 31.9 376 62.4 56.2 - 69.0
Melanoma Melanoma of the skin* 254 3.7 3.3 - 4.2 1,017 25.7 24.2 - 27.4 1,762 69.1 65.9 - 72.4 818 135.7 126.6 - 145.4
Melanoma (non-cutaneous) 14 0.2 0.1 - 0.3 53 1.3 1.0 - 1.8 96 3.8 3.0 - 4.6 28 4.6 3.1 - 6.7
Melanoma - mucosal ** ** ** 10† 0.3 0.1 - 0.5 24 0.9 0.6 - 1.4 11 1.8 0.9 - 3.3
Melanoma - ocular 15† 0.2 0.1 - 0.4 45 1.1 0.8 - 1.5 72 2.8 2.2 - 3.6 17 2.8 1.6 - 4.5
Thoracic system Lung 46 0.7 0.5 - 0.9 1,404 35.5 33.7 - 37.4 6,231 244.4 238.3 - 250.5 2,277 377.8 362.5 - 393.7
Lung - adenocarcinoma 19 0.3 0.2 - 0.4 727 18.4 17.1 - 19.8 2,781 109.1 105.0 - 113.2 781 129.6 120.7 - 139.0
Lung - large cell ** ** ** 20† 0.5 0.3 - 0.8 94 3.7 3.0 - 4.5 16 2.7 1.5 - 4.3
Lung - small cell ** ** ** 160† 4.0 3.4 - 4.7 650 25.5 23.6 - 27.5 132 21.9 18.3 - 26.0
Lung - squamous cell ** ** ** 140† 3.6 3.0 - 4.2 1,169 45.8 43.3 - 48.5 377 62.6 56.4 - 69.2
Urinary system Bladder 37 0.5 0.4 - 0.7 520 13.2 12.0 - 14.3 2,436 95.5 91.8 - 99.4 1,244 206.4 195.1 - 218.2
Kidney 111 1.6 1.3 - 1.9 775 19.6 18.3 - 21.1 1,267 49.7 47.4 - 52.9 285 47.3 42.9 - 54.2

Abbreviation: CI means confidence interval.

Symbols:

  • *Significant increasing trend in age-specific rate with increasing age.
  • **Suppressed due to small case count (less than 6).
  • †Count has been rounded to ensure confidentiality; associated rate and confidence interval have been adjusted to reflect rounded count.

Notes:

  1. Rates are per 100,000.
  2. Excludes cases with no age information.
  3. Only selected subsites and histological subtypes of major cancers are shown. As a result, counts for these may not sum to the total for the cancer type.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Ages 0 to 39 years

Five percent of all new cases occurred in people under age 40, with female breast and thyroid being the leading cancers.

The under-40 age group also accounted for the majority of new cases of Hodgkin lymphoma and testicular cancer, at 53.6% and 64.2%, respectively.

In 2016, about 0.5% of all new cancers occurred in children 0 to 14 years of age. Childhood cancer types are unique. The most common types are leukemias (32.5%), central nervous system tumours (23.7%) and lymphomas (12.8%) (see Spotlight: Childhood Cancer Incidence, Table S1).

For details about childhood cancer incidence, visit the POGO Surveillance Report.

Spotlight: Childhood Cancer Incidence

Table S1 Childhood cancer incidence counts and rates, by cancer type, 0 to 14 years, Ontario, 2012 to 2016
Types of cancer/tumour (ICCC diagnosis group) N % Age-specific incidence rate ASIR ASIR 95% CI
All cancers combined 2,021 100.0% 184.07 185.28 174.37 - 196.87
I. Leukemias, myeloproliferative diseases, and myelodysplastic diseases 656 32.5% 59.75 60.25 57.45 - 63.19
II. Lymphomas and reticuloendothelial neoplasms 258 12.8% 23.50 23.41 21.69 - 25.27
III. CNS and miscellaneous intracranial and intraspinal neoplasms 478 23.7% 43.53 43.58 41.21 - 46.09
IV. Neuroblastoma and other peripheral nervous system tumours 137 6.8% 13.39 13.76 12.41 - 15.26
V. Retinoblastoma 46 2.3% 10.62 10.69 8.95 - 12.76
VI. Renal tumours 82 4.1% 9.39 9.53 8.34 - 10.90
VII. Hepatic tumours 27 1.3% 5.35 5.43 4.31 - 6.85
VIII. Malignant bone tumours 75 3.7% 7.86 7.84 6.81 - 9.04
IX. Soft tissue and other extraosseous sarcomas 129 6.4% 11.75 11.82 10.61 - 13.16
X. Germ cell tumours, trophoblastic tumours, and neoplasms of gonads 64 3.2% 5.83 5.90 5.06 - 6.87
XI. & XII. Other and unspecified malignant neoplasms 69 3.4% 6.28 6.30 5.43 - 7.30

Abbreviations: ASIR means age-standardized incidence rate; CI means confidence interval; CNS means central nervous system; ICCC means International Classification of Childhood Cancer

Notes:

  1. Rates are per 1,000,000.
  2. The POGONIS database classifies childhood cancer according to the International Classification of Childhood Cancer, third edition, which has 12 main diagnostic groups.
  3. Childhood cancer incidence is reported over 5-year period due to variations in annual incidence and potential for small cell disclosure.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario (POGO)
Data source: Pediatric Oncology Group of Ontario Networked Information System (POGONIS, October 16, 2019), POGO

 

Ages 40 to 59 years

Of all new cases, 23.9% occurred in people 40 to 59 years of age, with colorectal and female breast being the leading cancers.

Nearly half of all new cases of thyroid cancer occurred in people ages 40 to 59, and 41.8% of new cervical cancer cases occurred in females in this age group.

null

Ages 60 to 79 years

Of all new cases, 52.1% occurred in people 60 to 79 years of age.

This age group was more likely than other age groups to be diagnosed with the most common cancers:

  • 46.0% of all new cases of breast cancer
  • 51.1% of new cases of colorectal cancer
  • 62.6% of new cases of lung cancer a
  • 69.5% of new cases of prostate cancer

Ages 80 and older

Of all new cases, 18.9% occurred in people 80 years of age or older, with prostate and female breast being the leading cancers.

Cancer incidence increased with age, from a rate of 59.6 per 100,000 in people diagnosed at age 39 or younger to 2,559.7 per 100,000 in those diagnosed at age 80 or older. Rates varied by cancer type. Incidence rates for the following cancer types increased significantly with age:

  • Malignant cancers of the brain and other nervous system
  • Colon (including right-sided colon)
  • Leukemia (including acute myeloid leukemia, acute monocytic leukemia and chronic myeloid leukemia)
  • Lymphoma (including non-Hodgkin lymphoma and extranodal non-Hodgkin lymphoma)
  • Melanoma of the skin

Testicular cancer and acute lymphocytic leukemia showed non-significant decreases with age, while all other cancer types increased non-significantly with age.

From 1981 to 2000, the cancer incidence rate for all cancers combined increased by 0.5% per year, remained stable until 2011 and then decreased by 1.2% per year until 2016 (Table 5.5).

Among males, the incidence rate increased by 0.8% per year between 1981 and 1992, remained stable and then began decreasing in 2007 by 1.6% per year until 2016. Although the cancer incidence rate among females has not seen a similar decrease, the incidence rate has stabilized in recent years following a steady increase by 0.4% per year between 1981 and 2012.

Table 5.5 Annual percent change in age-standardized incidence rates by cancer type and sex, Ontario, 1981 to 2016

Table 5.5A Annual percent change in age-standardized incidence rates by cancer type and sex, both sexes combined, Ontario, 1981 to 2016
Cancer type Both sexes
Period APC (%)
All cancers 1981 - 2000 0.5*
2000 - 2011 -0.1
2011 - 2016 -1.2*
Brain and other nervous system - malignant 1981 - 2009 -0.3*
2009 - 2016 -2*
Glioblastoma 1981 - 2001 2*
2001 - 2005 -4.5
2005 - 2016 2.3*
Meninges - malignant 1981 - 1998 2.4*
1998 - 2016 -7.3*
Brain and other nervous system - Non-malignant n/a **
Meninges - non-malignant n/a **
Pituitary, pineal and craniopharyngeal duct n/a **
Breast (female) n/a n/a
Cervix n/a n/a
Ovary n/a n/a
Prostate n/a n/a
Testis n/a n/a
Uterus n/a n/a
Uterus - endometrial n/a n/a
Uterus - uterine sarcoma n/a n/a
Colorectal 1981 - 1996 -0.7*
1996 - 2000 0.9
2000 - 2008 -0.9*
2008 - 2016 -2.3*
Colon excluding rectum 1981 - 1985 1.2
1985 - 1995 -1.1*
1995 - 2008 -0.4*
2008 - 2016 -2.4*
Colon - left sided 1981 - 2004 -1*
2004 - 2008 2
2008 - 2012 -5.6*
2012 - 2016 -2
Colon - right sided 1981 - 2010 0.1
2010 - 2016 -2.4*
Rectum and rectosigmoid junction 1981 - 1997 -0.6*
1997 - 2001 3.7*
2001 - 2016 -1.9*
Rectosigmoid junction 1981 - 1991 4.3*
1991 - 1996 -3.2
1996 - 2000 9.5
2000 - 2016 -3.9*
Rectum 1981 - 1985 0.2
1985 - 1991 -3.3*
1991 - 2008 0.4*
2008 - 2016 -1.8*
Esophagus 1981 - 2007 0.1
2007 - 2011 3.3
2011 - 2016 -4.4*
Esophagus - adenocarcinoma 1981 - 1996 5*
1996 - 2012 2.8*
2012 - 2016 -2.8
Esophagus - squamous cell carcinoma 1981 - 2016 -2.2*
Liver 1981 - 1999 4.9*
1999 - 2007 2.6*
2007 - 2011 10.9*
2011 - 2016 0
Pancreas 1981 - 2003 -0.8*
2003 - 2016 1.5*
Stomach 1981 - 1993 -2.5*
1993 - 2008 -1.5*
2008 - 2012 2
2012 - 2016 -1.5
Larynx 1981 - 1991 -0.9
1991 - 2016 -2.6*
Oral cavity & pharynx 1981 - 2004 -1.8*
2004 - 2012 2.3*
2012 - 2016 -1.8
Hypopharynx 1981 - 2016 -2.4*
Lip and oral cavity 1981 - 1990 -1.1
1990 - 2003 -3.7*
2003 - 2012 2.7*
2012 - 2016 -3.8
Nasopharynx 1981 - 2016 -0.1
Oropharynx 1981 - 1998 -0.6
1998 - 2016 2.4*
Thyroid 1981 - 1998 4.7*
1998 - 2002 12.9*
2002 - 2012 6.8*
2012 - 2016 -2
Thyroid - anaplastic 1981 - 2016 -0.6
Thyroid - follicular 1981 - 2016 -0.9*
Thyroid - medullary 1981 - 2016 2*
Thyroid - papillary 1981 - 2012 9.1*
2012 - 2016 -2.9
Leukemia 1981 - 2016 0.2*
Acute lymphocytic leukemia 1981 - 2016 0.8*
Acute monocytic leukemia 1981 - 2016 2.7*
Acute myeloid leukemia 1981 - 2016 0.8*
Chronic lymphocytic leukemia 1981 - 2000 0.3
2000 - 2004 6.3
2004 - 2016 -2.1*
Chronic myeloid leukemia 1981 - 2004 -0.9*
2004 - 2016 1.9*
Lymphoma 1981 - 1998 1.6*
1998 - 2008 0.5
2008 - 2016 2.6*
Hodgkin lymphoma 1981 - 2016 -0.4*
Non-hodgkin lymphoma 1981 - 1998 2*
1998 - 2008 0.5
2008 - 2012 4.1*
2012 - 2016 1.2
Non-hodgkin lymphoma - extranodal 1981 - 2007 7.2*
2007 - 2012 36.9*
2012 - 2016 0.3
Non-hodgkin lymphoma - nodal 1981 - 1990 2.7*
1990 - 2007 0.7*
2007 - 2011 -8.8*
2011 - 2016 -1.2
Myeloma 1981 - 2004 0.7*
2004 - 2008 -3
2008 - 2012 5.8*
2012 - 2016 1
Melanoma of the skin 1981 - 1987 5.2*
1987 - 1992 -1.4
1992 - 2016 2.2*
Melanoma (non-cutaneous) 1981 - 2016 0.5
Melanoma - mucosal 1981 - 2006 -0.6
2006 - 2010 43.8
2010 - 2016 -4.8
Melanoma - ocular 1981 - 2016 -0.2
Lung 1981 - 1989 1.3*
1989 - 2008 -0.8*
2008 - 2012 0.8
2012 - 2016 -2.8*
Lung - adenocarcinoma 1981 - 1992 4.3*
1992 - 2008 -0.4
2008 - 2012 8.6*
2012 - 2016 0.1
Lung - large cell 1981 - 2000 0.6
2000 - 2004 -15.5*
2004 - 2016 -7.3*
Lung - small cell 1981 - 1988 7*
1988 - 2011 -0.4*
2011 - 2016 -3.1*
Lung - squamous cell 1981 - 1988 0.3
1988 - 2008 -3.5*
2008 - 2012 4.1
2012 - 2016 -2.3
Bladder‡ 1989 - 2003 -0.5
2003 - 2016 -2.1*
Kidney 1981 - 1989 5.3*
1989 - 1996 -0.7
1996 - 2016 1.7*

*Statistically significant trend
**Too few cases to calculate
Bladder cancer trend begins at 1989 due to classification changes and excludes carcinomas in situ

Notes:

  1. IARC/IACR multiple primary rules used when presenting trends over time.
  2. Rates are standardized to the 2011 Canadian population.
  3. Only selected subsites and histological subtypes of major cancers are shown. As a result, counts for these may not sum to the total for the cancer type.

Analysis by: Surveillance, Analytics and Informatics, CCO
Data source: Ontario Cancer Registry (December 2018), CCO

Table 5.5B Annual percent change in age-standardized incidence rates by cancer type and sex, males, Ontario, 1981 to 2016
Cancer type Males
Period APC (%)
All cancers 1981 - 1992 0.8*
1992 - 2007 -0.1
2007 - 2016 -1.6*
Brain and other nervous system - malignant 1981 - 2016 -0.5*
Glioblastoma 1981 - 2016 0.9*
Meninges – Malignant 1981 - 1995 4.7*
1995 - 2016 -5.6*
Brain and other nervous system - Non-malignant n/a **
Meninges - non-malignant n/a **
Pituitary, pineal and craniopharyngeal duct n/a **
Breast (female) n/a n/a
Cervix n/a n/a
Ovary n/a n/a
Prostate 1981 - 1993 4.9*
1993 - 2007 1.2*
2007 - 2016 -5.9*
Testis 1981 - 2016 1.3*
Uterus n/a n/a
Uterus - endometrial n/a n/a
Uterus - uterine sarcoma n/a n/a
Colorectal 1981 - 2008 -0.3*
2008 - 2016 -2.7*
Colon excluding rectum 1981 - 2008 -0.4*
2008 - 2016 -2.4*
Colon - left sided 1981 - 2004 -0.7*
2004 - 2008 2.5
2008 - 2012 -6.1*
2012 - 2016 -1.7
Colon - right sided 1981 - 2010 0.2
2010 - 2016 -2.2*
Rectum and rectosigmoid junction 1981 - 1997 -0.3
1997 - 2001 3.5
2001 - 2016 -2*
Rectosigmoid junction 1981 - 2001 2.6*
2001 - 2016 -3.6*
Rectum 1981 - 1995 -1.4*
1995 - 2006 0.9*
2006 - 2016 -2.1*
Esophagus 1981 - 2006 0.3
2006 - 2011 3.1
2011 - 2016 -4.8*
Esophagus - adenocarcinoma 1981 - 1991 6.8*
1991 - 2012 3*
2012 - 2016 -4.1
Esophagus - squamous cell carcinoma 1981 - 2016 -2.4*
Liver 1981 - 2012 4.6*
2012 - 2016 0.7
Pancreas 1981 - 2004 -1.3*
2004 - 2016 2.2*
Stomach 1981 - 2008 -1.9*
2008 - 2016 0.5
Larynx 1981 - 2016 -2.3*
Oral cavity & pharynx 1981 - 2006 -2.1*
2006 - 2012 4.2*
2012 - 2016 -2.8
Hypopharynx 1981 - 2016 -2.3*
Lip and oral cavity 1981 - 2005 -3.6*
2005 - 2012 3.5
2012 - 2016 -5.8
Nasopharynx 1981 - 2016 0
Oropharynx 1981 - 1998 -0.7
1998 - 2016 3*
Thyroid 1981 - 1997 4.1*
1997 - 2012 7.7*
2012 - 2016 1.3
Thyroid - anaplastic 1981 - 2016 2.1*
Thyroid - follicular 1981 - 2016 -0.9*
Thyroid - medullary n/a n/a
Thyroid - papillary 1981 - 2012 8.5*
2012 - 2016 2.2
Leukemia 1981 - 2016 0.1
Acute lymphocytic leukemia 1981 - 2016 0.7*
Acute monocytic leukemia 1981 - 2016 2.4*
Acute myeloid leukemia 1981 - 2016 0.8*
Chronic lymphocytic leukemia 1981 - 1999 0
1999 - 2003 6.9
2003 - 2016 -1.8*
Chronic myeloid leukemia 1981 - 1997 0.7
1997 - 2002 -6
2002 - 2016 2.1*
Lymphoma 1981 - 2009 1.2*
2009 - 2016 2.8*
Hodgkin lymphoma 1981 - 2016 -0.7*
Non-hodgkin lymphoma 1981 - 2009 1.5*
2009 - 2016 3*
Non-hodgkin lymphoma - extranodal 1981 - 2007 7.2*
2007 - 2012 38.1*
2012 - 2016 0.1
Non-hodgkin lymphoma - nodal 1981 - 2007 1.3*
2007 - 2011 -9.7*
2011 - 2016 -0.1
Myeloma 1981 - 2004 0.6*
2004 - 2008 -3.3
2008 - 2012 7.2*
2012 - 2016 0.1
Melanoma of the skin 1981 - 1988 5.7*
1988 - 1992 -1.4
1992 - 2016 2.3*
Melanoma (non-cutaneous) 1981 - 2016 0.6*
Melanoma - mucosal ** **
Melanoma - ocular 1981 - 2016 0
Lung 1981 - 1989 -0.1
1989 - 2008 -2.1*
2008 - 2012 0.6
2012 - 2016 -4.2*
Lung - adenocarcinoma 1981 - 1992 3.1*
1992 - 2008 -1.5*
2008 - 2012 8.4*
2012 - 2016 -1.2
Lung - large cell 1981 - 2000 -0.6
2000 - 2004 -17.9*
2004 - 2016 -6.8*
Lung - small cell 1981 - 1990 3.5*
1990 - 2016 -1.7*
Lung - squamous cell 1981 - 1988 -0.6
1988 - 2008 -4.4*
2008 - 2012 3.2
2012 - 2016 -2.5
Bladder‡ 1989 - 2016 -1.4*
Kidney 1981 - 1989 4.6*
1989 - 2001 0
2001 - 2016 2.2*

*Statistically significant trend
**Too few cases to calculate
Bladder cancer trend begins at 1989 due to classification changes and excludes carcinomas in situ

Notes:

  1. IARC/IACR multiple primary rules used when presenting trends over time.
  2. Rates are standardized to the 2011 Canadian population.
  3. Only selected subsites and histological subtypes of major cancers are shown. As a result, counts for these may not sum to the total for the cancer type.

Analysis by: Surveillance, Analytics and Informatics, CCO
Data source: Ontario Cancer Registry (December 2018), CCO

Table 5.5C Annual percent change in age-standardized incidence rates by cancer type and sex, females, Ontario, 1981 to 2016
Cancer type Females
Period APC (%)
All cancers 1981 - 2012 0.4*
2012 - 2016 -0.4
Brain and other nervous system - malignant 2000 - 2016 -1.2*
Glioblastoma 1981 - 2001 2*
2001 - 2005 -6.8
2005 - 2016 3.5*
Meninges - malignant 1981 - 1999 1.4
1999 - 2016 -8*
Brain and other nervous system - Non-malignant n/a **
Meninges - Non-malignant n/a n/a
Pituitary, pineal and craniopharyngeal duct n/a **
Breast (female) 1981 - 1992 2*
1992 - 2016 -0.2*
Cervix 1981 - 2004 -2.1*
2004 - 2016 -0.9
Ovary 1981 - 2002 0.3*
2002 - 2016 -1.2*
Prostate n/a n/a
Testis n/a n/a
Uterus 1981 - 1989 -2.4*
1989 - 2005 0.5*
2005 - 2011 4*
2011 - 2016 1
Uterus - endometrial 1981 - 1990 -2.6*
1990 - 2005 0.7*
2005 - 2011 4.8*
2011 - 2016 1
Uterus - uterine sarcoma 1981 - 2016 1*
Colorectal 1981 - 1996 -1.2*
1996 - 2000 1.6
2000 - 2016 -1.7*
Colon excluding rectum 1981 - 2009 -0.8*
2009 - 2016 -2.5*
Colon - left sided 1981 - 2009 -1.3*
2009 - 2016 -3.3*
Colon - right sided 1981 - 2011 -0.1
2011 - 2016 -3.3*
Rectum and rectosigmoid junction 1981 - 1996 -1.4*
1996 - 2000 4.1
2000 - 2016 -1.6*
Rectosigmoid junction 1981 - 1991 4*
1991 - 1996 -5
1996 - 2000 12
2000 - 2016 -4.3*
Rectum 1981 - 1991 -3.1*
1991 - 2016 -0.1
Esophagus 1981 - 2016 -0.7*
Esophagus - adenocarcinoma 1981 - 2016 3.1*
Esophagus - squamous cell carcinoma 1981 - 2016 -2*
Liver 1981 - 2008 3.4*
2008 - 2012 14.7*
2012 - 2016 -3
Pancreas 1981 - 2006 -0.4*
2006 - 2012 2.9*
2012 - 2016 -2.1
Stomach 1981 - 1998 -2.9*
1998 - 2016 -0.1
Larynx 1981 - 1988 3.2
1988 - 2016 -2.9*
Oral cavity & pharynx 1981 - 2003 -1*
2003 - 2016 0.5
Hypopharynx 1981 - 2016 -3.2*
Lip and oral cavity 1981 - 2003 -1.1*
2003 - 2016 1.4*
Nasopharynx 1981 - 2016 -0.4
Oropharynx 1981 - 2016 -0.1
Thyroid 1981 - 1998 4.9*
1998 - 2002 14.5*
2002 - 2012 6.4*
2012 - 2016 -3*
Thyroid - anaplastic 1981 - 2016 -1.6*
Thyroid - follicular 1981 - 2016 -0.9*
Thyroid - medullary 1981 - 2016 1.4*
Thyroid - papillary 1981 - 1998 8*
1998 - 2002 14.3*
2002 - 2012 8.1*
2012 - 2016 -3.6*
Leukemia 1981 - 2016 0.1
Acute lymphocytic leukemia 1981 - 2016 0.8*
Acute monocytic leukemia 1981 - 2016 2.7*
Acute myeloid leukemia 1981 - 2016 0.6*
Chronic lymphocytic leukemia 1981 - 2007 1.1*
2007 - 2016 -2.1
Chronic myeloid leukemia 1981 - 2003 -1.1*
2003 - 2016 2*
Lymphoma 1981 - 1998 1.7*
1998 - 2008 0.4
2008 - 2016 2.1*
Hodgkin lymphoma 1981 - 2016 -0.1
Non-hodgkin lymphoma 11981 - 1998 1.9*
1998 - 2008 0.5
2008 - 2016 2.3*
Non-hodgkin lymphoma - extranodal 1981 - 2007 6.7*
2007 - 2011 42.7*
2011 - 2016 4.1
Non-hodgkin lymphoma - nodal 1981 - 1998 1.8*
1998 - 2008 -0.5
2008 - 2012 -9*
2012 - 2016 -0.7
Myeloma 1981 - 2001 0.8*
2001 - 2008 -1.4
2008 - 2016 3*
Melanoma of the skin 1981 - 1987 4.1*
1987 - 1992 -2.4
1992 - 2016 2*
Melanoma (non-cutaneous) 1981 - 2007 -0.5
2007 - 2016 4
Melanoma - mucosal ** **
Lung 1981 - 1985 6.5*
1985 - 1998 1.9*
1998 - 2012 0.5*
2012 - 2016 -0.8
Lung - adenocarcinoma 1981 - 1992 5.8*
1992 - 2008 0.7*
2008 - 2012 8.7*
2012 - 2016 1.2
Lung - large cell 1981 - 1999 3*
1999 - 2016 -9*
Lung - small cell 1987 - 1997 2.4*
1997 - 2016 -0.4
Lung - squamous cell 1981 - 1995 1.5*
1995 - 2007 -2.6*
2007 - 2012 4.8*
2012 - 2016 -1.9
Bladder‡ 1989 - 2003 -0.5
2003 - 2016 -2.8*
Kidney 1981 - 1986 9.1*
1986 - 2016 1.1*

*Statistically significant trend
**Too few cases to calculate
Bladder cancer trend begins at 1989 due to classification changes and excludes carcinomas in situ

Notes:

  1. IARC/IACR multiple primary rules used when presenting trends over time.
  2. Rates are standardized to the 2011 Canadian population.
  3. Only selected subsites and histological subtypes of major cancers are shown. As a result, counts for these may not sum to the total for the cancer type.

Analysis by: Surveillance, Analytics and Informatics, CCO
Data source: Ontario Cancer Registry (December 2018), CCO

Recent incidence trends for the 4 most common cancers

Breast cancer

Since 1992, the age-standardized incidence rate (ASIR) for female breast cancer in Ontario has been steadily decreasing at 0.2% per year, likely due to the diminishing number of women with undetected cancer. Such a rise and fall in the incidence rate is characteristic of the introduction in a population of a new method of early diagnosis.

In addition, the use of hormone replacement therapy (HRT), associated with an increased risk of breast cancer among post-menopausal women, began to decline in Canada in the early 2000s.[25,26] This may also have contributed to a continuing decline in the breast cancer incidence rate in subsequent years.

Colorectal cancer

The ASIR for colorectal cancer among males declined by 2.7% per year from 2008 to 2016. Individually, incidence rates for both colon and rectal cancers in males also declined during this period.

Among females, the colorectal cancer incidence rate was stable between 1996 and 2000, and then decreased after 2000 at a rate of 1.7% per year. These trends may reflect the following opposing trends for colorectal cancer sub-sites:

  • An increase in cancer of the rectosigmoid junction between 1996 and 2000
  • An overall decrease in colon cancer between 1981 and 2016 in females

Lung cancer

In males, the ASIR for lung cancer was stable from 2008 to 2012 and has since declined by 4.2% per year. The incidence rate among females increased from the early 1980s until 2012 – although the upward trend slowed after 1995. Since 2012, the female rate has been stable.

The decline in the lung cancer incidence rate in males and the slow plateauing in the incidence rate in females over the last 2 decades reflects differences in historical smoking rates between the sexes.[27] While tobacco use is the primary cause of lung cancer, other causes include exposure to radon, asbestos, environmental tobacco smoke and air pollution.

The increasing trend of lung adenocarcinoma among females has also been seen in other jurisdictions.[28-30] One explanation for this trend may be the longer latency of the effect of smoking cessation on adenocarcinoma rates. Once a person quits smoking, their risks for other lung cancer subtypes decline faster than their risk for adenocarcinomas.[29]

Given the historical differences in smoking rates between males and females, the increasing rate of adenocarcinomas among females may reflect the delay between quitting smoking and lowering adenocarcinoma risk in women. Finally, the declining trend in the male rate has allowed the female rate to surpass it.

Prostate cancer

The ASIR for prostate cancer increased 1.2% per year from 1993 to 2007, and then fell by 5.9% per year between 2007 and 2016. An abrupt rise and fall in the incidence rate is common when a new method of early diagnosis is introduced, such as prostate-specific antigen (PSA) testing for prostate cancer. The decrease starting in 2011 may also reflect the effect of recommendations from the U.S. Preventive Services Task Force against using PSA testing for the routine screening of healthy males.[31]

Notable changes in trend for other cancers

Liver cancer

Incidence rates for liver cancer increased steeply between 1981 and 2011, although the rates have stabilized in recent years. Among males, the ASIR increased at a rate of 4.6% per year from 1981 to 2012 and has been stable since then. The trend was more pronounced among females, with the ASIR increasing by 3.4% per year from 1981 to 2008, by 14.7% per year from 2008 to 2012 and stabilizing in the most recent period.

A rising incidence rate of liver cancer may be the result of:

  • increasing immigration from countries where certain risk factors (e.g., hepatitis B and C infections, exposure to aflatoxins) are more common[32]
  • a higher prevalence of hepatitis C infection caused by needle sharing[33]
  • increasing prevalence of obesity and diabetes[33]

Myeloma

The ASIR for myeloma increased by 5.8% per year between 2008 and 2012 before stabilizing in recent years. The increase was driven mainly by the increased rate in males, which went up by 7.2% per year between 2008 and 2012. The rate for females has been increasing by 3.0% per year since 2008.

Increasing trends in other jurisdictions suggest the rise in myeloma rates may be due to improvements in diagnostics and better registration of cases. [34]

Thyroid cancer

The ASIR for thyroid cancer increased significantly during the 1981 to 2016 period. The greatest increase occurred between 1998 and 2002, at 12.9% per year. This was mainly because of the increase in the female rate of 14.5% per year. The overall incidence rate continued to increase between 2002 and 2012, but at a slower pace of 6.8% per year, before stabilizing in recent years. Among females, the ASIR decreased by 3.0% per year starting in 2012.

The rising incidence rate has been attributed to the greater use of ultrasound and fine-needle aspiration, which may have improved the detection of subclinical tumours (i.e., early tumours that do not cause symptoms).[35-38] A similar change in trend among females has been seen in other jurisdictions,[39] which have reported that thyroid incidence rates among females have stabilized in recent years.

Uterine cancer

Following a period of declining incidence rates, the ASIR for uterine cancer increased by 4.0% per year from 2005 to 2011 before stabilizing in recent years. The increase was mainly because of increasing incidence rates for endometrial cancer over the same period (4.8% per year between 2005 and 2011).

Increasing incidence of endometrial cancer in other jurisdictions suggests trends may be linked to increasing rates of obesity and hormone therapy use as well as decreasing rates of pregnancy. All of these increase exposure to estrogen, a key risk factor for endometrial cancer.[40]

Thirty-Five Year Trend in Incidence

The age-standardized incidence rates (ASIR) from 1981 to 2016 for selected cancers are shown in Figure 5.3. These cancers represent the 4 most common cancers in Ontario (breast, prostate, lung and colorectal) as well as those with significantly increasing recent trends in ASIR.

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. IARC/IACR multiple primary rules used when presenting trends over time.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.3 Age-standardized incidence rates by cancer type for selected cancers, Ontario, 1981 to 2016
Year Breast (female) Prostate Lung Colorectal Non-Hodgkin Lymphoma Melanoma Thyroid Kidney Pancreas Liver Testis
1981 110 102.4 69.7 69.3 14.9 10.8 4 7.9 13.5 1.8 4
1982 110.1 98.3 70.8 71.9 16 11.8 3.3 7.9 13.8 2.1 3.9
1983 113.6 100.4 74.9 72.8 15.9 11.9 3.8 7.7 13.4 2.1 4.1
1984 116.1 104.4 74.6 74.9 16 11.4 3.8 9.5 12.8 2.6 3.6
1985 118.2 107.4 75.1 73.6 16.5 14 4.5 9.8 14 2.5 4.6
1986 114.8 112.6 76.7 70.5 16.6 13.3 4.6 9.6 13.4 2.6 4.4
1987 118.2 113.7 76.1 72.2 17.5 14.8 4.5 10.5 12.4 2.6 4.4
1988 127.7 113.9 77.5 72.2 17.7 14.8 4.4 11 13.6 2.7 3.9
1989 125.6 116.9 76.7 69.9 18.2 13.8 4.7 11.4 12.3 2.9 4.7
1990 124.7 130.9 77.6 70.2 19.1 14.3 5.3 11.5 12 3.1 4.8
1991 134.2 150.4 77.5 70.1 18.6 13.9 5.6 11.9 13.2 3.1 4.1
1992 135.9 166.3 77.4 68.2 18.9 13.3 5.8 10.9 12.7 3.4 3.9
1993 130.3 174.5 76.5 67.2 19.5 13.6 6.6 11.6 12.3 3.5 5
1994 129 166.1 74.1 68.5 20 13.6 7 11.2 12.5 4.2 5.3
1995 130.7 148.1 73.7 66.1 20.3 15 6.6 11 11.2 3.7 4.2
1996 129.7 155.8 74.6 65.4 19.9 15.3 6.9 11.3 12.2 3.5 4.7
1997 136.7 168.1 72.6 64.3 20.9 15.1 7.2 11 12.3 4.3 4.8
1998 136.5 166.9 74.3 67.9 21.9 15 7.3 11.7 11.8 4.5 4.5
1999 139.1 167 73.1 68.8 20.9 16.5 8.8 11.5 11.9 4.8 5
2000 133.5 176.5 73.5 69.9 21.8 16.6 9.8 12.2 12.1 4.7 5.3
2001 133.7 192.7 73.1 69.3 21.7 16.8 10.7 11.9 11.9 5.2 5.3
2002 137.4 179 70 67 21.6 16.2 13.4 11.9 11.2 5.1 5.1
2003 128.6 169.6 68.2 65.1 21.5 17 13 12 11.6 4.9 5.3
2004 129.9 179.9 68.8 66 22.7 17.1 14.1 12.3 11.6 5 5.2
2005 129.6 185 71 65.4 22.3 17.9 15.1 12.6 12.1 5.6 5.3
2006 128.5 188.5 69 64.7 22 19 16.2 13.1 11.2 5.8 5.3
2007 130.2 186.8 67.5 64.4 23.8 19.1 16.9 14.8 12.5 6 5
2008 125.4 169.2 66.2 65 22.6 19.2 18.4 14 12 6.1 5.8
2009 127.7 165.2 65.9 61.9 22.5 20.2 19.3 13.5 11.9 6.6 5.4
2010 131.1 163.3 69.7 61.2 23.8 20.6 19.3 13.9 12.1 8.1 5.6
2011 130.4 164.9 68.7 60.7 24.5 20.8 23.8 14.3 13.6 8.6 6.2
2012 127.3 135 70.3 57.8 26.9 19.9 23.6 14.5 14.1 8.4 6
2013 126.7 118.5 66.8 56.3 28 21.8 23.5 14.6 14 9.1 5.6
2014 130.2 112.9 65.7 55 27.2 22.3 24.3 14.6 13.2 8.7 6
2015 127.7 113.6 63.7 54.8 26.2 22.1 22.8 15.2 13.4 8.9 5.7
2016 129.1 117.7 62.5 52.7 28.2 22.5 21.2 15.6 13.5 8.4 6.6

Notes:

  1. Rates are per 100,000 and standardized to the age distribution of the 2011 Canadian population.
  2. IARC/IACR multiple primary rules used when presenting trends over time.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Over the last 35 years (1981 to 2016) the average annual percent change (AAPC) in ASIR for males (Figure 5.4):

  • increased most for thyroid (5.3%) and liver (4.2%) cancers, melanoma (2.6%), and kidney cancer (2.0%)
  • remained stable for esophageal, pancreatic, and prostate cancers, leukemia, myeloma and all cancers combined
  • decreased most for laryngeal (2.3%), lung (1.6%), bladder (1.4%) and stomach (1.4%) cancers

For females, the AAPC:

  • increased most for thyroid (5.5%), liver (3.9%) and kidney (2.2%) cancers, and melanoma (1.7%)
  • remained stable for pancreatic cancer, Hodgkin lymphoma and leukemia
  • decreased most for laryngeal (1.7%), cervical (1.7%), bladder (1.6%) and stomach (1.5%) cancers

Abbreviation: AAPC means average annual percent change

Symbols:]

  • † Excludes carcinomas in situ.

Notes:

  1. Bladder cancer trend begins in 1989 due to classification changes; AAPC is for period 1989 to 2016.
  2. Rates are standardized to the 2011 Canadian population.
  3. IARC/IACR multiple primary rules used when presenting trends over time.
  4. The AAPCs for the following cancer types were not statistically significant among males: all cancers esophagus, leukemia, myeloma, pancreas and prostate.
  5. The AAPCs for the following cancer types were not statistically significant among females: Hodgkin lymphoma, pancreas and leukemia.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.4 Average annual percent change in age-standardized incidence rates by cancer type and sex, Ontario, 1981 to 2016
Cancer Type Males Females
Larynx -2.3 -1.7
Cervix n/a -1.7
Lung -1.6 1.6
Bladder† -1.4 -1.6
Stomach -1.4 -1.5
Oral cavity & pharynx -1.1 -0.4
Colorectal -0.9 -1.1
Hodgkin lymphoma -0.7 -0.1
Brain -0.5 -0.6
Ovary n/a -0.3
All cancers -0.2 0.3
Pancreas -0.1 0
Esophagus 0.0 -0.7
Leukemia 0.1 0.1
Breast (female) n/a 0.5
Uterus n/a 0.5
Prostate 0.5 n/a
Myeloma 0.8 0.9
Testis 1.3 n/a
Non-Hodgkin lymphoma 1.8 1.6
Kidney 2.0 2.2
Thyroid 5.3 5.5

Abbreviation: AAPC means average annual percent change

Symbols:

  • † Excludes carcinomas in situ.

Notes:

  1. Bladder cancer trend begins in 1989 due to classification changes; AAPC is for period 1989 to 2016.
  2. Rates are standardized to the 2011 Canadian population.
  3. IARC/IACR multiple primary rules used when presenting trends over time.
  4. The AAPCs for the following cancer types were not statistically significant among males: all cancers esophagus, leukemia, myeloma, pancreas and prostate.
  5. The AAPCs for the following cancer types were not statistically significant among females: Hodgkin lymphoma, pancreas and leukemia.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Over the past 35 years, cancer incidence rates have been increasing among younger and middle-aged people, and decreasing among the elderly.

Ages 0 to 39

Among people under the age of 40, the cancer incidence rate increased by 0.5% per year between 1981 and 2001, then by 1.5% per year between 2001 and 2011 before stabilizing in recent years (Figure 5.5).

Different trends were seen in males and females. Among males, the rate increased by 1.8% per year between 1981 and 1991, remained stable until 2001 and has been increasing by 1.1% per year since. For females, the rate increased by 0.3% per year between 1981 and 1996, increased by 1.8% per year between 1996 and 2009, and has been stable since then. The increase in incidence among males is probably due to the increasing rates of testicular and thyroid cancers, and non-Hodgkin lymphoma in this age group (data not shown).

Among children ages 0 to 14 years, the average annual percent change (AAPC) in age-standardized incidence rates (ASIR) increased by 0.8% over the period from 1986 to 2016 and has been increasing by 1.7% per year between 2002 to 2016 (see Spotlight: Childhood Cancer Incidence Trend, Figure 5.S1).

For details about childhood cancer incidence trends, visit the POGO Surveillance Report.

Spotlight: Childhood Cancer Incidence Trend

Abbreviations: APC means annual percent change.

Notes:

  1. Rates are per 1,000,000.
  2. * indicates significant changing APC trends.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario (POGO)
Data source: Pediatric Oncology Group of Ontario Networked Information System (POGONIS, October 16, 2019), POGO


Period APC
1986-2002 0.0
2002-2016 1.7*
Data for Figure 5.S1 Annual percent change in age-standardized incidence rates of cancer in children, all cancers combined, 0 to 14 years, Ontario, 1986 to 2016
Year Age-standardized incidence rate
1986 148.5
1987 157.7
1988 140.2
1989 129.7
1990 166.2
1991 150.9
1992 136
1993 156
1994 143.6
1995 152.1
1996 152.5
1997 150.7
1998 160.6
1999 150.2
2000 155.5
2001 146.5
2002 141.6
2003 157.5
2004 155.5
2005 150
2006 160.7
2007 158.5
2008 173.3
2009 168.5
2010 184
2011 165.2
2012 182.3
2013 181.8
2014 187.4
2015 199.1
2016 176

Notes:

  1. Rates are per 1,000,000.

Analysis by: Health Analytics, Pediatric Oncology Group of Ontario (POGO)
Data source: Pediatric Oncology Group of Ontario Networked Information System (POGONIS, October 16, 2019), POGO

 

Ages 40 to 59

Among people ages 40 to 59, the rate of cancer increased by 0.5% per year from 1981 to 2007 and then decreased by 0.5% per year from 2007 onward. While the trend among males was the same, the female rate has been increasing by 0.4% per year since 1981.

Ages 60 to 79

For those ages 60 to 79, the rate increased by 1.2% per year between 1981 and 1992, remained stable between 1992 and 2007, and has since been decreasing by 1.3% per year. The rate among males was similar, although the rate of decrease in the most recent period (2007 to 2016) has been greater, at 2.3% per year. Females in this age group had no decrease in incidence rate; their rate increased by 1.0% per year between 1981 and 1991, and then by 0.3% per year between 1991 and 2012 before stabilizing in the most recent period.

Ages 80 and older

In the oldest age group (those 80 and older), the incidence rate declined steadily throughout the whole period by 0.1% per year. While the male rate had 2 periods of decline, by 1.1% per year between 1991 and 2007 and 1.9% per year from 2011 onward, the female rate has been increasing slowly by 0.1% per year since 1981.

Both Sexes APCs

0 to 39 Years
Period APC
1981-2001 0.5*
2001-2011 1.5*
2011-2016 0.3
40 to 59  Years
Period APC
1981-2007 0.5*
2007-2016 -0.5*
   
60 to 79 Years
Period APC
1981-1992 1.2*
1992-2007 0.2
2007-2016 -1.3*
80 or older
Period APC
1981-2016 -0.1*

 

 

 

 

Males APCs

0 to 39 Years
Period APC
1981-2001 1.8*
1991-2001 -0.6
2001-2016 1.1*
40 to 59  Years
Period APC
1981-2007 0.6*
2007-2016 -1.7*
   
60 to 79 Years
Period APC
1981-1993 1.2*
1993-2007 0
2007-2016 -2.3*
80 or older
Period APC
1981-1991 1.8
1991-2007 -1.1*
2007-2011 1.3
2011-2016 -1.9*

 

 

 

 

Female APCs

0 to 39 Years
Period APC
1981-1996 0.3*
1996-2009 1.8*
2009-2016 0.2
40 to 59  Years
Period APC
1981-2016 0.4*
   
   
60 to 79 Years
Period APC
1981-1991 1.0*
1991-2012 0.3*
2012-2016 -0.6*
80 or older
Period APC
1981-2016 0.1*

Abbreviation: APC means annual percent change.
Notes: Rates are per 100,000. Only significant changing APC trends are shown.
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.5A Annual percent change in age-standardized incidence rates by cancer type and sex (both sexes), Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 43.1 420.0 1,441.5 2,374.8
1982 42.1 409.8 1,455.8 2,398.2
1983 43.8 422.4 1,467.6 2,547.6
1984 43.5 425.1 1,509.4 2,439.0
1985 44.3 439.9 1,521.7 2,415.1
1986 44.9 429.6 1,497.5 2,396.6
1987 46.6 430.9 1,539.7 2,455.1
1988 46.5 442.7 1,574.1 2,418.2
1989 44.8 422.9 1,552.5 2,383.4
1990 46.8 432.9 1,578.2 2,465.7
1991 46.1 442.8 1,645.7 2,520.2
1992 45.6 445.7 1,661.8 2,391.9
1993 46.7 440.6 1,658.8 2,462.5
1994 47.1 436.0 1,656.7 2,399.9
1995 47.5 437.6 1,589.6 2,352.9
1996 46.3 434.1 1,627.1 2,336.1
1997 46.9 446.6 1,647.1 2,364.4
1998 47.3 450.2 1,659.6 2,427.9
1999 49.2 457.3 1,685.3 2,431.8
2000 48.2 464.7 1,702.1 2,444.3
2001 46.1 475.4 1,721.2 2,438.7
2002 51.0 466.7 1,677.5 2,370.9
2003 49.5 447.8 1,661.4 2,398.9
2004 51.2 464.1 1,674.6 2,348.9
2005 49.7 469.5 1,675.0 2,340.2
2006 52.8 472.6 1,672.7 2,292.6
2007 53.1 480.9 1,693.3 2,346.6
2008 53.9 467.7 1,624.0 2,372.6
2009 55.0 469.1 1,629.9 2,317.9
2010 54.7 465.6 1,643.4 2,403.7
2011 56.2 475.1 1,654.8 2,480.8
2012 56.6 463.7 1,593.8 2,385.1
2013 55.5 453.0 1,548.8 2,437.6
2014 56.6 454.8 1,522.5 2,349.5
2015 57.5 456.9 1,504.6 2,344.2
2016 56.8 451.6 1,521.3 2,342.5


Data for Figure 5.5B Annual percent change in age-standardized incidence rates by cancer type and sex (male), Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 35.4 378.0 1,842.2 3,592.0
1982 33.8 375.3 1,866.2 3,471.1
1983 35.3 382.3 1,871.4 3,758.5
1984 36.2 386.0 1,927.4 3,633.7
1985 37.7 397.9 1,928.1 3,525.2
1986 37.7 390.7 1,902.2 3,699.8
1987 39.4 393.0 1,953.4 3,740.9
1988 38.7 396.5 1,981.6 3,623.3
1989 38.5 386.6 1,981.7 3,499.9
1990 41.5 390.7 2,010.6 3,700.3
1991 40.3 395.0 2,086.4 3,838.6
1992 40.4 399.0 2,151.8 3,729.7
1993 40.5 403.6 2,170.7 3,625.6
1994 41.4 399.9 2,145.3 3,503.9
1995 40.1 382.5 2,013.8 3,428.4
1996 39.9 391.4 2,060.8 3,371.4
1997 38.2 399.0 2,110.9 3,368.6
1998 39.5 394.4 2,078.1 3,450.5
1999 40.5 412.1 2,116.2 3,399.4
2000 38.5 421.1 2,177.3 3,397.7
2001 37.5 444.9 2,202.7 3,433.6
2002 40.8 411.8 2,103.7 3,300.9
2003 39.7 409.2 2,079.9 3,268.5
2004 40.1 427.4 2,104.5 3,191.3
2005 37.5 432.2 2,112.0 3,215.6
2006 40.9 439.4 2,114.1 3,109.4
2007 41.2 443.6 2,120.0 3,140.7
2008 42.5 429.5 2,007.9 3,154.6
2009 41.1 421.1 1,987.6 2,992.3
2010 41.2 411.7 1,995.3 3,202.0
2011 44.5 418.2 2,006.3 3,415.6
2012 45.3 402.0 1,871.9 3,146.5
2013 42.8 384.1 1,782.1 3,163.0
2014 43.9 378.9 1,744.7 3,028.3
2015 45.6 384.5 1,735.9 3,022.4
2016 45.5 374.2 1,764.5 2,990.3


Data for Figure 5.5C Annual percent change in age-standardized incidence rates by cancer type and sex (female), Ontario, 1981 to 2016
Year 0 to 39 40 to 59 60 to 79 80 or older
1981 50.8 463.6 1,130.7 1,802.9
1982 50.4 445.8 1,140.6 1,894.2
1983 52.2 463.8 1,156.9 1,978.9
1984 50.7 465.4 1,186.9 1,881.9
1985 50.7 482.8 1,209.9 1,895.8
1986 52.1 469.4 1,184.5 1,794.9
1987 53.7 469.5 1,217.8 1,849.7
1988 54.3 489.6 1,256.9 1,857.9
1989 51.0 459.7 1,218.2 1,853.5
1990 51.9 475.6 1,237.4 1,872.9
1991 51.8 490.8 1,298.0 1,875.2
1992 50.7 492.4 1,273.4 1,746.8
1993 52.9 477.3 1,247.9 1,893.5
1994 52.6 471.5 1,258.9 1,853.3
1995 54.8 491.6 1,248.5 1,827.8
1996 52.7 475.9 1,272.2 1,826.0
1997 55.7 493.3 1,263.6 1,863.4
1998 55.3 504.9 1,311.5 1,924.1
1999 57.9 501.7 1,323.9 1,949.6
2000 58.0 507.4 1,298.6 1,973.1
2001 54.8 505.4 1,308.3 1,949.1
2002 61.3 520.7 1,312.0 1,901.3
2003 59.4 486.2 1,300.8 1,956.6
2004 62.4 501.0 1,301.2 1,913.1
2005 61.9 507.2 1,293.3 1,884.7
2006 64.8 506.6 1,285.1 1,855.9
2007 64.9 519.0 1,318.9 1,911.5
2008 65.2 506.6 1,287.1 1,938.8
2009 68.5 517.4 1,314.0 1,924.9
2010 67.7 519.7 1,332.7 1,936.8
2011 67.4 531.9 1,344.2 1,932.3
2012 67.4 525.1 1,348.2 1,923.0
2013 67.6 521.1 1,342.8 1,996.0
2014 68.7 529.6 1,326.7 1,923.9
2015 68.7 528.0 1,299.9 1,910.0
2016 67.6 527.4 1,305.6 1,924.8

Abbreviation: APC means annual percent change.
Note: Rates are per 100,000. 
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Incidence by Stage

“Cancer staging” refers to classifying people with cancer into groups according to the extent of the disease. “Stage at diagnosis” is the extent of the disease at the time of initial diagnosis.

A stage group (i.e., stage 0, 1, 2, 3 or 4) is based on distinct characteristics of a tumour that describe the extent of spread of a cancer in the body. Knowing the stage of the disease helps physicians plan appropriate treatment and determine the likely outcome or course of the disease. Information about stage at diagnosis is one of the most important factors for predicting the outcome for a person with cancer.

A cancer diagnosed at an early stage is more likely to be treated successfully. If the cancer has spread, treatment becomes more difficult and a person’s chances of survival are generally much lower.

The stage group is useful as a comparator within and across different cancer types, as well as for comparing trends over time. High-quality stage information at the population level supports healthcare providers, administrators, researchers and decision-makers in planning, evaluating and enhancing quality of care to improve treatment outcomes.

Note: Cases that had no stage group data were excluded from this analysis. Case counts are as follows: prostate n = 7,596 (excludes unknown stage = 23); breast n = 10,329 (excludes unknown stage = 59); colorectal n = 6,988 (excludes unknown stage = 164); lung n = 8,259 (excludes unknown stage = 27); cervix n = 526 (excludes unknown stage less than 6).
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.6 Proportion of new cases by stage at diagnosis and cancer type for selected cancers, Ontario, 2016
Cancer Type Stage 1 (%) Stage 2 (%) Stage 3 (%) Stage 4 (%)
Breast (female) 45 38 13 5
Cervix 55 21 14 10
Prostate 22 51 14 13
Colorectal 24 26 32 18
Colon excluding rectum 23 29 29 19
Colon - left sided 26 27 29 18
Colon - right sided 21 31 31 17
Rectum and rectosigmoid junction 28 19 36 17
Rectosigmoid junction 22 21 36 20
Rectum 29 19 36 16
Lung 26 8 19 46
Lung - adenocarcinoma 30 7 15 47
Lung - large cell 22 9 27 41
Lung - small cell 5 4 23 68
Lung - squamous cell 28 13 28 31

Note: Cases that had no stage group data were excluded from this analysis. Case counts are as follows: prostate n = 7,596 (excludes unknown stage = 23); breast n = 10,329 (excludes unknown stage = 59); colorectal n = 6,988 (excludes unknown stage = 164); lung n = 8,259 (excludes unknown stage = 27); cervix n = 526 (excludes unknown stage less than 6).
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Population-level stage-at-diagnosis data with high completeness are available in Ontario for 5 cancers: female breast, prostate, colorectal, lung and cervical (see Data Source for important notes about this data).

The majority of breast, prostate and cervical cancer cases, and half of all staged colorectal cancer cases were diagnosed at stage 1 or 2 (Figure 5.6). This may partly be because screening is available for breast, colorectal and cervical cancers, which increases the likelihood of finding these cancers at early stages. The distribution of stage varied by cancer type:

  • The majority of staged breast cancer cases were diagnosed at stage 1 (44.7%) or stage 2 (37.7%) in 2016.
  • Cervical cancer was even more likely to be diagnosed at stage 1 (55.1%) than breast cancer. Females diagnosed at a later stage are less likely to have been routinely screened.[41] Despite the successes of screening programs in reducing cervical cancer new cases and deaths, 10.1% of cases were still not diagnosed until stage 4.
  • The majority of staged colorectal cancer cases were diagnosed at stage 2 (26.0%) or stage 3 (31.5%). The distribution of stage was similar for the colorectal cancer sub-sites; however, a greater proportion of cancers of the rectum (35.7%) and rectosigmoid junction (36.5%) were diagnosed at stage 3.
  • Prostate cancer cases were most likely to be diagnosed at stage 2 (51.3%) followed by stage 1 (22.5%).
  • Lung cancer cases were the most likely to be diagnosed at stage 4, which accounted for 46.3% of all staged lung cancer cases. Out of all lung cancer subtypes, small cell lung cancer had the greatest proportion (68.1%) of cases diagnosed at stage 4.

The majority of breast, prostate and cervical cancer cases, and half of all staged colorectal cancer cases were diagnosed at stage 1 or 2.

Incidence by stage among screening-program-eligible cases

Among people within the screening-eligible age groups for Ontario’s population-based breast, cervical and colorectal screening programs, a greater proportion of cases was diagnosed at stage 1 (Figure 5.7) compared with all ages (Figure 5.6):

  • 51% of breast cancer cases diagnosed at stage 1 among females ages 50 to 74 (Ontario Breast Screening Program eligible age group) compared with 45% among females of all ages
  • 58% of cervical cancer cases diagnosed at stage 1 among females ages 21 to 69 (Ontario Cervical Screening Program eligible age group) compared with 55% among females of all ages
  • 26% of colorectal cancer cases diagnosed at stage 1 among people ages 50 to 74 (ColonCancerCheck eligible age group) compared with 24% among people of all ages.

Reasons for the lower proportion of stage 1 colorectal cancers may include lower screening participation rates (compared with breast and cervical screening) and inappropriate screening of people with symptoms. For colorectal cancer, a decrease in stage 4 diagnoses is more important than an increase in stage 1, because cancers at stages 1 to 3 have a fairly good prognosis compared with those at stage 4. However, not all cancers diagnosed within the screening age groups are screening-detected cancers.

Note: Cases that had no stage group data were excluded from this analysis. Case counts are as follows: breast n = 6,492 (excludes unknown stage = 20); colorectal n = 3,842 (excludes unknown stage = 48); cervix n = 464 (excludes unknown stage less than 6).
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Data for Figure 5.7 Proportion of new cases by stage at diagnosis and cancer type for screening program age groups, Ontario, 2016
Cancer TyPe Stage 1 (%) Stage 2 (%) Stage 3 (%) Stage 4 (%)
Breast (female) 45 38 13 5
Cervix 55 21 14 10
Colon excluding rectum 23 29 29 19
Colon - left sided 26 27 29 18
Colon - right sided 21 31 31 17
Rectum and rectosigmoid junction 28 19 36 17
Rectosigmoid junction 22 21 36 20
Rectum 29 19 36 16

Note: Cases that had no stage group data were excluded from this analysis. Case counts are as follows: breast n = 6,492 (excludes unknown stage = 20); colorectal n = 3,842 (excludes unknown stage = 48); cervix n = 464 (excludes unknown stage less than 6).
Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

Trend in stage distribution

The distribution of stage at diagnosis for female breast, prostate, colorectal, lung and cervical cancers has changed over the 2010 to 2016 period (Figure 5.8).

  • The proportion of prostate cancer cases diagnosed at stage 1 has decreased from 27% in 2010 to 22% in 2016. On the other hand, the proportion of cases diagnosed at stage 4 has increased from 8% in 2010 to 13% in 2016. This shift in distribution by stage may be partly because less opportunistic screening for prostate cancer took place following a recommendation against screening using PSA.[31,42] This would have resulted in the detection of fewer early stage cases and, likely, of more symptomatic cases at later stages.
  • The proportion of lung cancer cases diagnosed at stage 1 has increased from 18% in 2010 to 26% in 2016, while the proportion of cases diagnosed at stage 4 has decreased from 57% in 2010 to 46% in 2016. Some evidence suggests that this downward shift in stage at diagnosis may reflect earlier detection resulting from recent lung cancer awareness campaigns.[43]
  • The stage distribution has remained relatively unchanged for colorectal cancers. There was no change in the proportion of cases diagnosed at early stages over the 2010 to 2016 period. The proportion of cases diagnosed at later stages shifted slightly from 20% diagnosed at stage 4 in 2010 to 18% in 2016, and from 30% diagnosed at stage 3 in 2010 to 32% in 2016.
  • The proportion of cervical cancer cases diagnosed at stage 1 dropped from 62% in 2010 to 55% in 2016, while the proportion of cases diagnosed at stage 2 increased from 9% in 2010 to 21% in 2016. However, the overall proportion of early stage cases (stages 1 and 2) increased from 71% to 76%.
  • The stage distribution of breast cancer cases remained relatively stable, with the proportion of early stage cases increasing slightly (from 43% to 45% for stage 1 cases and 37% to 38% for stage 2) over the 2010 to 2016 period.

Notes:

  1. Case counts for 2010: prostate count = 8,767 (excludes unknown stage = 51); breast n = 8,433 (excludes unknown stage = 59); colorectal count = 7,391 (excludes unknown stage = 206); lung count = 7,946 (excludes unknown stage = 84); cervix count = 195 (excludes unknown stage less than 6).
  2. Case counts for 2016: prostate count = 7,596 (excludes unknown stage = 23); breast count = 10,329 (excludes unknown stage = 59); colorectal count = 6,988 (excludes unknown stage = 164); lung count = 8,259 (excludes unknown stage = 27); cervix count = 526 (excludes unknown stage less than 6).
  3. Cases not staged were excluded from this analysis.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

 
Data for Figure 5.8 Proportion of new cases by stage at diagnosis and cancer type, Ontario, 2010 versus 2016
Cancer Type Stage 1 (%) Stage 2 (%) Stage 3 (%) Stage 4 (%)
Prostate (2010) 27 53 12 8
Prostate (2016) 22 51 14 13
Lung (2010) 18 8 18 57
Lung (2016) 26 8 19 46
Colorectal (2010) 24 26 30 20
Colorectal (2016) 24 26 32 18
Cervix (2010) 62 9 16 13
Cervix (2016) 55 21 14 10
Breast (female, 2010) 43 37 14 5
Breast (female, 2016) 45 38 13 5

Notes:

  1. Case counts for 2010: prostate count = 8,767 (excludes unknown stage = 51); breast n = 8,433 (excludes unknown stage = 59); colorectal count = 7,391 (excludes unknown stage = 206); lung count = 7,946 (excludes unknown stage = 84); cervix count = 195 (excludes unknown stage less than 6).
  2. Case counts for 2016: prostate count = 7,596 (excludes unknown stage = 23); breast count = 10,329 (excludes unknown stage = 59); colorectal count = 6,988 (excludes unknown stage = 164); lung count = 8,259 (excludes unknown stage = 27); cervix count = 526 (excludes unknown stage less than 6).
  3. Cases not staged were excluded from this analysis.

Analysis by: Surveillance, Analytics and Informatics, Ontario Health (Cancer Care Ontario)
Data source: Ontario Cancer Registry (December 2018), Ontario Health (Cancer Care Ontario)

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