Projection du fardeau du cancer au Canada en 2024.

CONTEXTE: Les données de surveillance du cancer sont essentielles pour mieux comprendre les lacunes et les progrès réalisés dans la lutte contre le cancer. Nous avons cherché à résumer les répercussions prévues du cancer au Canada en 2024, en effectuant des projections sur les nouveaux cas de cancer et les décès par cancer, par sexe et par province ou territoire, pour tous les âges confondus. MÉTHODES: Nous avons obtenu les données sur les nouveaux cas de cancer (c.-à-d., l'incidence, 1984­2019) et les décès par cancer (c.-à-d., la mortalité, 1984­2020) du Registre canadien du cancer et de la Base canadienne de données de l'état civil ­ Décès, respectivement. Nous avons projeté les chiffres et les taux d'incidence du cancer et de mortalité jusqu'en 2024 pour 23 types de cancer, par sexe et par province ou territoire. Nous avons calculé des taux normalisés selon l'âge au moyen de données de la population type canadienne de 2011. RÉSULTATS: En 2024, les nombres de nouveaux cas de cancer et de décès causés par le cancer devraient atteindre 247 100 et 88 100, respectivement. Le taux d'incidence normalisé selon l'âge (TINA) et le taux de mortalité normalisé selon l'âge (TMNA) devraient diminuer légèrement par rapport aux années précédentes, tant chez les hommes que chez les femmes, avec des taux plus élevés chez les hommes (TINA de 562,2 pour 100 000, et TMNA de 209,6 pour 100 000 chez les hommes; TINA de 495,9 pour 100 000 et TMNA de 152,8 pour 100 000 chez les femmes). Les TINA et les TMNA de plusieurs cancers courants devraient continuer à diminuer (p. ex., cancer du poumon, cancer colorectal et cancer de la prostate), tandis que ceux de plusieurs autres cancers devraient augmenter (p. ex., cancer du foie et des voies biliaires intrahépatiques, cancer du rein, mélanome et lymphome non hodgkinien). INTERPRÉTATION: Bien que l'incidence globale du cancer et la mortalité connexe sont en déclin, il devrait y avoir une augmentation des nouveaux cas et des décès au Canada en 2024, en grande partie en raison de la croissance et du vieillissement de la population. Les efforts en matière de prévention, de dépistage et de traitement ont atténué les répercussions de certains cancers, mais ces projections à court terme soulignent l'effet potentiel du cancer sur les gens et les systèmes de soins de santé au Canada.

Projected estimates of cancer in Canada in 2024.

BACKGROUND: Cancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. METHODS: We obtained data on new cancer cases (i.e., incidence, 1984-2019) and deaths from cancer (i.e., mortality, 1984-2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. RESULTS: In 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). INTERPRETATION: Although the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada.

Progress in site-specific cancer mortality in Canada over the last 70 years.

In Canada, the absolute number of cancer deaths has been steadily increasing, however, age-standardized cancer mortality rates peaked decades ago for most cancers. The objective of this study was to estimate the reduction in deaths for each cancer type under the scenario where peak mortality rates had remained stable in Canada. Data for this study were obtained the Global Cancer Observatory and Statistics Canada. We estimated age-standardized mortality rates (ASMR, per 100,000) from 1950 to 2022, standardized to the 2011 Canadian standard population. We identified peak mortality rates and applied the age-specific mortality rates from the peak year to the age-specific Canadian population estimates for subsequent years (up to 2022) to estimate the number of expected deaths. Avoided cancer deaths were the difference between the observed and expected number of cancer deaths. There have been major reductions in deaths among cancers related to tobacco consumption and other modifiable lifestyle habits (417,561 stomach; 218,244 colorectal; 186,553 lung; 66,281 cervix; 32,732 head and neck; 27,713 bladder; 22,464 leukemia; 20,428 pancreas; 8863 kidney; 3876 esophagus; 290 liver). There have been 201,979 deaths avoided for female-specific cancers (breast, cervix, ovary, uterus). Overall, there has been a 34% reduction in mortality for lung cancer among males and a 9% reduction among females. There has been a significant reduction in cancer mortality in Canada since site-specific cancer mortality rates peaked decades ago for many cancers. This shows the exceptional progress made in cancer control in Canada due to substantial improvements in prevention, screening, and treatment. This study highlights priority areas where more attention and investment are needed to achieve progress.

Progress in cancer control leads to a substantial number of cancer deaths avoided in Canada.

It is currently not known how many more cancer deaths would have occurred among Canadians if cancer mortality rates were unchanged following various modern human interventions. The objective of this study was to estimate the number of cancer deaths that have been avoided in Canada since the age-standardized overall cancer mortality rate peaked in 1988. We applied the age-specific overall cancer mortality rates from 1988 to the Canadian population for all subsequent years to estimate the number of expected deaths. Avoided cancer deaths were estimated as the difference between the observed and expected number of cancer deaths for each year. Since 1988, there have been 372 584 (standardized mortality ratio = 0.77) and 120 045 (standardized mortality ratio = 0.90) avoided cancer deaths in males and females, respectively (492 629 total). Nearly half a million cancer deaths have been avoided in Canada since the overall cancer mortality rate peaked, which demonstrates the exceptional progress made in modern cancer control in Canada.

Lifetime probability of developing cancer and dying from cancer in Canada, 1997 to 2020.

Background: The lifetime probabilities of developing (LPdev) cancer and dying (LPdying) from cancer are useful summary statistics that describe the impact of cancer within a population. This study aims to present detailed LPdev and LPdying for cancer by sex and cancer type and to describe changes in these lifetime probabilities over time among the Canadian population. Data and methods: Cancer incidence data (1997 to 2018) were obtained from the Canadian Cancer Registry. All-cause and cancer mortality data (1997 to 2020) were obtained from the Canadian Vital Statistics - Death Database. LPdev and LPdying were calculated using the DevCan software, and trends over time were estimated using Joinpoint. Results: The LPdev for all cancers combined was 44.3% in Canada in 2018, with all results excluding Quebec. At the age of 60, the conditional probability of developing cancer was very similar (44.0% for males and 38.2% for females). The LPdying was 22.5% among the Canadian population in 2020, while the probability of dying from cancer conditional on surviving until age 60 was 25.1% for males and 20.5% for females. Generally, males experienced higher LPdev and LPdying for most specific cancers compared with females. Interpretation: LPdev and LPdying for cancer mirror cancer incidence and mortality rates. Cancer-specific changes in these probabilities over time are indicative of the cancer trends resulting from cancer prevention, screening, detection, and treatment. These changes in LPdev and LPdying provide insight into the shifting landscape of the Canadian cancer burden.

Time Trends in Colorectal Cancer Incidence From 1992 to 2016 and Colorectal Cancer Mortality From 1980 to 2018 by Age Group and Geography in Canada.

INTRODUCTION: Several reports have highlighted increasing colorectal cancer (CRC) incidence among younger individuals. However, little is known about variations in CRC incidence or mortality across age subgroups in different geographical locations. We aimed to examine time trends in CRC incidence and mortality in Canada by age group and geography in this population-based, retrospective cohort study. METHODS: Individuals diagnosed with CRC from 1992 to 2016 or who died of CRC from 1980 to 2018 in Canada were studied. Geography was determined using an individual's postal code at diagnosis from the Canadian Cancer Registry or province or territory of death from the Canadian Vital Statistics Death Database. Geography was categorized into Atlantic, Central, Prairies, West, and Territories. Canadian Cancer Registry data were used to determine CRC incidence from 1992 to 2016. Canadian Vital Statistics Death data were used to determine CRC mortality from 1980 to 2018. RESULTS: Among all age groups, CRC incidence was highest in Atlantic Canada, was lowest in Western Canada, and increased with age. CRC incidence increased over time for individuals aged 20-44 years and was stable or decreased for other age groups in all regions. CRC mortality was highest in Atlantic Canada and lowest in the Prairies and Western Canada. CRC mortality decreased for individuals in all age groups and regions except among individuals aged 20-49 years in the Territories. DISCUSSION: Most of Canada has not yet seen an increase in CRC burden in the age group of 45-49 years, which is a reason to not lower the start age for CRC screening in Canada. Targeted CRC screening should be considered for individuals younger than 50 years who live in the Territories.

Update on cancer incidence trends in Canada, 1984 to 2017. / Le point sur les tendances de l'incidence du cancer au Canada (1984-2017).

This paper highlights findings on cancer trends from the Canadian Cancer Statistics 2021 report. Trends were measured using annual percent change (APC) of age-standardized incidence rates. Overall, cancer incidence rates are declining (-1.1%) but the findings are specific to the type of cancer and patient sex. For example, in males, the largest decreases per year were for prostate (-4.4%), colorectal (-4.3%), lung (-3.8%), leukemia (-2.6%) and thyroid (-2.4%) cancers. In females, the largest decreases were for thyroid (-5.4%), colorectal (-3.4%) and ovarian (-3.1%) cancers.

Overall, cancer incidence is declining at a rate of −1.1% per year. In males, the two largest decreases were for prostate (−4.4% per year) and colorectal (−4.3% per year) cancer. In females, they were for thyroid (−5.4% per year) and colorectal (−3.4% per year) cancer. Melanoma (males: 2.2% per year; females: 2.0% per year) and multiple myeloma (males: 2.5% per year; females: 1.6% per year) rates are increasing. Cancer trends in Canada are dynamic and type-specific. The decreases for prostate and thyroid cancer underscore the importance of updating testing practices based on best evidence.

Dans l'ensemble, l'incidence du cancer diminue à un taux de −1,1 % par année. Les deux plus fortes baisses ont été observées chez les hommes pour le cancer de la prostate (−4,4 % par année) et le cancer colorectal (−4,3 % par année) et, chez les femmes, pour le cancer de la thyroïde (−5,4 % par année) et le cancer colorectal (−3,4 % par année). Les taux de mélanome sont en hausse (hommes : 2,2 % par année; femmes : 2,0 % par année) ainsi que ceux de myélome multiple (hommes : 2,5 % par année; femmes : 1,6 % par année). Les tendances en matière de cancer au Canada sont dynamiques et elles dépendent de chaque type de cancer. La diminution de l'incidence du cancer de la prostate et du cancer de la thyroïde souligne l'importance de mettre à jour les pratiques de dépistage à partir des meilleures données probantes.

Projected estimates of cancer in Canada in 2022.

BACKGROUND: Regular cancer surveillance is crucial for understanding where progress is being made and where more must be done. We sought to provide an overview of the expected burden of cancer in Canada in 2022. METHODS: We obtained data on new cancer incidence from the National Cancer Incidence Reporting System (1984-1991) and Canadian Cancer Registry (1992-2018). Mortality data (1984-2019) were obtained from the Canadian Vital Statistics - Death Database. We projected cancer incidence and mortality counts and rates to 2022 for 22 cancer types by sex and province or territory. Rates were age standardized to the 2011 Canadian standard population. RESULTS: An estimated 233 900 new cancer cases and 85 100 cancer deaths are expected in Canada in 2022. We expect the most commonly diagnosed cancers to be lung overall (30 000), breast in females (28 600) and prostate in males (24 600). We also expect lung cancer to be the leading cause of cancer death, accounting for 24.3% of all cancer deaths, followed by colorectal (11.0%), pancreatic (6.7%) and breast cancers (6.5%). Incidence and mortality rates are generally expected to be higher in the eastern provinces of Canada than the western provinces. INTERPRETATION: Although overall cancer rates are declining, the number of cases and deaths continues to climb, owing to population growth and the aging population. The projected high burden of lung cancer indicates a need for increased tobacco control and improvements in early detection and treatment. Success in breast and colorectal cancer screening and treatment likely account for the continued decline in their burden. The limited progress in early detection and new treatments for pancreatic cancer explains why it is expected to be the third leading cause of cancer death in Canada.

Time Trends in Colorectal Cancer Incidence Rates by Income and Age at Diagnosis in Canada From 1992 to 2016.

Importance: Colorectal cancer (CRC) incidence rates among individuals younger than 50 years have been increasing in many countries, including Canada. Whether changes in CRC incidence rates over time are uniform across income and age groups remains unknown. Objective: To examine time trends in CRC incidence rates in Canada by area-level average household income by age group from 1992 to 2016. Design, Setting, and Participants: A population-based, retrospective cohort study was conducted including individuals aged 20 years or older diagnosed with CRC in Canada (excluding Québec) from 1992 to 2016. Data analysis was performed from February 27 to September 28, 2020. Exposures: Average household income was determined by linking an individual's postal code at diagnosis from the Canadian Cancer Registry to Canadian Census data. Average household income was then categorized into quintiles from Q1, the lowest income group, to Q5, the highest income group. Main Outcomes and Measures: Canadian Cancer Registry data were used to determine CRC incidence rates from 1992 to 2016. Results: There were 340 790 cases of CRC diagnosed from 1992 to 2016; 11 790 cases (3.5%) were diagnosed in individuals aged 20 to 44 years. Colorectal cancer incidence rates for individuals aged 20 to 44 years increased for all income quintiles, with higher incidence rates in the lower income quintiles. The ratio between the maximum and minimum CRC incidence rates was highest among the 20- to 29-year age group from 1992 to 1996 (ratio, 2.67; 95% CI, 1.47-4.83) and 2012 to 2016 (ratio, 2.00; 95% CI, 1.29-3.10). For individuals aged 45 to 49 years, CRC incidence rates increased only for individuals in the lower income quintiles (eg, incidence in Q1, 1992-1996 vs 2012-2016: 4.54 per 100 000 [95% CI, 4.05-5.03] vs 5.37 per 100 000 [95% CI, 4.91-5.83]), with higher incidence rates in the high income quintiles (eg, incidence rate for Q5 in 1992-1996: 5.92 per 100 000 [95% CI, 5.36-6.48]). For those aged 50 to 54 years, CRC incidence rates were stable for all income quintiles, with less variability between income quintiles. For individuals aged 55 to 74 years, CRC incidence rates were stable or decreased for all income quintiles (eg, incidence rate for age 55-59 years in Q5, 1992-1992 vs 2012-2016: 17.97 per 100 000 [95% CI, 16.76-19.18] vs 14.56 per 100 000 [95% CI, 13.80-15.32]), and there was less variability in the rates by income quintile, particularly from 2012 to 2016. After age 75 years, CRC incidence rates were stable or decreased (eg, incidence rate for age 75-79 years, 1992-1996 vs 2012-2016: 66.43 per 100 000 [65.00-67.87] vs 57.34 per 100 000 [56.24-58.45]), were highest for the lower income quintiles, and variability between income quintiles increased relative to younger age groups. Conclusions and Relevance: In this cohort study, trends in CRC incidence rates in Canada differed by age group and income quintile. These results suggest that, although population-based screening can reduce income disparities, targeted interventions and further research are needed to address the increasing CRC incidence rate among younger individuals in Canada, particularly in the lower income quintiles.

Validation of Canproj for projecting Canadian cancer incidence data. / Validation de Canproj pour les projections de données sur l'incidence du cancer au Canada.

INTRODUCTION: Cancer projections can provide key information to help prioritize cancer control strategies, allocate resources and evaluate current treatments and interventions. Canproj is a cancer-projection tool that builds on the Nordpred R-package by adding a selection of projection models. The objective of this project was to validate the Canproj R-package for the short-term projection of cancer rates. METHODS: We used national cancer incidence data from 1986 to 2014 from the National Cancer Incidence Reporting System and Canadian Cancer Registry. Cross-validation was used to estimate the accuracy of the projections generated by Canproj and relative bias (RB) was used as validation measure. The Canproj automatic model selection decision tree was also assessed. RESULTS: Five of the six models had mean RB between 5% and 10% and median RB around 5%. For some of the cancer sites that were more difficult to project, a shorter time period improved reliability. The Nordpred model was selected 79% of the time by Canproj automatic model selection although it had the smallest RB only 24% of the time. CONCLUSIONS: The Canproj package was able to provide projections that closely matched the real data for most cancer sites.

Examining the Impact of First Nations Status on the Relationship Between Diabetes and Cancer.

Purpose: This population-based study examined the relationship between diabetes and cancer and determined if this relationship was influenced by First Nations (FN) status. Methods: In a matched case-cohort study, individuals 30-74 years of age diagnosed with diabetes during 1984-2008 in the province of Manitoba, Canada, with no cancer diagnosis before their diabetes diagnosis were matched to one diabetes-free control by age, sex, FN status, and residence. Flexible competing risk and Royston-Parmar regression models were used to compare cancer rates. Results: Overall, 72,715 individuals diagnosed with diabetes were matched to controls. In all age groups, diabetes was related to an increased risk of cancer. The relationship between diabetes and any type of cancer was not influenced by FN status (i.e., there was no interaction between the diagnosis of diabetes and people's FN status for any age group). The only significant interaction between diabetes and FN status was for kidney cancer for individuals 60-74 years of age; diabetes increased the risk of kidney cancer for all other Manitobans (AOMs) but not for FN. Conclusions: Diabetes increased the risk of cancer. The association was not modified by FN status except for kidney cancer where diabetes increased the risk for AOMs but not for FN.

Projected estimates of cancer in Canada in 2020.

BACKGROUND: Cancer projections to the current year help in policy development, planning of programs and allocation of resources. We sought to provide an overview of the expected incidence and mortality of cancer in Canada in 2020 in follow-up to the Canadian Cancer Statistics 2019 report. METHODS: We obtained incidence data from the National Cancer Incidence Reporting System (1984-1991) and Canadian Cancer Registry (1992-2015). Mortality data (1984-2015) were obtained from the Canadian Vital Statistics - Death Database. All databases are maintained by Statistics Canada. Cancer incidence and mortality counts and age-standardized rates were projected to 2020 for 23 cancer types by sex and geographic region (provinces and territories) for all ages combined. RESULTS: An estimated 225 800 new cancer cases and 83 300 cancer deaths are expected in Canada in 2020. The most commonly diagnosed cancers are expected to be lung overall (29 800), breast in females (27 400) and prostate in males (23 300). Lung cancer is also expected to be the leading cause of cancer death, accounting for 25.5% of all cancer deaths, followed by colorectal (11.6%), pancreatic (6.4%) and breast (6.1%) cancers. Incidence and mortality rates will be generally higher in the eastern provinces than in the western provinces. INTERPRETATION: The number of cancer cases and deaths remains high in Canada and, owing to the growing and aging population, is expected to continue to increase. Although progress has been made in reducing deaths for most major cancers (breast, prostate and lung), there has been limited progress for pancreatic cancer, which is expected to be the third leading cause of cancer death in Canada in 2020. Additional efforts to improve uptake of existing programs, as well as to advance research, prevention, screening and treatment, are needed to address the cancer burden in Canada.

Continued increasing incidence of malignant appendiceal tumors in Canada and the United States: A population-based study.

BACKGROUND: To the authors' knowledge, there are limited data regarding the epidemiology of malignant appendiceal tumors. It remains unknown whether the previously reported trends are occurring in different countries and/or continuing in recent years and/or whether they are possibly due to increasing rates of appendectomies. In the current study, the authors investigated the patterns and time trends of malignant appendiceal tumor diagnosis by age group, sex, stage of disease, and histology in Canada and the United States and concomitant rates of appendectomies in Canada. METHODS: The Canadian Cancer Registry and the US Surveillance, Epidemiology, and End Results incidence databases were used to identify incident patients of malignant appendiceal tumors in the 2 countries between 1992 and 2016. The Canadian national hospitals Discharge Abstract Database was used to identify appendectomies performed between 2004 and 2015. Joinpoint regression analyses were performed to determine time trends. RESULTS: There was an overall increase in the incidence of malignant appendiceal tumors of 232% in the United States and 292% in Canada between 2000 and 2016. The increase was noted for malignant adenocarcinomas and neuroendocrine appendiceal tumors in both countries. The increase occurred across all age groups, sexes, and stages of disease. The highest rate of increase was noted for appendiceal neuroendocrine malignant tumors diagnosed among the youngest age groups. The rate of appendectomies was stable in the recent time periods, resulting in a decreasing rate of appendectomies per malignant appendiceal tumor diagnosis. CONCLUSIONS: The incidence of malignant appendiceal tumor is continuing to increase, which is not likely due to the increasing diagnosis of asymptomatic tumors at the time of appendectomies.

Trends in Prescribing Menopausal Hormone Therapy and Bisphosphonates in Australia and Manitoba, Canada and Adherence to Recommendations.

Background: Recommendations for using menopausal hormone therapy (MHT) and bisphosphonates for postmenopausal osteoporosis management have changed over time. After the release of the Women's Health Initiative (WHI) trial results in 2002, new evidence on risks and benefits of MHT became available, and newer guidelines generally specify that MHT should not be prescribed for prevention of chronic disease, including osteoporosis. This raises the question of whether bisphosphonate prescribing changed over time to compensate for the decrease in MHT use. Materials and Methods: We examined trends in dispensed prescriptions in Australia (national) and Canada (province of Manitoba) in relation to prescribing recommendations. Administrative data were used to describe dispensing patterns and changes for persons of all ages from 1996 to 2008, and for women aged 50 to ≥80 years from 2003 to 2008 in Australia and 1996 to 2008 in Canada. Results: In both geographic settings, MHT dispensing increased 1996-2001, peaked in 2001, and declined substantially thereafter (67% reduction in MHT prescriptions for Australia; 64% reduction for Manitoba, Canada to 2008). From 2003 to 2008, the number of MHT prescriptions declined among all age groups in both settings, with the highest declines among women in their 50s. Concurrently, bisphosphonate dispensing increased until 2005 (2001-2005: 260% increase in the number of prescriptions in Australia; 125% increase in Manitoba) and stabilized thereafter, in both settings. Annual bisphosphonate dispensing rates increased 4.1-10.9% for women in their 70s and 80s in Australia and Manitoba during the period studied. Conclusions: Based on dispensed prescriptions data, more recent guidelines for MHT and bisphosphonates use for postmenopausal osteoporosis, which were updated during the study period (and are still consistent with the current guidelines), appear to have been broadly adhered to in both settings.

At-a-glance - Cancer trends in Canada, 1984 to 2015. / Aperçu - Tendances en matière de cancer au Canada, 1984-2015.

Examining incidence trends of all cancers combined in order to understand cancer trends can be misleading, as patterns can vary across individual cancer types. This paper highlights findings on trends over time from Canadian Cancer Statistics 2019, as measured by the annual percent change (APC) of age-standardized incidence rates. Among the results were a recent increase in thyroid cancer in males (APC: 6.4%, 1997-2015), as well as decreases in prostate cancer (APC: -9.1%, 2011-2015) and cervical cancer (APC: -3.3%, 2010-2015).

The incidence of some cancers is changing rapidly in Canada. Recent trends show increasing rates of thyroid cancer in males, drawing attention to the potential impact of overdiagnosis. Prostate cancer incidence is decreasing rapidly, likely reflecting recent changes in screening guidelines.

Les tendances liées à l'incidence de certains cancers évoluent rapidement au Canada. Les tendances récentes révèlent une augmentation des taux d'incidence de cancer de la glande thyroïde chez les hommes, ce qui incite à étudier les répercussions potentielles de surdiagnostic. L'incidence du cancer de la prostate connaît une diminution rapide, ce qui témoigne vraisemblablement des changements récents apportés aux lignes directrices en matière de dépistage.

Recent trends in prostate cancer in Canada.

BACKGROUND: Prostate cancer is the most common type of cancer in Canadian men. Screening recommendations have changed substantially over the last 25 years. Since 2011 (United States) and 2014 (Canada), taskforce guidelines have recommended against screening using the prostate-specific antigen (PSA) test in low-risk men of all ages. This work reports on trends in prostate cancer incidence, mortality, and stage at diagnosis in Canada from 1992 to 2015. DATA AND METHODS: Prostate cancer incidence, mortality, and stage at diagnosis were retrieved from Statistics Canada's Canadian Cancer Registry and Canadian Vital Statistics - Death Database. Joinpoint analysis was used to examine trends over time. RESULTS: The age-standardized incidence rate (ASIR) of prostate cancer peaked in 1993 and 2001, and declined thereafter. From 2011 to 2015, the ASIR declined by 9.3% per year. The age-standardized mortality rate (ASMR) decreased continuously from 1992 to 2015, but fell most rapidly (2.9% per year) after 2001. Data from two provinces show that, from 2005 to 2015, the rate of Stage I and Stage II cancers decreased by 3.2% per year, while the rate of Stage III and Stage IV cancers remained relatively stable. DISCUSSION: Incidence of prostate cancer has declined substantially in recent years. Most of the decline seems to be in localized cases (Stage I and Stage II). Changes in incidence have mirrored changes to PSA screening recommendations. Future work should continue to monitor trends over time at the national level, especially as they relate to screening recommendations.

Risk of colorectal cancer after the diagnosis of prostate cancer: A population-based study.

BACKGROUND: A rigorous assessment of the risk of colorectal cancer (CRC) among prostate cancer (PC) survivors that controls for important confounding factors and competing risks is necessary to determine the risk of CRC in this population and to inform screening guidelines. METHODS: With data from Manitoba, Canada, subjects diagnosed with PC as their first cancer between 1987 and 2009 were age-matched with up to 5 men with no history of invasive cancer on the PC diagnosis date. Subjects were followed to the date of diagnosis of CRC or another cancer, death, emigration, or the study endpoint (December 31, 2009). Competing risk proportional hazards models were used to compare the CRC incidence between those with PC and those without PC with the following model covariates: history of lower gastrointestinal endoscopy, frequency of health care visits, diabetes, and socioeconomic status. Mutually exclusive competing outcomes included CRC, another primary cancer, and death. RESULTS: For a total of 559,081 person-years, 14,164 men with PC and 69,051 men without PC were followed. Men diagnosed with PC had an increased risk of a subsequent diagnosis of CRC (all CRC: hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.02-1.27; rectal cancer: HR, 1.36; 95% CI, 1.09-1.71). The treatment of PC with radiation was associated with an increased risk for rectal cancer (HR, 2.06; 95% CI, 1.42-2.99) in comparison with PC cases not treated with radiation. CONCLUSIONS: The risk of CRC is increased after a diagnosis of PC and is highest for rectal cancer among those treated with radiation. CRC screening should be considered soon after the diagnosis of PC, especially for men planning for radiotherapy.

Reducing income-related inequities in colorectal cancer screening: lessons learned from a retrospective analysis of organised programme and non-programme screening delivery in Winnipeg, Manitoba.

OBJECTIVE: We examined organised colorectal cancer (CRC) screening programme and non-programme faecal occult blood test (FOBT) use from 2008 to 2012 for individuals living in Winnipeg, Manitoba, by area-level income. SETTING: Winnipeg, Manitoba, a region with universal healthcare and an organised CRC screening programme. PARTICIPANTS: Individuals who had a non-programme FOBT were identified from the Provincial Medical Claims database. Individuals who had a programme FOBT were identified from the provincial screening registry. Census data were used to determine average household income based on area of residence. STATISTICAL ANALYSIS: Trends in age-standardised FOBT rates were examined using Joinpoint Regression. Logistic regression was performed to explore the association between programme and non-programme FOBT use and income quintile. RESULTS: FOBT use (non-programme and programme) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Q5) were more likely to have a non-programme FOBT compared with those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had programme FOBT than those living in areas with the highest average income level (OR 0.80, 95% CI 0.77 to 0.82). There was no difference in programme FOBT use for individuals living in areas with the second lowest income level (Q2) compared with those living in areas with the highest. Individuals living in areas with a moderate-income level (Q3 and Q4) were more likely to have had a programme FOBT compared with those living in an area with the highest income level (OR 1.12, 95% CI 1.09 to 1.15 for Q3 and OR 1.10, 95% CI 1.07 to 1.13 for Q4). CONCLUSIONS: Inequities by income observed for non-programme FOBTs were largely eliminated when programme FOBTs were examined. Targeted interventions within organised screening programmes in very low-income areas are needed.

Effect of changes in treatment practice on survival for cervical cancer: results from a population-based study in Manitoba, Canada.

BACKGROUND: Results from clinical trials in the 1990s led to changes in the recommended treatment for the standard therapy for stage IIB-IVA cervical cancer from radiotherapy alone to chemo-radiotherapy. We conducted the first population-based study in Canada to investigate temporal treatment patterns for cervical cancer and long-term survival in relation to these changes in the treatment guidelines. METHODS: Detailed information on stage and treatment for 1085 patients diagnosed with cervical cancer in 1984-2008 and identified from the population-based Manitoba Cancer Registry (MCR) in Canada was obtained from clinical chart review and the MCR. Factors associated with receiving guideline treatment were identified using logistic regression. All cause and cervical cancer specific survival were compared in patients who were and were not treated as recommended in the guidelines, using Cox proportional hazards models. RESULTS: The median follow-up time was 6.4 years (range: 0.05-26.5 years). The proportion of women who received guideline treatment was 79 % (95 % confidence interval [CI]: 76-81 %). However, the likelihood of being treated according to the guidelines over time was modified by age (p < 0.0001) and tumour stage at diagnosis (p = 0.002). Women who were treated according to the guidelines after the change in recommended clinical practice (1999-2008) had a significantly lower risk of death from all causes and from cervical cancer. This was driven by lower mortality rates in cases with stage IIB-IVA tumours (all causes of death: hazard ratio [HR] = 0.60, 95 % CI: 0.43-0.82, p = 0.002; cervical cancer related death: HR = 0.64, 95 % CI: 0.44-0.93, p = 0.02). CONCLUSIONS: The management of cervical cancer patients in Manitoba, Canada was in good agreement with treatment guidelines although reasons for departure from the guideline recommendations could not be examined further due to lack of data. Treatment of stage IIB-IVA cervical cancers with recommended concurrent chemo-radiotherapy, which is now standard practice, was associated with substantially increased survival, although the effect of changes in clinical practice including maintenance of haemoglobin levels on improved survival cannot be ruled out as a contributing factor.

Longitudinal Rates of Colon Cancer Screening Use in Winnipeg, Canada: The Experience of a Universal Health-Care System with an Organized Colon Screening Program.

OBJECTIVES: We examined trends in colorectal cancer (CRC) screening (fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy (FS)) and differences in CRC screening by income in a population with an organized CRC screening program and universal health-care coverage. METHODS: Individuals who had an FOBT, colonoscopy, or FS were identified from the provincial Physician Claims database and the population-based colon cancer screening registry. Trends in age-standardized rates were determined. Logistic regression was performed to explore the association between CRC screening and income quintiles by year. RESULTS: Up-to-date CRC screening (FOBT, colonoscopy, or FS) increased over time for men and women, all age groups, and all income quintiles. Up-to-date CRC screening was very high among 65- to 69- and 70- to 74-year-olds (70% and 73%, respectively). There was a shift toward the use of an FOBT for CRC screening for individuals in the lower income quintiles. The disparity in colonoscopy/FS coverage by income quintile was greater in 2012 than in 1995. Overall, there was no reduction in disparities by income in up-to-date CRC screening nor did the rate of increase in up-to-date CRC screening or FOBT use change after the introduction of the organized provincial CRC screening program. CONCLUSIONS: CRC screening is increasing over time for both men and women and all age groups. However, a disparity in up-to-date CRC screening by income persisted even with an organized CRC screening program in a universal health-care setting.