ABSTRACT
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.
Subject(s)
Neoplasms , Registries , Humans , Canada/epidemiology , Neoplasms/epidemiology , Neoplasms/mortality , Male , Female , Incidence , Sex Distribution , Forecasting , Middle Aged , Aged , Age Distribution , Adult , Mortality/trendsABSTRACT
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.
Subject(s)
Colorectal Neoplasms , Humans , Middle Aged , Retrospective Studies , Incidence , Canada/epidemiology , Colorectal Neoplasms/diagnosis , GeographyABSTRACT
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.
Subject(s)
Neoplasms , Female , Male , Humans , Middle Aged , Canada/epidemiology , Quebec , Databases, Factual , ProbabilityABSTRACT
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.
Subject(s)
Lung Neoplasms , Aged , Canada/epidemiology , Female , Forecasting , Humans , Incidence , Lung Neoplasms/epidemiology , Male , RegistriesABSTRACT
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.
Subject(s)
Adenocarcinoma/epidemiology , Appendectomy/statistics & numerical data , Appendiceal Neoplasms/epidemiology , Neuroendocrine Tumors/epidemiology , Adenocarcinoma/surgery , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Appendiceal Neoplasms/surgery , Canada/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Neuroendocrine Tumors/surgery , Registries , United States/epidemiology , Young AdultABSTRACT
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.
Subject(s)
Neoplasms/epidemiology , Canada , Female , Forecasting , Humans , Incidence , Male , Neoplasms/mortality , Sex FactorsABSTRACT
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.
ABSTRACT
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.
Subject(s)
Mass Screening/statistics & numerical data , Prostatic Neoplasms/epidemiology , Registries/statistics & numerical data , Age Distribution , Aged , Canada/epidemiology , Humans , Incidence , Male , Mass Screening/standards , Mass Screening/trends , Middle Aged , Prostatic Neoplasms/mortalityABSTRACT
OBJECTIVE: To establish a baseline for physicians' knowledge of and counseling practices on the use of antibiotics and antimicrobial resistance (AMR), and to determine potential changes in these measures after the implementation of a national AMR awareness campaign. DESIGN: Cross-sectional design. SETTING: Canada. PARTICIPANTS: A total of 1600 physicians. MAIN OUTCOME MEASURES: Physicians' knowledge of and counseling practices on antibiotic use and AMR at baseline and after implementation of the AMR awareness campaign. RESULTS: A total of 336 physicians responded to the first-cycle survey (before the campaign), and 351 physicians responded to the second-cycle survey (after the campaign). Overall, physicians' knowledge of appropriate antibiotic use and AMR was high and their counseling practices in relation to antibiotics were appropriate in both surveys. Counseling levels about topics related to infection prevention and control (eg, food handling, household hygiene) were slightly lower. Counseling levels were also lower for certain antibiotic-use practices (eg, proper disposal of antibiotics). In addition, physicians with less than 10 years of practice experience had significantly lower odds of counseling their patients on topics related to preventing antibiotic resistance and infection prevention than those with 15 or more years of practice experience (adjusted odds ratio = 0.27, 95% CI 0.10 to 0.74). Significantly more physicians from the second-cycle survey counseled patients on the appropriate disposal of antibiotics (P = .03), as well as on some of the infection prevention topics (eg, using antibacterial hand soap [P = .02] and cleaning supplies [P = .01]). Most respondents in both surveys reported feeling confident with respect to counseling their patients on the appropriate use of antibiotics and AMR. CONCLUSION: Physicians' knowledge of and levels of counseling on the use of antibiotics and AMR were high and fairly stable in both survey results. This shows that Canadian physicians are demonstrating behaviour patterns of AMR stewardship. Existing gaps in counseling practices might be a result of physicians believing that pharmacists or nurses are addressing these issues with patients. Future national surveys conducted among pharmacists and nurses would contribute to the evidence base for AMR stewardship activities.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Medication Therapy Management/organization & administration , Physicians/standards , Canada , Clinical Competence , Counseling/methods , Counseling/standards , Cross-Sectional Studies , Drug Resistance, Bacterial , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Needs Assessment , Practice Patterns, Physicians'/standardsABSTRACT
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.
Subject(s)
Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Registries , Adult , Age Factors , Aged , Aged, 80 and over , Canada , Cohort Studies , Comorbidity , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Prognosis , Proportional Hazards Models , Reference Values , Retrospective Studies , Risk Assessment , Survival AnalysisABSTRACT
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.
Subject(s)
Colonic Neoplasms/prevention & control , Colonoscopy/statistics & numerical data , Early Detection of Cancer , Income , Mass Screening , Occult Blood , Universal Health Insurance , Age Distribution , Age Factors , Aged , Colonic Neoplasms/diagnosis , Colonic Neoplasms/economics , Colonic Neoplasms/epidemiology , Colonoscopy/economics , Early Detection of Cancer/economics , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , Early Detection of Cancer/trends , Female , Humans , Income/statistics & numerical data , Longitudinal Studies , Male , Manitoba/epidemiology , Mass Screening/economics , Mass Screening/methods , Mass Screening/statistics & numerical data , Mass Screening/trends , Middle Aged , Sigmoidoscopy/statistics & numerical data , Universal Health Insurance/statistics & numerical dataABSTRACT
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.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Chemotherapy, Adjuvant , Radiotherapy, Adjuvant , Uterine Cervical Neoplasms/drug therapy , Adult , Aged , Canada , Cisplatin/administration & dosage , Female , Humans , Middle Aged , Neoplasm Staging , Proportional Hazards Models , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/radiotherapyABSTRACT
Children with high-grade glioma (HGG) have a poor prognosis compared to those with low-grade glioma (LGG). Adjuvant chemotherapy may be beneficial, but its optimal use remains undetermined. Histology and extent of resection are important prognostic factors. We tested the hypothesis that patients with midline HGG treated on Children's Cancer Group Study (CCG) CCG-945 have a worse prognosis compared to the entire group. Of 172 children eligible for analysis, 60 had midline tumors primarily localized to the thalamus, hypothalamus and basal ganglia. Time-to-progression and death were determined from the date of initial diagnosis, and survival curves were calculated. Univariate analyses were undertaken for extent of resection, chemotherapy regimen, anatomic location, histology, proliferation index, MGMT status and p53 over-expression. For the entire midline tumor group, 5-year PFS and OS were 18.3 ± 4.8 and 25 ± 5.4 %, respectively. Many patients only had a biopsy (43.3 %). The sub-groups with near/total resection and hypothalamic location appeared to have better PFS and OS. However, the effect of tumor histology on OS was significant for children with discordant diagnoses on central pathology review of LGG compared to HGG. Proliferative index (MIB-1 > 36 %), MGMT and p53 over-expression correlated with poor outcomes. Children treated on CCG-945 with midline HGG have a worse prognosis when compared to the entire group. The midline location may directly influence the extent of resection. Central pathology review and entry of patients on clinical trials continue to be priorities to improve outcomes for children with HGG.
Subject(s)
Brain Neoplasms/mortality , Brain Neoplasms/pathology , Glioma/mortality , Glioma/pathology , Adolescent , Brain Neoplasms/therapy , Child , Child, Preschool , Combined Modality Therapy , Disease-Free Survival , Female , Glioma/therapy , Humans , Infant , Infant, Newborn , Kaplan-Meier Estimate , Male , Neoplasm Grading , PrognosisABSTRACT
INTRODUCTION: First Nations (FN) women historically have low rates of preventive care, including breast cancer screening. We describe the frequency of breast cancer screening among FN women living in Manitoba and all other Manitoba (AOM) women after the introduction of a provincial, organized breast screening program and explore how age, area of residence, and time period influenced breast cancer screening participation. METHODS: The federal Indian Registry was linked to 2 population-based, provincial data sources. A negative binomial model was used to compare breast cancer screening for FN women with screening for AOM women. RESULTS: From 1999 through 2008, 37% of FN and 59% of AOM women had a mammogram in the previous 2 years. Regardless of area of residence, FN women were less likely to have had a mammogram than AOM women (relative rate [RR] = 0.69 in the north, RR = 0.55 in the rural south, and RR = 0.53 in urban areas). CONCLUSIONS: FN women living in Manitoba had lower mammography rates than AOM women. To ensure equity for all Manitoba women, strategies that encourage FN women to participate in breast cancer screening should be promoted.
Subject(s)
Breast Neoplasms/diagnosis , Indians, North American/psychology , Mammography/statistics & numerical data , Mass Screening/statistics & numerical data , Aged , Early Detection of Cancer , Female , Humans , Indians, North American/statistics & numerical data , Mammography/psychology , Manitoba/ethnology , Mass Screening/trends , Middle Aged , Models, Statistical , Population Surveillance , Program Evaluation , Registries , Women's HealthABSTRACT
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.
Subject(s)
Leukemia , Lung Neoplasms , Neoplasms , Male , Humans , Female , Canada/epidemiology , Breast , Life Style , Mortality , IncidenceABSTRACT
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 372â584 (standardized mortality ratio = 0.77) and 120â045 (standardized mortality ratio = 0.90) avoided cancer deaths in males and females, respectively (492â629 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.
Subject(s)
Neoplasms , Female , Humans , Male , Canada/epidemiology , Neoplasms/mortality , Neoplasms/prevention & controlABSTRACT
BACKGROUND: Chemoprevention is a potentially attractive strategy for decreasing the burden of colorectal cancer (CRC). Preclinical studies suggest that bisphosphonates (BPs) may have direct antitumour effects against CRC. The objective of this study was to determine the effect of exposure to BPs on the incidence of CRC. METHODS: The Manitoba Cancer Registry was used to identify patients who were diagnosed with CRC from 2000 to 2009 who had been living in Manitoba for at least 5 years before diagnosis (cases). Each case was matched to 10 controls of similar age, sex, and duration of residence in Manitoba using incidence density sampling. Exposure to BPs was determined using the provincial Drug Program Information Network database. Conditional logistic regression analysis was performed to determine the effect of exposure to BPs on CRC incidence with adjustment for health care use, medical procedures (including lower gastrointestinal endoscopy), socioeconomic status, and pre-existing health conditions. RESULTS: In total, 5425 patients with CRC were matched to 54,242 controls. In the multivariate analysis, exposure to BPs was associated with a reduction in the risk of CRC (2-13 BP prescriptions over ≥5 years: odds ratio [OR] 0.84; 95% confidence interval [CI], 0.71-1.00; ≥14 BP prescriptions over ≥5 years: OR, 0.78; 95% CI, 0.65-0.94). When the effect of specific BP agents was evaluated, the effect was significant only for exposure to risedronic acid (OR, 0.50; 95% CI, 0.30-0.85). There was no significant effect of increasing duration or cumulative dose of alendronic acid. CONCLUSIONS: The results from this study suggested that exposure to BPs, especially risedronic acid, may be associated with a decreased risk of developing CRC.
Subject(s)
Carcinoma/etiology , Colorectal Neoplasms/etiology , Diphosphonates/therapeutic use , Aged , Aged, 80 and over , Carcinoma/chemically induced , Carcinoma/epidemiology , Carcinoma/pathology , Case-Control Studies , Colorectal Neoplasms/chemically induced , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/pathology , Comorbidity , Diphosphonates/adverse effects , Female , Humans , Male , Middle Aged , Neoplasm Staging , Occupational Exposure/statistics & numerical data , Population , Registries , Risk FactorsABSTRACT
BACKGROUND & AIMS: There are limited data on the risk of nonmelanoma skin cancer (NMSC) among individuals with inflammatory bowel disease (IBD), including those with or without exposure to immunosuppressant medications. METHODS: Individuals with IBD (n = 9618) were identified from the University of Manitoba IBD Epidemiology Database and matched with randomly selected controls (n = 91,378) based on age, sex, and postal area of residence on the date of IBD diagnosis (index date). Groups were followed up from the index date until a diagnosis of any invasive cancer (including NMSC), death, migration from the province, or the end of the study (December 31, 2009), whichever came first. Cox regression analysis was performed to calculate the relative risk of NMSC among the individuals with IBD, adjusting for frequency of ambulatory care visits and socioeconomic status. RESULTS: Of the individuals followed, 1696 were diagnosed with basal cell skin cancer (BCC) and 341 were diagnosed with squamous cell skin cancer (SCC). Individuals with IBD had an increased risk for BCC, compared with controls (hazard ratio, 1.20; 95% confidence interval [CI], 1.03-1.40). Among patients with IBD, use of thiopurines increased the risk of SCC (hazard ratio, 5.40; 95% CI, 2.00-14.56), compared with controls. Use of thiopurines also was associated with SCC in a case-control, nested analysis of individuals with IBD (odds ratio, 20.52; 95% CI, 2.42-173.81). CONCLUSIONS: The risk of BCC could be increased among individuals with IBD. Use of thiopurines increases the risk of SCC among individuals with IBD.
Subject(s)
Inflammatory Bowel Diseases/complications , Neoplasms, Basal Cell/epidemiology , Neoplasms, Squamous Cell/epidemiology , Skin Neoplasms/epidemiology , Adrenal Cortex Hormones/therapeutic use , Adult , Case-Control Studies , Female , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Male , Middle Aged , Prevalence , Purines/adverse effects , Purines/therapeutic use , Risk FactorsABSTRACT
BACKGROUND: There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and/or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes. METHODS: The present historical cohort study used Manitoba's population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis. RESULTS: The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III/IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75). CONCLUSION: Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.
Subject(s)
Adenocarcinoma/diagnosis , Colonic Neoplasms/diagnosis , Outcome Assessment, Health Care , Aged , Aged, 80 and over , Colonic Neoplasms/mortality , Colorectal Neoplasms/diagnosis , Delayed Diagnosis/statistics & numerical data , Female , Humans , Logistic Models , Male , Manitoba , Middle AgedABSTRACT
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.