2 Incidence SABER This module presents statistics from Chapter 2: Incidence Ontario Cancer Statistics 2016 Chapter 2: Incidence

Incidence Overview 85,648 new cases of cancer expected to be diagnosed in 2016 (569.9 per 100,000) Males: 614.0 per 100,000 Females: 540.6 per 100,000 88.4% of all cases will be diagnosed in people over the age of 50 19.2% in people aged 80 and older SABER In 2016, we project that over 85 thousand new cases of cancer will be diagnosed in Ontario resulting in an age-standardized rate of 569.9 new cases per 100,000 people Cancer incidence is higher in males than females Males have an incidence rate of 614 new cases per 100,000 compared to 540.6 new cases per 100,000 in females Cancer remains a disease that primarily affects older people. Over 88% of all cases diagnosed in 2016 will occur in people aged 50 and older and over 19% will occur in people aged 80 and older Ontario Cancer Statistics 2016 Chapter 2: Incidence Ontario Cancer Statistics 2016 Incidence

Probability of Developing Cancer Approx. 1 in 2 people in Ontario will develop cancer in their lifetime Males Females Prostate – 1 in 6.5 Breast – 1 in 7.8 Lung – 1 in 11.4 Lung – 1 in 13.7 Colorectal – 1 in 12.8 Colorectal – 1 in 15.1 SABER For the first time, we are publishing Ontario-specific probabilities of developing and dying from cancer In Ontario, approximately 1 in 2 people will develop cancer in their lifetime. Among males, the greatest risk is for prostate cancer at 1 in 6.5 Among females, the greatest risk is for breast cancer 1 in 7.8 women in Ontario will develop breast cancer in their lifetime For both men and women the second and third greatest risks are for lung and colorectal cancer respectively Ontario Cancer Statistics 2016 Incidence

Incidence by Cancer Type Males: Prostate (21.6%) Lung (13.3%) Colorectal (12.4%) Bladder (8.9%) Non-Hodgkin lymphoma (5.3%) Melanoma (4.4%) Leukemia (3.4%) Kidney (3.3%) Oral cavity and pharynx (3.3%) Pancreas (2.4%) Females: Breast (26.6%) Lung (12.6%) Colorectal (11.1%) Uterus (6.5%) Thyroid (6.5%) Non-Hodgkin lymphoma (4.2%) Melanoma (3.5%) Bladder (3.1%) Ovary (3.0%) Leukemia (2.5%) SABER This slide illustrates the 10 most commonly diagnosed cancers in 2012 for males and females The most commonly diagnosed cancers in males were prostate, lung and colorectal PAUSE Among females, the most commonly diagnosed cancers were breast, lung and colorectal There were a number of differences in the incidence of cancer between the sexes For example, bladder cancer was more common in males than females There were more than three times the number of bladder cancer cases in males than in females This difference may be the result of males having a greater prevalence of bladder cancer risk factors including smoking and occupational exposure to certain chemicals Ontario Cancer Statistics 2016 Incidence

THYROID, LIVER AND UTERINE CANCERS RISING FASTEST Incidence Over Time Cancer incidence rate increased since 1981 but slowed over the past two decades Fastest rising cancers are thyroid, liver and uterine cancers Greatest decreases have been in laryngeal, prostate and bladder cancers THYROID, LIVER AND UTERINE CANCERS RISING FASTEST SABER This slide presents information on incidence trends over time. The incidence rate for all cancers combined in Ontario has been increasing since 1981. Between 1981 and 1991 the incidence rate increased by 0.8% per year and then slowed to 0.2% per year between 1991 and 2012. PAUSE The fastest rising cancers over the past 10 years have been thyroid, liver and uterine cancers. The incidence rate for thyroid cancer increased between 1981 and 2012, with the greatest increase occurring after 1988, when the rate rose by 12.9% per year. This increase is most likely the result of improved diagnostic technology which has allowed for the detection of subclinical tumours. Liver cancer incidence increased by 4.5% per year between 1981 and 2012. This increase may also be the result of diagnostic improvements, as well as an increase in risk factors such as obesity. Uterine cancer incidence increased by 4.6% per year between 2006 and 2012. This follows after a period of time when the incidence rate decreased or remained stable. This recent increase in uterine cancer is most likely the result of a greater prevalence in the population of risk factors such as exposure to unopposed estrogen therapies, a lower number of full-term pregnancies and obesity. Over the past 10 years, the greatest decreases in incidence have been in cancers of the larynx, prostate and bladder. Ontario Cancer Statistics 2016 Incidence

Percentage of new cases Incidence by Stage Majority of cases diagnosed at stage I or II Most cancers in younger people diagnosed at early stages Breast, cervical and prostate Colorectal cancer Lung cancer Stage Percentage of new cases Stage I 28.8% Stage II 37.9% Stage III 18.7% Stage IV 20.6% SABER As the Ontario Cancer Registry only recently started producing stage data, data was only available for five cancer types: breast, prostate, lung, colorectal and cervix and only for the diagnosis years 2010-2012 The majority of cancer cases diagnosed in Ontario between 2010 and 2012 were diagnosed at stage 1 or 2. In fact, among people aged 69 and younger, the greatest proportion of cases were diagnosed at stage 1 Breast, cervical and prostate cancers were most often diagnosed at stage 1 or 2, while colorectal cancer cases were most often diagnosed at stage 2 or 3 Among the cancer types for which stage data was available, lung cancer was the most likely to be diagnosed at an advanced stage, and almost half of all lung cancer cases were diagnosed at stage 4 Ontario Cancer Statistics 2016 Incidence

Regional Incidence Incidence lowest: South-central Ontario LHINs Northwestern, Peel, Toronto and York Region PHUs Incidence highest: North East and South East LHINs SABER While most of the report focuses on Ontario-wide statistics, we also looked at the incidence of cancer in the regions Rates are presented geo-spatially in maps by LHIN and by PHU for males and females By LHIN, cancer incidence rates in 2012 were lowest in LHINs located in south-central Ontario and highest in the North East and South East LHINs By PHU, cancer incidence rates were lowest in the Northwestern, Peel, Toronto and York Region PHUs while the highest rates were found in various PHUs scattered throughout the province Complete incidence counts and rates for all LHINs and PHUs are available in the report itself Ontario Cancer Statistics 2016 Incidence