In Focus 6 Spotlight on Specific Cancers TANYA This module provides summary statistics from the six In Focus sections found in the report. These sections focus on six different cancer types: breast, colorectal, lung, prostate, cervix and head and neck Using newly available data from the OCR on biomarkers these sections present indicators informed by clinicians and based on their recommendations This represents a first step in making surveillance data more applicable and useful to the clinical community Ontario Cancer Statistics 2016 In Focus

Female Breast Cancer Remains leading cancer in Ontario’s women Incidence rate fluctuations Molecular subtypes Survival increased by 13.3 percentage points TANYA Breast cancer remains the most commonly diagnosed cancer among Ontario females and the second leading cause of cancer death. Breast cancer incidence increased in the 1980’s and early 1990s, but has been declining since 1992. This increase and the subsequent decrease is likely due to the introduction of the Ontario Breast Screening program in the late 1980s. CLICK As shown in the figure in this slide, the majority of breast cancer cases were luminal A cancers with almost 70% of all cases falling within this subtype. While luminal A is one of the least aggressive subtypes the second most common subtype was triple negative which is more likely to metastasize and re-occur than other subtypes. Mortality from female breast cancer has been declining since 1986, with the rate of decline accelerating since 1995. Between the early 1980s and now, five-year relative survival for female breast cancer increased by 13.3 percentage points, likely due to a combination of screening and improved treatments Ontario Cancer Statistics 2016 In Focus

Colorectal Cancer Incidence rate falling Distal colon cancer incidence has been generally decreasing since 1981, while rectal cancer declined only until 1997 and then stabilized No change in proximal colon cancer incidence Mortality falling Colon cancer mortality has been declining since 1981, rectal cancer mortality has been increasing since 1998 Survival increased by 14.3 percentage points ZEINAB The incidence rate for colorectal cancer fell by 0.4% per year between 1981 and 2012. CLICK The subsites of colorectal cancer however, had differing incidence trends over time. Distal colon cancer incidence has been generally declining since 1981 with the greatest declines coming since 2008. Rectal cancer on the other hand, declined between 1981 and 1997 and then stabilized. Proximal colon cancer had no significant change in incidence between 1981 and 2012. Colorectal cancer mortality has also been declining since 1981, however, since 2003 the decrease has been greater in males. The decrease in mortality is attributed to changes in risk and protective factors, screening and improvements in treatment. Mortality for just colon cancer declined between 1981 and 2012, with the rate of decline increasing after 2002. Mortality for rectal cancer meanwhile, declined until 1998 and then increased slightly between 1998 and 2012. Five-year relative survival for colorectal cancer has increased by 14.3 percentage points since the early 1980s. Ontario Cancer Statistics 2016 In Focus

Lung Cancer Males: incidence has stabilized Females: incidence increasing Majority of lung cancers were non-small cell lung cancers – 70.9% Non-small cell lung cancer incidence vs. small cell lung cancer incidence Males: mortality declining Female: mortality has stabilized PRITHWISH Lung cancer incidence trends have differed between males and females. In males, the lung cancer incidence rate decreased between 1989 and 2008 and then remained stable. In females, on the other hand, the incidence rate has been increasing since the 1980s although the upward trend has been slowing over time. These differing trends are largely a reflection of historically different smoking patterns between men and women CLICK The majority of lung cancers diagnosed in 2012 were non-small cell lung cancers, which accounted for 70.9% of all lung cancers. The incidence rate of non small cell lung cancer has been stable since the mid-1980s. The other major sub-type of lung cancer, small-cell lung cancers accounted for 10.0% of lung cancers. The incidence rate of small cell cancer increased by 3.1% per year between 1981 and 1987, decreased between 1987 and 2006 and then remained stable. Lung cancer mortality also differed by sex. The mortality rate among men has been declining since 1988 while in women it increased between 1981 and 2000 before stabilizing. Ontario Cancer Statistics 2016 In Focus

Prostate Cancer Incidence declining since 2007 Majority of cases diagnosed in 2012 were low risk cancers Mortality declining since 1981 Survival increased by 24.2 percentage points SABER Although the prostate cancer incidence rate declined by 4.9% per year between 2007 and 2012, it remains one of the most commonly diagnosed cancers. CLICK As shown in this figure, the majority of prostate cancers diagnosed in Ontario in 2012 were low risk cancers according to their Gleason score which suggests the possibility of over-diagnosis and over-treatment. Among males, prostate cancer is the third leading cause of cancer death. However, mortality has been declining since 1981 likely because of increased early detection and improved treatments. Five-year relative survival from prostate cancer has increased by 24.2 percentage points since the early 1980s, probably as a result of greater PSA testing and more frequent identification of early-stage, slow-growing cancers. As less PSA testing results in the detection of fewer low-risk, early stage cancers, we can expect a decline in relative survival, however this will be an artificial decline. Ontario Cancer Statistics 2016 In Focus

Cervical Cancer Incidence has stabilized Squamous cell carcinoma paralleled the overall cervical cancer trend Incidence of adenocarcinoma currently increasing Five-year relative survival has not changed significantly ANIQ While cervical cancer incidence is relatively low, it remains a cancer of strong interest. The incidence rate for cervical cancer declined between 1981 and 2006 and then stabilized, likely due to the effects of organized screening programs. Screening, however did not appear to have the same effect on the incidence of cervical adenocarcinomas as it did on squamous cell carcinomas. The incidence of squamous cell carcinoma has paralleled the overall cervical cancer rate. The incidence of adenocarcinoma, however, increased between 1981 and 1996 and 2005 and 2012, with a period of decline in between. As a result of these fluxuating trends, the rate of adenocarcinoma remains fairly similar to what it was in 1981, while the rate of squamous cell carcinoma has been halved. This is of particular concern as adenocarcinomas tend to have a poorer prognosis. PAUSE Five-year relative survival from cervical cancer has seen no significant change over the past three decades. Ontario Cancer Statistics 2016 In Focus

Head And Neck Cancers Tongue cancer the most commonly diagnosed HNC Laryngeal cancer the cause of the most deaths Incidence over time: Tongue cancer – increasing Laryngeal cancer – declining Glottis, supraglottis Tonsil cancer – increasing Pharynx cancer – declining Oropharynx, nasopharynx, hypopharynx AMY There are approximately 5,700 head and neck cancers diagnosed each year in Ontario. The most common head and neck cancer in 2012 was tongue cancer followed by cancer of the larynx. CLICK The incidence of tongue cancer increased between 2003 and 2012 after remaining stable over the previous two decades. Cancer of the larynx has been declining since 1981. CLICK The main subsite of larynx cancer, glottis, also decreased over this time period, however cancer of the the second most common subsite, supraglottis, saw a greater decline. Particularly interesting incidence trends were found for two head and neck cancers: tonsil and pharynx The incidence of tonsil cancer has been increasing since 1998 after two decades of stability. Cancer of the pharynx has been declining since 1981. While the most common subtype of pharynx cancer, cancer of the nasopharynx also declined during this time, the other two types, oropharynx and nasopharynx saw no change in their incidence rate. Ontario Cancer Statistics 2016 In Focus