Impact of US population demographic changes on projected incident cancer cases from 2019 to 2045 in three major cancer types.

Abstract

e19044 Background: The United States (US) Census Bureau has forecasted an unprecedented shift in the US demographics by 2045, in which there will be no single majority race/ethnicity. Due to well-characterized health disparities among different races/ethnicities in oncology and projected demographic changes, it is of interest to assess changes in the burden of three most frequent cancers: breast cancer (BC) for women, prostate cancer (PC) for men, and colorectal cancer (CRC) for both genders between 2019 and 2045. Methods: Historical age-adjusted rates (AARs) for BC in women, PC in men, and CRC in patients of all ages and stratified by race/ethnicity were collected from the SEER 18 database for 2000-15 period. AARs for cancers of interest were analyzed in Joinpoint Regression Program to obtain an average annual percent change (AAPC) for 2000-15. AARs were then projected to 2045 by assuming the rate behavior is equal to the AAPC. Projected absolute cases per 100,000 were generated by multiplying projected AARs with the associated projected population, retrieved from the US Census Bureau 2017 National Population Projects, and dividing by 100,000. The absolute change in projected patient numbers of cancer cases by race/ethnicity were assessed between 2019 and 2045. Results: From 2019 to 2045, a decrease of 4% is expected in the White Non-Hispanic (WNH) population while the Black (B), Hispanic (H), and Asian/Pacific Islander (API) populations are projected to increase 24%, 54%, and 57%, respectively. In the same time period, the projected number of BC incident cases for women of all ages decreased by 1% in WNH while the B, WH, and API populations were projected to increase 72%, 98%, and 120%, respectively. In both genders of all ages, a 39% and 17% reduction in the number of CRC incident cases in the WNH and B is expected compared to a 61% and 11% increase in the WH and API populations, respectively. Given observed reduction in PC incidence, especially in men 65+, the number of incident PC cases is projected to decrease by 2045 for all included races/ethnicities. Conclusions: Among racial and ethnic minorities, an increase in the number of BC and CRC cases is expected between 2019 and 2045. Projected decrease in PC cases is likely a result of decrease in incidence rates between 2010 and 2015 and should be assessed as new data become available. Currently, racial and ethnic minorities comprise < 20% of patients enrolled in clinical trials, demonstrating the need to understand biologic and social underpinnings of disparities in clinical outcomes in underrepresented groups.