International trends in cancer incidence and mortality among older adults, 1983–2012

Abstract

Introduction In 2012, about half of all new cancer diagnoses and deaths were estimated to occur among people age 65 years and older; these will be around two third by 2035. Assessing trends in cancer incidence and mortality in this growing population is of great importance to understand the impact of cancer on this vulnerable population and to design cancer control and management plans. We therefore described temporal trends in incidence and mortality for the most common cancers–i.e. breast, prostate, colorectal and lung cancers–in adults aged 65 years or older in 17 countries with long history of population-based cancer registration. Methods Data on incidence for cancers of the colorectum, breast, prostate and lung from 1983 to 2012 were obtained from the Cancer Incidence in Five Continents in17 countries in Asia, northern America, central and south America, northern Europe, western and southern Europe and Oceania. Cancer mortality data were obtained from the World Health Organization mortality database. Country- and sex-specific truncated age-standardized rates (65 + ) and average annual percentage changes were calculated. Results Between 1983 and 2012, incidence rates of colorectal cancer have increased between +0.4–22% on average annually in older males and between +0.0–15.7% in older females in most countries under study, while incidence rate has significantly decreased in USA (−8.3% in females and −10.6% in males). In contrast, mortality from colorectal cancer has decreased in all countries from −10.5% in Switzerland to −0.8% in Singapore but it has significantly increased in Costa Rica (+5.5% in males and 2.8% in females) and Spain (8.7% in males and +1.6% in females). The incidence of prostate and breast cancers has increased in almost all countries between 2.6% in Canada and +38.8% in Japan for prostate cancer and between +1.1% in USA and 19.4% in Japan for breast cancer. However, prostate and breast cancer mortality rates have decreased in most countries, except in Costa Rica (+4.5% and +3.3% for prostate and breast cancers respectively), Japan (+8.6% and +13.4%) and Singapore (+9.4% and +6.1%). In almost all countries, incidence and mortality rates for lung cancer have greatly increased in females over the 30-year period following the smoking epidemic pattern (from 5.2% and 0.7% respectively in Japan to 35.8% and 26.0%, respectively in Netherlands), while lung cancer in males are largely decreasing, notably in UK, Netherlands and Finland (> −10% per year on average for incidence and mortality rates). Conclusion Decreasing deaths from cancer in older adults might probably be related to earlier cancer detection and better management. Yet, the rising incidence of the most common cancer sites will increase strain in national health care resources and therefore prevention programs needs to be strengthen. The expected rise in the number of new older cancer patients must encourage the development of geriatric oncology worldwide.