NAACCReview

On behalf of the NAACCR (this year’s lead agency), I’m pleased to announce that the latest Annual Report to the Nation on the status of cancer (ARN) was published on May 30, 2019. This 21st “edition” of ARN represents an annual collaborative effort by the ACS, CDC, NAACCR, and NCI. These reports would not be possible without the contributions of the state and regional cancer registry staff who collected the data.

During 1999-2015, the overall cancer incidence rates continued to decrease among men and remained stable among women. The overall cancer death rates continued to decline during 1999-2016 among men, women, and children. The decreases in death rates are the continuation of trends over the past 20 years. Factors that have contributed to these decreasing trends include reduced tobacco use, improved early detection (e.g., colorectal, breast, and cervical cancer), and improved treatments for many cancers. In contrast, increasing trends in cancers related to excess weight and to physical inactivity, including uterus, post-menopausal breast, and colorectal (only in young adults) have been shown to be associated with changing prevalence of these risk factors in recent decades.  Historical changes in prevalence of other risk factors, including human papillomavirus (HPV) and Hepatitis C infection, play an important role in declining or increasing trends in certain cancers.

Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. We noted that this could be due to changes in diagnostic processes related to revisions in American Thyroid Association management guidelines for small thyroid nodules.

The report also shows rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.  We noted that these declines are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,

This year’s ARN features cancer among adults ages 20 to 49. During 2011 to 2015, the rate of new cancers diagnosed among women ages 20 to 49 was almost twice the rate among men the age (115.3 new cancers per 100,000 people for men and 203.3 for women from 2011 to 2015). The rates of death from cancer were about 1.2 times higher among women (22.8 per 100,000 people compared to 27.2 for women from 2012-2016).  The most common cancers in this age group were:

• Breast, thyroid and melanoma of the skin for women, with breast cancer far outpacing any of the other cancers; and
• Colorectal, testicular and melanoma of the skin for men.

The study also found that the incidence rates of in situ breast cancer and nonmalignant central nervous system (CNS) tumors among women and men ages 20 to 49 are substantial, with the incidence of nonmalignant CNS tumors being twice as high in younger women compared to younger men. We noted that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment, and that  that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.

Additional information, including sharable infographics, HERE

Abstract

Background: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries (NAACCR) provide annual updates on cancer occurrence and trends by cancer type, sex, race, ethnicity, and age in the US. This year’s report highlights the cancer burden among men and women ages 20–49 years.

Methods: Incidence data for the years 1999 to 2015 from the Centers for Disease Control and Prevention- and National Cancer Institute- funded population-based cancer registry programs compiled by NAACCR and death data for the years 1999 to 2016 from the National Vital Statistics System were used. Trends in age-standardized incidence and death rates, estimated by joinpoint, were expressed as average annual percent change.

Results: Overall cancer incidence rates (per 100,000) for all ages during 2011–2015 were 494.3 among men and 420.5 among women; during the same time period, incidence rates decreased 2.1% (95% confidence interval [CI] = –2.6% to –1.6%) per year in males and were stable in females. Overall cancer death rates (per 100,000) for all ages during 2012–2016 were 193.1 among males and 137.7 among females. During 2012–2016, overall cancer death rates for all ages decreased 1.8% (95% CI = –1.8% to –1.8%) per year in males and 1.4% (95% CI =–1.4% to –1.4%) per year in females. Important changes in trends were stabilization of thyroid cancer incidence rates in women and rapid declines in death rates for melanoma of the skin (both sexes).  Among adults ages 20–49, overall cancer incidence rates were substantially lower among males (115.3 per 100,000) than among females (203.3 per 100,000); cancers with the highest incidence rates (per 100,000) among males were colon and rectum (13.1), testis (10.7) and melanoma of the skin (9.8) and among females were breast (73.2), thyroid (28.4) and melanoma of the skin (14.1). During 2011 to 2015, the incidence of all invasive cancers combined among adults ages 20–49 decreased  –0.7% (95% CI = –1.0% to –0.4%) among males and increased among females (1.3%; 95% CI = 0.7% to 1.9%).  The death rate (per 100,000) adults ages 20–49 for all cancer sites combined during 2012 to 2016 was 22.8 among males and 27.1 among females;  during the same time period, death rates decreased 2.3% (95% CI = –2.4% to –2.2%) per year among males and 1.7% (95% CI = –1.8% to –1.6%) per year among females..

Conclusions: Among people of all ages and ages 20–49, both favorable and unfavorable trends in site-specific cancer incidence were observed, while trends in death rates were generally favorable. Characterizing the cancer burden may inform research and cancer control efforts.