Predictions of cancer incidence are required when planning the amount of hospital beds, equipment and staff needed for treatment. Predictions can also be used to evaluate the effectiveness of different cancer prevention methods.
Karri Seppä
Reliable data on disease burden in upcoming years is required for health care planning and resourcing. Predictions of the future development of cancer incidence are necessary to plan the number of hospital beds, equipment and staff needed for treatment. Predictions are useful because they can also be used to target actions at cancer prevention and early detection and to evaluate the effectiveness of various methods of preventing cancer.
The Finnish Cancer Registry’s projections on the incidence of cancer have been conducted several times and a great deal of experience has been gained on the accuracy of various methods. The following predictions have been made with the Nordpred statistics program. [1, 2].
Figure 1. Age-standardised cancer incidence and mortality rates (per 100 000 person-years) in 1953–2013 and projected rates until 2030.
According to a recent prediction, the age-adjusted incidence of cancer in men will remain approximately the same during upcoming years, while the incidence in women will increase slightly (Figure 1). Even though the age-adjusted incidence of cancer would remain more or less unchanged, in 2030 about 11 000 more cancer cases would be detected than in 2013.
The annual number of new cancer cases in Finland exceeded 30 000 in 2012. The Finnish Cancer Registry estimates that in 2030 approximately 43 000 new cancer cases will be detected throughout the country, of which an estimated 23 000 will be diagnosed in men and 20 000 in women. All in all, the number of cancer cases will increase by 37% in men compared to the 2013 level, and women’s cancer cases will increase by 29%.
The strong increase in the number of cases is due to the fact that the Finnish population will increase substantially in the oldest age groups in which the risk of developing cancer is the highest. Population growth in the oldest age groups, in turn, is due to the fact that the baby-boomers born after the war are getting older and average life expectancy is increasing.
The number of cancer cases is expected to increase only amongst people over 65 years of age (Figure 2). In turn, the number of cancers detected in the population of under 65 years of age will be reduced slightly. The impact of the baby-boomers is clearly reflected in the number of cancers found in the 65-74-year-old age-group. According to the prediction the annual number of cases will increase by 23% by 2020, but will start declining after this. The annual number of cases in the group of over 75 years of age is expected to nearly double from 2013 to 2030.
The development of cancer incidence in men is strongly influenced by how the incidence of prostate cancer changes. The prediction assumes that the prostate cancer incidence of all age groups will remain at the same level that it was during 2009-2013 (Figure 3). The incidence of prostate cancer peaked in 2004-2005, and now its incidence is expected to return close to the trend seen before the use of PSA testing increased.
Should the age-adjusted incidence of all cancer types remain at the level of years 2009-2013 in the future as well, the number of cancer cases would increase 38% in men, and 18% in women. The number of cancer cases of women is projected to increase by clearly more than that–29 percent–since predictions indicate an increased risk of skin cancers for women, and the risk of developing breast cancer increases markedly for women over 75 years of age.
The future trends of most cancer types follows the directions observed in the past (Tables 1-2, Figures 3-4). Men’s lung cancer will clearly become increasingly rare, while the female lung cancer incidence is estimated to further increase to some extent. Thus in 2030 more than 1 200 cases of lung cancer would be detected in women, which would be under 700 fewer than in men. Skin cancers have become much more common over the last few years, and the age-adjusted incidence is estimated to increase further. Already more skin cancers are diagnosed annually than colorectal cancers.
The increase in the number of cases means that cancer requires a growing share of health resources. In addition to cancer diagnostics, more resources are needed for active and supportive care, for the treatment of complications from treatment, palliative treatment and follow-up.
The sheer increase in the number of cases does not tell the whole story of the future workload. Cancers with poor prognosis, such as lung, stomach and esophageal cancer, become rarer. An increasing proportion of cancers are curable. Also, the survival time of patients with incurable cancer will be longer as treatments advance.
The active care of elderly patients or patients affected with a number of basic diseases is possible. On the other hand, the cancer treatment of elderly patients or patients otherwise in weak health burden health care more than basic care and the treatment of healthy working patients.
It is estimated that at the end of 2030 about 73 000 male and 65 000 female cancer survivors who were diagnosed less than five years earlier, will be alive. These patients require a lot of specialized health care resources due to cancer treatment and follow-up. Compared to the 2013 the number of cancer patients alive will increase 46% in men and 29% in women. In particular, the amount of over 75-year-olds who have been diagnosed with cancer will increase, the prediction suggests an increase in men of 110% and 100% in women.
Cancers are closely connected to an individual’s lifestyle, behavioral habits and the aspects of their living environments. Some cancers can be prevented, and it is possible to change the development trends of cancers.
The main challenges in cancer research over the next decades have not changed: It is still important to find causes of cancer and to develop methods for the early diagnosis of cancer. The challenge to society’s decision-makers remains to find the means to make living conditions safer and support people in life-style changes to better enhance health.
Cancer is a very common disease group and it is known in every family. However, fewer and fewer people will die from cancer (Figures 1, 5-6). According to predictions, the age-adjusted mortality rate will decrease by 13% in men and 7% in women from 2013 to 2030. Amongst men, lung, prostate and stomach cancer mortality will continue to decline. Women’s mortality rates for breast, ovarian and stomach cancer and non-Hodgkin lymphoma will decrease, but the mortality rate of lung cancer will increase.
In a survey performed in May 2006, approximately one in four Finnish considered cancer a very frightening disease, but in the future this fear is likely to decrease. Even now, the fear of cancer is least among highly educated people: proper information reduces pain.
[1] Møller B, Fekjær H, Hakulinen T et al. Prediction of cancer incidence in the Nordic countries up to the year 2020. Eur J Cancer Prev 2002; 11 (Suppl 1): 1–96.
[2] Møller B, Fekjær H, Hakulinen T et al. Prediction of cancer incidence in the Nordic countries: Empirical comparison of different approaches. Stat Med 2003; 22: 2751–66.
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