Canadian Cancer Statistics 2013 Special topic: Liver cancer Produced by Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, Provincial/Territorial Cancer Registries 1 888 939 3333 | cancer.ca cancer.ca/statistics Citation: Material appearing in this publication may be reproduced or copied without permission; however, the following citation must be used to indicate the source: Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Toronto, ON: Canadian Cancer Society; 2013. [May 2013] ISSN 0835-2976 This publication is available in English and French on the Canadian Cancer Society’s website at cancer.ca/statistics. The website includes additional resources, such as individual figures from the publication and an archive of previous editions. The development of this publication over the years has benefited considerably from the comments and suggestions of readers. The Advisory Committee appreciates and welcomes such comments. To be notified about next year’s publication or to offer ideas on how the publication can be improved, please complete the evaluation form or e-mail [email protected]. Canadian Cancer Society n Canadian Cancer Statistics 2013 2 Members of the Canadian Cancer Statistics Advisory Committee Les Mery, MSc (Chair) Hannah K. Weir, PhD Centre for Chronic Disease Prevention, Public Health Division of Cancer Prevention and Control, Centers Agency of Canada, Ottawa, Ontario for Disease Control and Prevention, Atlanta, Georgia Kimberley Boyuk, MA Analytic and statistical support Health Statistics Division, Statistics Canada, Ottawa, Robert Semenciw, MSc Ontario Centre for Chronic Disease Prevention, Public Health Gillian Bromfield, MSc Agency of Canada, Ottawa, Ontario Cancer Control Policy, Canadian Cancer Society, Lin Xie, MSc (Statistics), MSc (MIS) Toronto, Ontario Centre for Chronic Disease Prevention, Public Health Darlene Dale, BASc, FHA Agency of Canada, Ottawa, Ontario Princess Margaret Cancer Registry, Princess Margaret Dianne Zakaria, PhD Cancer Centre, Toronto, Ontario Health Statistics Division, Statistics Canada, Ottawa, Prithwish De, PhD Ontario Cancer Control Policy, Canadian Cancer Society, Toronto, Ontario The analysts were supported by: Dagny Dryer, MD, FRCPC Amanda Shaw, MSc, and Maggie Stewart, BA Public Health Agency of Canada, Ottawa, Ontario PEI Cancer Treatment Centre and Cancer Registry, Charlottetown, Prince Edward Island Review of French translation: Maureen MacIntyre, MHSA Jean-Marc Daigle, MSc Surveillance and Epidemiology Unit, Cancer Care Institut national de santé publique du Québec, Nova Scotia, Halifax, Nova Scotia Québec, Québec Rami Rahal, BSc, MBA System Performance and Surveillance, Canadian Partnership Against Cancer, Toronto, Ontario Canadian Cancer Society n Canadian Cancer Statistics 2013 3 Table of Contents Executive summary . 6 CHAPTER 2: Incidence by sex, age and geography: About this publication . 8 Who gets cancer in Canada? . 26 Purpose and intended audience . 8 Highlights . 26 Format . 8 Introduction . 26 Analysis and production . 8 Incidence by sex . 2. 6 A note on data . 8 Incidence by age . 27 Actual and estimated data . 9 Incidence by geographic region . 2. 8 INTRODUCTION: What do these statistics mean? . 30 Cancer in Canada . 10 CHAPTER 3: CHAPTER 1: Mortality: How many people in Canada Incidence: How many people in Canada die of cancer? . 35 get cancer? . 14 Highlights . 35 Highlights . 14 Introduction . 35 Introduction . 14 Probability of dying from cancer . 35 Probability of developing cancer . 1. 4 Deaths from cancer in 2013 . 36 New cases of cancer in 2013 . 15 Trends over time . 37 Trends over time . 16 Trends for selected cancers . 38 Trends for selected cancers . 17 What do these statistics mean? . 40 What do these statistics mean? . 20 Canadian Cancer Society n Canadian Cancer Statistics 2013 4 Table of Contents CHAPTER 4: CHAPTER 6: APPENDIX I: Mortality by sex, age and geography: Prevalence: How many people diagnosed with Actual data for new cases and deaths . 88 Who dies of cancer in Canada? . .47 cancer are alive today? . 64 APPENDIX II: Highlights . 47 Highlights . 64 Data sources and methods . 94 47 64 Introduction . Introduction . Data sources . 94 47 65 Mortality by sex . Tumour-based prevalence . Methods . 95 48 66 Mortality by age . Person-based prevalence . Data and methods issues . 100 Mortality by geographic region . 50 What do these statistics mean? . 67 APPENDIX III: What do these statistics mean? . 51 CHAPTER 7: Previous special topics, abbreviations and CHAPTER 5: Special topic: Liver cancer . 72 indices . 106 Relative survival: What is the likelihood of Highlights . 72 Previous special topics . 106 surviving cancer? . 56 Epidemiology of liver cancer . 72 Abbreviations . 107 Highlights . 56 Risk factors . 74 Index of tables and figures . 108 Introduction . 56 Diagnosis, treatment, survival and prevalence . 75 FOR FURTHER INFORMATION . 110 Five-year relative survival . 57 Prevention and control . 78 Partner organizations . 110 Five-year conditional relative survival . 59 Costs associated with liver cancer care . 79 Canadian Council of Cancer Registries . 111 What do these statistics mean? . 60 New developments in liver cancer management 113 and research . 80 Canadian Cancer Society offices . What do these statistics mean? . 81 Canadian Cancer Society n Canadian Cancer Statistics 2013 5 Executive summary Canadian Cancer Statistics is an annual publication that provides estimates of the burden of cancer in Canada for the current year. About 2 in 5 Canadians will develop cancer in their 838,724 lifetime and about 1 in 4 Canadians will die of cancer. Canadians were alive at In 2013, it is estimated that 187,600 Canadians will the beginning of 2009 2 in 5 develop cancer and 75,500 will die of cancer. More with a cancer diagnosed Canadians will than half of new cancer cases (52%) will be lung, in the previous develop cancer in breast, colorectal and prostate cancer. Lung cancer is 10 years their lifetime the leading cause of cancer death, causing more cancer deaths among Canadians than the other three cancer types combined. Despite this large impact, there has been a significant drop in the lung cancer death rate (especially for men) over the past 20 years, which has driven a decline in the overall cancer death rate. 187,600 Slightly more men than women get cancer in Canada, Canadians will be diagnosed and the vast majority (88%) of Canadians who develop % with cancer in 2013 cancer are over the age of 50. However, cancer can 63 occur at any age. Its impact at a younger age can be 75,500 The likelihood of Canadians particularly devastating: according to Statistics Canadians with cancer will die of cancer Canada, in 2009, cancer was the leading cause of surviving 5 years relative in 2013 disease-related death in children under the age of to the general 15 years. population Overall, the five-year relative survival ratio for people diagnosed with cancer is 63%, but it ranges widely by the type of cancer. Some cancers have very high 1 in 4 five-year relative survival ratios, including thyroid Canadians will die cancer (98%). Other cancers have consistently low of cancer five-year relative survival ratios, such as pancreatic cancer (8%). Canadian Cancer Society n Canadian Cancer Statistics 2013 6 Executive Summary As of January 2009, 838,724 Canadians had been Measuring the cancer burden in Canada is vital for diagnosed with cancer within the previous 10 years health policy and it helps decision-makers assess the and were still alive on that date. This means that about type and allocation of health resources needed. The 2.5% of the Canadian population were living with, or data are also essential in focusing prevention efforts, in beyond, a cancer diagnosis in the decade leading up both primary prevention of cancer and secondary to 2009. prevention, allowing more effective treatment of This year’s publication also features an in-depth certain cancers through earlier detection. Finally, these analysis of liver cancer (Chapter 7: Special topic: Liver statistics can be useful for prioritizing services to help cancer). This cancer is one of the fastest growing cancer Canadians and their families who have been affected types in Canada with regard to new cases and deaths. by cancer and who may need supportive care after It is increasing particularly quickly in men, with an their treatment has ended. We hope that our readers average annual percent increase in incidence of 3.6% will think critically about what these numbers mean (1970 to 2007). An estimated 1,550 men and 490 and how they can be used to improve survival, develop women will be diagnosed with liver cancer this year. better overall care for those with cancer and reduce Major risk factors for liver cancer include viral cancer incidence in Canada. hepatitis infection (hepatitis B and C), smoking, alcohol consumption and obesity. A higher risk of liver cancer in lower income populations and concomitant barriers to accessing healthcare, early detection and treatment need to be investigated further to reduce the impact of this cancer. More Canadian data are also needed to understand the best strategies for risk reduction, early detection and treatment of hepatitis infection, as well as approaches to community engagement in promoting healthy behaviours in hard-to-reach populations. Canadian Cancer Society n Canadian Cancer Statistics 2013 7 About this publication Canadian Cancer Statistics is part of an annual series • Chapters