Estimating the Current and Future Burden of Cancer in Canada: Identifying Opportunities for Prevention

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1 Estimating the Current and Future Burden of Cancer in Canada: Identifying Opportunities for Prevention Darren R. Brenner Assistant Professor Departments of Oncology and Community Health Sciences Cumming School of Medicine University of Calgary On Behalf of the ComPARe Study Team

2 IS. The Burden of Cancer in Canada

3 Canadian Cancer Statistics, 2017 The Burden of Cancer in Canada

4 The Burden of Cancer in Canada Scope of the ComPARe Project Past Burden Current Burden Future Burden Cancer Incidence Prevention Strategies Avoidable Burden Year

5 The Burden of Cancer in Canada Past Trends Cancer Incidence Year

6 Looking Back - Success in Primary Prevention UV Exposure and Melanoma Males Crude rate Females Crude rate Year Data source: Canadian Cancer Registry, Year years years

7 Looking Back - Success in Primary Prevention Smoking and Lung Cancer Males Crude rate Females Crude rate Year Year Data source: Canadian Cancer Registry, Younger Age Older Age Groups

8 Crude rate Looking Back - Success in Secondary Prevention Cervical Cancer Year Year Year years years years

9 Looking Back - Success in Secondary Prevention Colorectal Cancer Males Crude rate Females Crude rate Year Year Year years years years

10 Looking Back Opportunities for Prevention Kidney Cancer Males Crude rate Females Crude rate Year Year Year years years years

11 Past Trends The Scope of the ComPARe Project Current Burden Cancer Incidence Prevention Targets Year

12 Attributable Risk Framework Risk Estimat e Exposure Prevalence Cancer Incidence PAR = Pe P e ( RR 1) ( RR 1) + 1 Excess Attributable Cases = PAR Incident Cancer Cases

13 Exposures of Interest Tobacco Dietary Intake Energy Imbalance Environmen t Hormone Therapies Infectious Agents Active Passive Fruit/ Vegetable Red/Processed meat Alcohol Salt Calcium/Vitamin D supplements Overweight/Obesity Physical inactivity Abdominal adiposity Sedentary behaviour Air pollution Water disinfection byproducts Ultraviolet radiation Radon Oral contraceptives Hormone replacement therapy Epstein Kaposi Sarcoma Barr Virus Human Papillomavirus Hepatitis B/C Virus Helicobacter Pylori Human T-lymphotropic virus

14 Prevention Targets 150 mins/week < 25kg/m 2 No intake 4 servings/day Based on National or International Guidelines*

15 Current Attributable Burden

16 Current Attributable Burden: Active and Passive Smoking Lung Cancer 18,034 Head and Neck Cancer 2,484 9,790 8,244 31,699 Cancer Cases Esophageal Cancer 816 Colorectal Cancer 2,614 18,358 13,341 Stomach Cancer 624 Breast Cancer 1,375 Ovarian and cervical Cancer 508 Bladder Cancer 2,985 Kidney Cancer 939 Pancreatic Cancer 748 Liver and gallbladder Cancer 562

17 Current Attributable Burden- Geographic Variation Colorectal Cancer Attributable to Obesity Lung Cancer Attributable to Active Smokin % % % % % % % % % %

18 The Scope of the ComPARe Project Future Burden Cancer Incidence Year

19 Melanoma Number of Cases ASR per 100,000 Number of Cases ASR per 100,000 Negative-binomial based ADPC model Calendar Year Abbey Poirier

20 Poisson-based age-cohort model Calendar Year Lung Cancer Number of Cases ASR per 100,000 Number of Cases ASR per 100,000

21 Negative-binomial based ADPC model Calendar Year Kidney Number of Cases ASR per 100,000 Number of Cases ASR per 100,000

22 The Scope of the ComPARe Project Future Burden Cancer Incidence Prevention Strategies Avoidable Burden Year

23 Impact Fraction Framework Risk Estimate Projected Distribution of Exposure Counterfactual Distribution of Exposure Projected Cancer Incidence

24 Preventable Cancers: Alcohol and all associated cancer sites

25 Preventable Cancers: Excess Body Weight and All Associated Cancer Sites

26 Preventable Cancers: Excess Body Weight and All Associated Cancer Sites 25% Reduction in Obesity

27 KT Advisory Committee Turning Results to Action

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29 Conclusions >40% of Cancers in Canada are attributable to modifiable factors Past prevention initiatives have made a difference Project facilitated by high-quality registry data Epidemiologic shifts in exposure call for increased efforts in prevention WE CAN BEND THE CURVE

30 Acknowledgements Lifestyle Knowledge Translation Christine Friedenreich Darren Brenner Methods Prithwish De Robert Nuttall Leah Smith Environment Stephen Walter Infections Paul Villeneuve Will King Paul Demers Eduardo Franco

31 Perry Hystad Tasha Narain Abbey Xin Yibing Farah Poirier Grevers Ruan Khandwala Zeinab El-Masri Dylan O Sullivan Priyanka Gogna Mariam Karena Sheila