A new report from the American Cancer Society (ACS) estimates the cancer diagnoses and deaths expected in 2021 and underscores the disease-specific trends expected to shape a new year in oncology care.
The annual statistics summary, published in CA: A Cancer Journal for Clinicians, projects that 1,898,160 new cancer cases will be identified over the next year (Figure 1). Using incidence data collected by the Surveillance, Epidemiology, and End Results (SEER) Program, the National Program of Cancer Registries (NAACR), and the North American Association of Central Cancer Registries (NAACR) through 2017, the ACS estimates that men will account for 970,250 of the new diagnoses and women, 927,910.1
Among men, the 5 most common types of cancer cases in 2021 are expected to encompass the prostate (26%), the lung and bronchus (12%), the colon and rectum (8%), the urinary bladder (7%), and the skin (6%). In women, cancer cases are projected to span breast (30%), lung and bronchus (13%), colon and rectum (8%), uterine corpus (7%), and the skin (5%; Figure 2).
The ACS data suggest that a total of 608,570 cancer-related deaths will be observed in 2021, with men anticipated to have a higher mortality than women (319,420 deaths vs 289,150 deaths). In men, the 5 leading causes of cancer-related death in 2021 are estimated as follows: malignancy of the lung and bronchus, 22%; prostate, 11%; colon and rectum, 9%; pancreas, 8%; and liver and intrahepatic bile duct, 6%. In women, cancers of the lung and bronchus (22%), breast (15%), colon and rectum (8%), pancreas (8%), and ovary (5%) are estimated to result in the highest mortality.
Mortality data aggregated through 2018 by the National Center for Health Statistics (NCHS) informed these conjectures. Notably, the 2021 projections “are based on currently available incidence and mortality data and thus do not reflect the impact of COVID-19 on cancer cases and deaths,” Siegel et al wrote.
“The impact of COVID-19 on cancer diagnoses and outcomes at the population level will be unknown for several years because of the time necessary for data collection, compilation, quality control, and dissemination,” Rebecca Siegel, MPH, lead author of the report, said in a statement. “We anticipate that disruptions in access to cancer care in 2020 will lead to downstream increases in advanced stage diagnoses that may impede progress in reducing cancer mortality rates in the years to come.”2
The Cancer Death Rate Continues Its Historic Decrease
As of 2018, the cancer death rate had dropped by 31%, down from the rate’s 1991 peak (215.1 per 100,000). Cumulatively, this decrease equates to 3.2 million fewer cancer-related deaths.1
Though the cancer death rate rose for most of the 20th century, decreases in smoking — particularly among men — coupled with advancements in the early detection of and treatment for various malignancies have translated to a continuous decline in the cancer death rate since 1991. Factors at the heart of these survival gains in lung cancer are EGFR tyrosine kinase inhibitors targeted against prominent, actionable non-small cell lung cancer (NSCLC) driver mutations; the refinement of pathologic staging; the advent of video-assisted thorascopic surgery; and increased access to care in the wake of the 2014 Patient Protection and Affordable Care Act and Medicaid expansion.
The downward trend in the national cancer death rate can be attributed in part to “large decreases” in lung, breast, colorectal, and prostate cancer-associated mortality. Of these 4 leading malignancies, long-term declines in mortality have stagnated for prostate cancer and slowed for breast and colorectal cancers. Lung cancer-related death, however, continues to rapidly reduce and has largely driven the dip in the national cancer death rate.
“The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5.0% overall,” Siegel et al stated. They noted that beyond improvements in lung cancer diagnostics and treatment modalities, recent strides made in NSCLC survival have also contributed to the plunge in lung cancer deaths.
Similar activity has been seen in the melanoma setting, which has also been associated with an “accelerated” decline in mortality. From 2014 to 2018, the disease-specific mortality rate fell by 5.7% annually. As with lung cancer, the improvement in melanoma mortality is thought to be due to new treatment developments that have effectively moved the needle in the space.
The reduction in lung cancer mortality has since caused breast cancer to supplant lung cancer as the most commonly occurring cancer globally, according to new World Health Organization (WHO) findings that identify breast cancer as responsible for 12% of new cancer cases around the world annually.3
Breast cancer incidence rates have increased by approximately 0.5% annually, according to ACS data.1 This rise “is attributed at least in part to continued declines in the fertility rate and increased body weight,” Siegel et al observed.
Despite Declines, Mortality Is Rising for Some Malignancies
It is important to note that even amid decreases in some disease-specific mortality rates, increases in cancer-related deaths have been observed for select malignancies. For example, uterine corpus cancer mortality has increased from 0.3% per year from 1997 through 2008 to 1.9% annually from 2008 through 2018.
Death rates have also spiked for cancers of the oral cavity and pharynx, translating to a cumulative rise of 0.5% per year from 2009 to 2018. However, “this trend is confined to subsites associated with HPV [human papillomavirus].”
Further, an arch in pancreatic cancer-associated mortality has been documented in men, a group for whom the death rate has risen by 0.3% each year. By contrast, the pancreatic cancer death rate has remained stable in women.
Health Disparities Play a Part
In addition to trends in disease-specific mortality rates, the ACS report also accounts for health equity patterns, identifying “persistent” racial, socioeconomic, and geographic disparities for cancers considered “highly preventable,” such as those of the cervix and lung.1 The discrepancies are significant because the incidence and mortality rates for these diseases can vary up to 5-fold and 3-fold, respectively, across states.2
Of note, the disparity between Black and White patients in overall cancer mortality among both men and women has declined from a peak of 33% in 1993 (279.0 vs 210.5 per 100,000, respectively) to 13% in 2018 (174.2 vs 154.1 per 100,000). This percentage drop can be credited to decreases in smoking-related deaths among Black individuals, according to the report.1
“While recent advances in treatment for lung cancer and several other cancers are reason to celebrate, it is concerning to see the persistent racial, socioeconomic, and geographic disparities for highly preventable cancers,” concluded William G. Cance, MD, chief medical and scientific officer of the ACS. “There is a continued need for increased investment in equitable cancer control interventions and clinical research to create more advanced treatment options to help accelerate progress in the fight against cancer.”2
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654
- American Cancer Society staff. Record drop in cancer mortality for second straight year due to improved lung cancer treatment; COVID-19 impact still unknown. American Cancer Society. Published January 12, 2021. Accessed February 2, 2021.
- Reuters staff. Breast cancer overtakes lung as most common cancer-WHO. Reuters. Published February 2, 2021. Accessed February 2, 2021.
This article originally appeared on Cancer Therapy Advisor