IMPORTANCE Coping with the current and future burden of cancer requires an in-depth understanding of trends in cancer incidences and deaths. Estimated projections of cancer incidences and deaths will be important to guide future research funding allocations, health care planning, and health policy efforts.
OBJECTIVE To estimate cancer incidences and deaths in the United States to the year 2040.
DESIGN AND SETTING This cross-sectional study’s estimated projection analysis used population growth projections and current population-based cancer incidence and death rates to calculate the changes in incidences and deaths to the year 2040. Cancer-specific incidences and deaths in the US
were estimated for the most common cancer types. Demographic cancer-specific delay-adjusted incidence rates from the Surveillance, Epidemiology, and End Results Program were combined with US Census Bureau population growth projections (2016) and average annual percentage changes in incidence and death rates. Statistical analyses were performed from July 2020 to February 2021.
MAIN OUTCOMES AND MEASURES Total cancer incidences and deaths to the year 2040.
RESULTS This study estimated that the most common cancers in 2040 will be breast (364 000 cases) with melanoma (219 000 cases) becoming the second most common cancer; lung, third (208 000 cases); colorectal remaining fourth (147 000 cases); and prostate cancer dropping to the
fourteenth most common cancer (66 000 cases). Lung cancer (63 000 deaths) was estimated to continue as the leading cause of cancer-related death in 2040, with pancreatic cancer (46 000 deaths) and liver and intrahepatic bile duct cancer (41 000 deaths) surpassing colorectal cancer
(34 000 deaths) to become the second and third most common causes of cancer-related death, respectively. Breast cancer (30 000 deaths) was estimated to decrease to the fifth most common cause of cancer death.
CONCLUSIONS AND RELEVANCE These findings suggest that there will be marked changes in the landscape of cancer incidence and deaths by 2040.
There were an estimated 1.8 million diagnoses and more than 600 000 deaths from cancer in the US in 2020.1 Malignant neoplasms are the leading cause of death in individuals aged 45 to 64 years, 2 and a substantial proportion of health care spending is attributed to cancer.3 Coping with the burden of cancer requires an in-depth understanding of trends in cancer incidence and death by all stakeholders. As incidence and death rates for many cancer types vary by age, sex, and ethnicity, the changing demographic characteristics of the US must be considered.
To determine the most accurate estimated projections, we integrate changing cancer incidence and death rates with updated demographic data from the 2016 population estimates based on 2010 US Census data4 to estimate cancer incidences and deaths to 2040. These estimated projections
are important to guide future research funding allocations, health care planning, and health policy efforts.
TheMD Anderson institutional review board determined that this study was not human participants research. This study was also granted a waiver of informed patient consent.
Estimation of Cancer Incidence Using Population Growth
We combined the most recent sex, age, race and origin, and cancer-specific delay-adjusted incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program5 with existing US Census Bureau demographic projections by sex and race for 2016 to 2040, based on 2010 US Census data, 4 to calculate estimated incidences to 2040, as previously described.6 SEER collects demographic characteristics, cancer data, and vital status from population-based cancer registries covering approximately 35%of the US population with patient demographic data collected at individual registries and reported to SEER. Sex, age, and race and origin delay-adjusted incidence rates were calculated for 2014 to 2016, the most recent 3-year data available for incidence rates in SEER. The US Census data reported for each age were collapsed to match the SEER age categories. US
Census data on Asian and Pacific Islander individuals were combined to match the SEER reporting (Asian/Pacific Islander). Cancer incidence rates for the category all races were used for multiracial individuals identified in US Census data, as SEER does not provide data for this group. The total
cancer-specific incidences by sex were calculated by combining age, race, and origin specific incidences for each sex. A subgroup analysis for age group 20 to 49 years was performed to examine differences in cancer incidence and mortality trends in this subgroup.
Estimated Cancer Incidences Using Population Growth and Cancer Trends
Average annual percent change (AAPC) adjusted estimations of cancer incidences were calculated for the 10 most common cancers for male and female individuals using incidence estimated projections based on demographic characteristics, as previously decribed, and applying the most
recently reported delay-adjusted AAPC in incidence by race for male and female individuals (2011-2015) for all ages and for age subgroup 20 to 49 years as reported.7 The number of cases were calculated using the projected incidence based on demographic characteristics and applying the
delay-adjusted AAPC in incidence for a specific sex, race, and cancer type. Because the last year of incidence data was 2016, adjustments in years were made starting in 2017. Mathematical equations and annotations are provided as supplementary material (eMethods in the Supplement). AAPCs for the category all races were used for multiracial individuals, as SEER does not provide incidence rates for this group. AAPC in incidence rates that are not statistically significantly different from 0 were considered to be 0.7 AAPCs for each cancer type categorized by sex and race were calculated
separately and then combined. Calculations assumed that the AAPC in the incidence rates observed from 2011 to 2015 will remain constant through 2040. A sensitivity analysis was conducted using AAPC in incidence rate from 2006 to 2015.8
Estimated Cancer Deaths
In addition to the 10 most common cancers, cancer types in the top 10 causes of cancer death for male or female individuals were included in the estimated cancer deaths analysis. Combined changes of demographic characteristics and death rates were calculated using the 2016 number of deaths by sex and race and for all ages or for ages 20 to 49 years as provided by SEER*Stat Database9 and applying the most recently reported AAPC in death rate from 2012 to 2016 by race and sex.7 The number of deaths from 2017 to 2040 was adjusted for demographic changes by determining the percentage increase in new cancer cases from 2017 to 2040 relative to the 2016 US Census projection, and this number was adjusted by the AAPC in the death rates for 1 to 24 years for 2017 to 2040 projections. Mathematical equations and annotations are provided as supplementary material (eMethods in the Supplement). AAPC in death rate not statistically significantly different from 0 were considered to be 0.7 Separate calculations for male and female individuals by race were combined to derive the total population projection. Calculations assumed that the AAPC in the death rates observed from 2012 to 2016 will remain constant.
The AAPCs in incidence rate for esophagus cancer in female individuals and death rates for thyroid cancer in male and female individuals were not reported7 and were calculated by sex and race in SEER*Stat Database using the Joinpoint Regression program version 22.214.171.124 (NCI).9We used the
Joinpoint Regression program to model changes in rates over time with as many as 3 joinpoints in the period 1999 to 2015.7 Tests were considered significant if 2-sided P < .05. Analyses were conducted in R statistical software version 4.0.2 (R Project for Statistical Computing) from July 2020 to
February 2021.10,11 A sensitivity analysis was conducted using AAPC in death rate from 2007 to 2016.8 Model estimates of incidence and death for the year 2020 were compared with known data from 2020 to assess alignment and were found to be consistent.1 In addition to our primary model, precision incidence and death estimates were made for each cancer through 2040 by calculating the percentage change in AAPCs for all cancer types for incidence (2011-2016 compared with 2000- 2004) and death (2012-2016 compared with 2000-2004); these calculations were performed by
determining the 90th percentile change for all cancers to calculate a change in AAPC, and then calculating the median change in AAPC, which was added or subtracted from the AAPC used in our primary analysis to generate upper and lower estimated projections.
Estimated cancer incidences for the 10 most common cancers in male and female individuals based on (1) changing demographic characteristics alone using the 2016 national population projections (Figure 1A, Figure 1B, Table 1, and eTable 1 in the Supplement) and (2) changing demographic
characteristics and AAPC in incidence rate (Figure 1D, Figure 1E, Table 1, and eTable 1 in the Supplement) are reported. On the basis of changing demographic characteristics alone, there was no change in the estimated top 4 cancer sites for male individuals in 2040, compared with 2020
(Figure 1A).1 When applying the AAPC for cancer incidence rate in male individuals, the estimated top cancer sites in 2040 changed to melanoma (127 000 cases), lung (93 000 cases), bladder (77 000 cases), kidney (76 000 cases), and colorectal (75 000 cases) (Figure 1D, Table 1, and eTable 1 in the
Supplement). The estimated top 4 cancers in 2040 for female individuals based on demographic changes alone were unchanged from 2020: breast, lung, colorectal, and uterine cancer (Figure 1B). When applying the AAPC in incidence rate, the top 4 cancer sites for female individuals were estimated to be breast (364 000 cases), lung (114 000 cases), uterine (99 000 cases), and melanoma (92 000 cases), with colorectal (72 000 cases) as the fifth most common cancer (Figure 1E, Table 1, and eTable 1 in the Supplement).
The incidence of the top 4 estimated cancer sites in 2040 for male and female individuals combined based on changing demographic characteristics alone did not vary from 2020: breast, lung, prostate, and colorectal cancer (Figure 1C). When applying the AAPC in incidence rate, the top cancers for male and female individuals combined were breast (364 000 cases), melanoma (219 000 cases), lung (208 000 cases), and colorectal (147 000 cases) (Figure 1F, Table 1, and eTable 1 in the Supplement). The difference in estimated projections based on demographic