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Subject 101: Cancer incidence in the aging population

Cancer incidence in the aging population

Cancer is the leading cause of death in the Netherlands, with ~48.000 deaths and ~108.000 new diagnoses in 2016.1,2 The incidence of cancer is expected to increase by ~70% in the next 20 years.3 A possible cause for this apparent increase in incidence may be due to improvements in diagnostic modalities and may imply that a proportion of the increasing cancer incidence is due to overdiagnosis, which has been described for breast cancer and thyroid cancer.4,5

However, a more plausible explanation for increasing cancer incidence rates is that the average age in most Western populations is increasing. Cancer is a genetic disease that arises after stepwise acquisition of DNA defects that provide (pre)malignant cells a proliferative advantage and ultimately causes a tumor.6

These DNA defects, mutations, may be inherited, induced by environmental factors, such as smoking or pollution, or result from DNA replication errors.7 As an individual gets older, his or her stem cells are also subjected to an increasing cumulative exposure to environmental factors and DNA replication errors.

Increasing number of cancer diagnosis in the Netherlands between 1990 and 2016

Besides rare genetic predisposition syndromes, in which cancer incidences are highest during childhood or early adulthood, the incidence rates of most cancers are therefore increasing by age. One can relatively easily derive epidemiological statistics from cancer from free and easy-to-use websites.1,2 Figure 1 is a graph showing the increasing number of cancer diagnosis in the Netherlands between 1990 and 2016. The data shows the cumulative risk that one is diagnosed with any type of cancer between two ages. For example, in 2009 a male had a lifetime cancer risk of 45,2% between birth and his 85th year of age.

In addition, the bidirectional orientation of this table can be used to look up cumulative cancer risks between two older ages, e.g. an 70-year old male has an 25,2% risk to be diagnosed with any cancer before his 80th birthday. One can see that the cumulative cancer risks increase most rapidly in the seventh and eighth decade of life. Knowing that with an aging population, the absolute increase in population demographics is highest in the age group of 65 to 85 years, it is not surprising to see the incidence of cancer rising so rapidly.

R.J. Molenaar & J.W. Wilmink

References

  1. Centraal Bureau voor de Statistiek (CBS), Available here, accessed on 12 July 2017
  2. Integrale Kankerregistratie Nederland (IKNL), Available here, accessed on 12 July 2017
  3. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013.
  4. Welch HG, Prorok PC, O’Malley AJ, Kramer BS. Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness. N Engl J Med. 2016;375(15):1438-1447.
  5. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”–screening and overdiagnosis. N Engl J Med. 2014;371(19):1765-7.
  6. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-74.
  7. Tomasetti C, Li L, Vogelstein B. Stem cell divisions, somatic mutations, cancer etiology, and cancer prevention. Science. 2017;355(6331):1330-1334.
  8. Centraal Bureau voor de Statistiek (CBS), Available here, accessed on 12 July 2017

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