The future burden of cancer in England: incidence and numbers of new patients in 2020

Abstract

We estimated the future cancer incidence rates and the future numbers of cancer cases in England up to 2020 using cancer registration data for 1974 -2003, and the official population projections from ONS up to 2023. Data were analysed using an ageperiod-cohort model as developed for the Nordic countries. We predict that for all cancers combined there will be relatively little change in age-standardised incidence rates in 2020. The number of new cancer cases per year in England is, however, predicted to increase by 33%, from 224 000 in 2001 to 299 000 cases in 2020. This increase is mainly due to the anticipated effects of population growth and ageing; cancer patients in 2020 will be older than today's cancer population. We can quantify the future burden of cancer from two different perspectives. Firstly, age-standardised rates describe the occurrence of cancer on a per capita basis, taking account of changes in age composition and size of the population (Parkin, 2006). Secondly, from the point of view of cancer care and cancer services provision, the burden of cancer is more usefully measured as the total number of persons with cancer who require diagnostic, therapeutic, supportive or palliative services (Bray and Møller, 2006). Several large studies have forecast future cancer rates and numbers, using a variety of statistical methods (Møller et al, 2002; New Zealand Ministry of Health, 2002; Scottish Executive, 2004;Clements et al, 2005). The most common methods relate incidence to the three interdependent time dimensions of age, calendar period and generation. When cancer rates have changed linearly in recent periods and in consecutive generations, it is reasonable to expect the change to continue, at least to some degree and for some time. When particularly low or high rates are observed in a recent generation at a young age, it may be reasonable to assume that this generation will be subject to similar rates when they become older. Future changes are only predictable if they are linear extensions of past trends; otherwise, future period effects are not predictable from past rates. This is a major source of uncertainty in cancer forecasts and is the main reason why many predictions turn out to be too low or too high. SUBJECTS AND METHODSFor this analysis of the future cancer rates and numbers of cancer cases in England, we have used a method of estimation that was developed in a comprehensive and systematic analysis of cancer trends in the Nordic countries (Møller et al, 2002. Møller and co-workers used the long data series in the Nordic countries to develop a large number of predictions of present rates as would have been forecast 20 years ago, and compared the predicted rates with those actually observed, identifying a set of analysis options that tended to give the most accurate predictions. Our analysis of the English data adopts the Nordic method of estimation and the standard set of recommendations with very few modifications. The analysis makes no assumption about changes in exposure to risk factors, ...

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Projecting Cancer Incidence using Age-period-cohort Models Incorporating Restricted Cubic Splines

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