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.