We analysed trends in UK cancer incidence and mortality for all cancers combined and for the most common causes of cancer cases or deaths in adults aged 35-69 from 1993 to 2018.
Trends in in cancer incidence and mortality in 35 to 69-year-olds can indicate future patterns of cancer in older people. This analysis also provides a benchmark for the following decade, which will include the impact of COVID-19 on cancer incidence and outcomes.
Between 1993 and 2018, cancer cases in UK adults aged 35 to 69 years increased by 57% in men and 48% in women, with age-standardised rates increasing by 15% and 16%, respectively.
Prostate and breast cancers, the two largest most common cancers in men and women respectively, were major contributors to these increases. The increase in prostate cancer incidence is likely to be a result of the uptake of prostate specific antigen (PSA) testing over the study period.
When prostate and breast cancer were excluded from the analyses, the change in age-standardised incidence rates for all cancers combined was smaller for females (12% increase) and decreased in males (7% decrease).
A small number of less common cancers showed concerning increases in incidence rates over time, including melanoma skin, liver, oral and kidney cancers. This is likely caused by increased prevalence of non-smoking risk factors.
Between 1993 and 2018, cancer deaths decreased by 20% in men and 17% in women, with age-standardised mortality rates declining by 37% and 33%, respectively.
Mortality trends reflect advancements in cancer prevention (e.g., smoking prevention policies and cessation programmes), earlier detection (e.g., screening programmes) and improved diagnostic tests and treatment.
Mortality rates decreased across nearly all cancer types included in the study. Only liver, oral and uterine cancers showed an increase, and melanoma skin cancer in men and pancreatic cancer in women showed small increases.
The largest decreases in mortality rates were for stomach, mesothelioma and bladder cancers in men and stomach and cervical cancers and non-Hodgkin lymphoma in women.
Lower rates of many cancers, including lung and laryngeal, is positive and likely to be driven by the decrease in smoking prevalence across the UK.
However, an increase in incidence rates of other cancers may be a result of the increasing prevalence of overweight/obesity and other risk factors.
Screening programmes have led to an increase in cancer incidence but have also contributed to a reduction in cancer mortality across the UK.
While more people are being diagnosed with cancer, fewer people are dying from it, reflecting progress in cancer prevention, earlier diagnosis and treatment.
Read the full article on the BMJ websiteJon Shelton, Ewa Zotow, Lesley Smith, Shane A Johnson, Catherine S Thomson, Amar Ahmad, Lars Murdock, Diana Nagarwalla, David Forman.
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