Considering that cancer occurs more commonly in older adults, the aging of America is expected to increase the number of cancer diagnoses substantially. The expected increase in minorities may impact cancer care, particularly since certain minority groups have higher cancer incidence rates and lower disease-specific survival rates than non-minorities. “Compounding the problem is that minorities and older adults can be particularly vulnerable to suboptimal cancer care,” explains Benjamin D. Smith, MD. “Both groups have been under-represented in cancer clinical trials and are also subject to disparities in cancer treatment. Quantifying the likely trajectory of the number of cancer cases in older and minority patients can help clinicians define the expected societal burden of cancer and guide research and health policy priorities.”

 Compelling New Data

 In the April 29, 2009 Journal of Clinical Oncology, Dr. Smith and colleagues conducted a study designed to project the anticipated number of cancer cases through 2030. Data collected on all cancer sites demonstrated that the total expected cancer incidence in the United States will increase by an additional 45% over the next 20 years, rising from about 1.6 million cases in 2010 to 2.3 million in 2030 (Figure 2). “Between 2010 and 2030, a 67% increase in cancer incidence is anticipated for patients aged 65 and older as compared with only an 11% increase in cancer incidence anticipated for patients younger than 65,” Dr. Smith notes. “Overall, the percent of all cancers diagnosed in older adults is expected to increase from 61% to 70% in the next 20 years.”

 According to site-specific data in the study, the leading cancer sites in men in 2030 are still expected to be prostate, lung, and colorectum, and breast, lung, and colorectum in women (Figure 1). “Two of these cancers—lung and colorectum—are sites for men and women in which it is expected that there will be high percentage increases between 2010 through 2030, but the incidence of other cancers is also expected to rise sharply,” says Dr. Smith. For patients 65 and older, a more than 50% increase in incidence by 2030 was projected for every single cancer site examined. The projections were even stronger in minority groups that were examined.

Overall cancer incidence is expected to increase by 45% in the next 20 years, with the greatest increases expected in older adults and minorities. By 2030, 70% of all cancers will be diagnosed in older adults, and 28% will be diagnosed in minorities. “Unless substantial improvements in cancer therapy and prevention strategies emerge, the number of cancer deaths is also likely to increase significantly during this timeframe,” Dr. Smith says.

 Greater Efforts Needed

 Current efforts to address the rising number of older adults and minorities diagnosed with cancer have only been modestly successful, and disparities continue to persist. Recent data suggest that minorities are still more likely to receive substandard care for breast, lung, prostate, and colorectal cancers. Also, African Americans continue to experience a disproportionate burden of cancer incidence and mortality. Clinical trials have failed to recruit and retain sufficient numbers of minorities and older adults. “Several new programs have been launched in an effort to address shortcomings of the past,” Dr. Smith says, “and such preparation for the future is critical. The striking increase in cancer incidence and anticipated increase in prevalence could exceed the capacity of healthcare systems. Furthermore, there will likely be a shortage of physicians. All of these factors underscore the need for major investments in the infrastructure needed to deliver cancer care.”

 Several professional societies are actively exploring strategies to increase the total number of physicians trained and recruitment to oncology-oriented specialties. “It may be worthwhile to routinely integrate geriatrics training into oncology fellowship programs,” adds Dr. Smith. “Efforts to counter the expected rise in cancer cases via prevention strategies of proven efficacy need to be promoted, such as vaccination for hepatitis B and HPV, chemoprevention, social interventions (eg, tobacco and alcohol cessation), and removal of premalignant lesions.”

 Age at diagnosis is another critical factor modifying both cancer biology and response to therapy, according to Dr. Smith. “We need randomized clinical trials and non-randomized clinical studies to identify clinically beneficial, cost-effective treatment strategies tailored to older adults. The hope is that such investigations will lead to new guidelines that will help the oncology community, especially for those treating older patients. A high priority should also be placed on addressing disparities and increasing recruitment of minorities to cancer clinical trials. The ultimate goal should be to provide skilled and timely cancer care to even the most vulnerable segments of the population.”

 

References

Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon aging, changing nation. J Clin Onc. 2009. 29 Apr [Epub ahead of print]. Available at: http://jco.ascopubs.org/cgi/content/abstract/JCO.2008.20.8983v1

McKoy JM, Samaras AT, Bennett CL. Providing cancer care to a graying and diverse cancer population in the 21st century: are we prepared? J Clin Onc. 2009. 29 Apr [Epub ahead of print]. Available at: http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.22.4352v1

Erikson C, Salsberg E, Forte G, et al. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Practice. 2007;3:79-86. 
 
Bouchardy C, Rapiti E, Blagojevic S, et al. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007;25:1858-1869. 

Gross CP, Smith BD, Wolf E, et al. Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer. 2008;112:900-908. 

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71-96.