A cross sectional study published in the JAMA Open Network in April 2021 examines U.S. population-based cancer statistics and census data to predict trends in cancer incidence and mortality over the next 20 years.^[1]Estimated Projection of US Cancer Incidence and Death to 2040. Rahib L, Wehner MR, Matrisian LM, Nead KT.JAMA Netw Open. 2021 Apr 1;4(4):e214708. doi: 10.1001/jamanetworkopen.2021.4708.PMID: 33825840 Based on the analysis, breast cancer is projected to become the most common malignancy by 2040, followed by melanoma, lung cancer, and colorectal cancer. While the incidence of lung cancer continues to decline, it is projected to remain the most common cause of cancer-related death.

The projections are understandable in the context of current health trends. Lung cancer is on the decline as fewer people are smoking. On the other hand, a steady rise in the rates of obesity is contributing to an increase in certain malignancies including breast, colon, uterus, and liver. Non-alcoholic fatty liver disease (NAFLD), a primary cause of cirrhosis which is directly linked to obesity, has become a leading cause of chronic liver disease in industrialized nations and a major driver for the projected increase in primary liver cancer. Of note, both pancreatic cancer and liver cancer are projected to surpass colorectal cancer to become the second and third leading causes of cancer-related death by 2040.

The overall incidence of colorectal cancer incidence is expected to remain stable, and mortality estimates show a steady downward trend. However, in the subgroup aged 20-49 years, it is expected to be the leading cause of cancer-related death by 2030.

The data appears to support the effectiveness of existing screening programs and provides opportunities for future efforts in the areas of early detection and improved treatment options. Understanding these trends can also inform the need for training of health care professionals, target areas for resource allocation, and help government and insurers to anticipate future spending.

The oncology team at Carelon is committed to staying ahead of these changing trends. Our Medical Oncology pathways program has recently added content for treatment of hepatobiliary tumors, and evidence-based criteria have been developed for the appropriate use of proton beam therapy in treating these tumors. Carelon has continued to develop and enhance criteria for screening and early detection as data becomes available, including newly updated criteria for lung and colorectal cancer screening, and new MRI criteria for early detection of hepatocellular carcinoma.