Impact of universal health care on trends of incidence and mortality of cancers with screening recommendations in North America. A GLOBOCAN 2020 study.

Abstract

e18513 Background: Cancers with screening recommendations in general population include breast, colorectal, cervical and prostate cancers. Our study is aimed at comparing the current and future trends in incidence and mortality amongst two biggest countries in North America (United States of America and Canada) with and without universal health care. Methods: Incidence and mortality data, their trends were obtained from the GLOBOCAN 2020 database. Crude rate and age standardized rate (ASR) data on incidence and mortality was obtained to minimize population-based distribution errors. Age groups were divided as 20-40, 40-49, 50-65 and above 65. Current incidence, mortality and future trends were obtained for both USA and Canada and compared. Results: Breast cancer incidence is higher in USA in all age groups. Mortality in the age groups of 20-39 and 50-64 is comparable in Canada and USA with ASR of 9.6 (Canada), 9.5 (USA) 197.2 (Canada), 195 (USA) respectively. Future trends predict higher increase in incidence and mortality in Canada in age groups of 40-49 (I: Canada +22.5% USA +19.2%. M: Canada +22.8% USA +19.3%) above 65 (I: Canada +52.3% USA +40.8%. M: Canada +70.9%. USA +57.3%). In age group above 65 the mortality is significantly higher in USA compared to Canada (p=0.001). The incidence of colorectal cancer is higher in USA compared to Canada. The ASR mortality of above 65 age group is significantly higher in Canada (p=0.0009) (M: Canada: 835.6 USA: 713.9). Mortality trends for the 2040 year are higher in the age groups of 50-64 and above 65 in Canada (50-64 M: Canada: +25.9% USA: +21.2%) (above 65: M: Canada +70.9% USA: +57.3%). Prostate cancer has higher incidence in 50-64 age group. The mortality is higher in 40-49 age group. The predicted incidence for 2040 is also higher in Canada in above 65 age group (Canada +48.3%, USA: 39.9%). Similarly, mortality is higher in Canada for the above 65 age group (Canada: +112.7%, USA: +90.2%). Both USA and Canada have higher mortality for prostate cancer in age group 40-49 than 50-64. Cervical cancer incidence and mortality ASR are higher in USA for age groups of 20-39 and 40-49. For ages 50-64, while the incidence is higher in the USA, mortality is higher in Canada. For ages above 65 the mortality is significantly higher in Canada (p=0.0022) compared to USA. The predicted percentage change in 2040, incidence and mortality of age group 40-49 is higher compared to 50-64. Conclusions: Though both health care systems have screening recommendations for breast, CRC, prostate and cervical cancers, mortality appears to be higher compared to the world population suggesting need for improvement in screening access/awareness. Younger adults (20-39) and middle age adults (40-49) appear to be more vulnerable population and need for improvement in identifying high risk population.