Declining cancer incidence at the oldest ages: Hallmark of aging or lower diagnostic activity?

Abstract

Background: The incidence of most cancers increases with age from early adulthood into old age, but tends to level off or decrease at the highest ages. This decline may be caused by age-related mechanisms or due to lower diagnostic activity, leaving some cancers undiagnosed at the oldest ages.Methods: For breast, colon, lung, and all sites except non-melanoma skin cancer, age-specific incidence rates of verified as well as suspected cancer were estimated up to ages 95+ years for a random sample of the Danish population, 1994-2011, based on nationwide health registers (40,008 verified and 9,110 suspected cancers). Moreover, for cancers diagnosed in Denmark, 1978Denmark, -2012 (613,384 cancers), age-specific percentages of tumors with microscopic verification (histological/cytological/hematological examination) were calculated.Results: The age-specific cancer incidence rates reached a peak at ages 65-89 years followed by a decline. The corresponding incidence pattern of suspected but not verified cancer was similar, with a trend of a slight absolute and relative decrease with age compared to verified cancer incidence.The proportion of cancers with microscopic verification decreased linearly from approximately 95% at ages 0-69 years all years to 70% (1978-1982) and to 80% (2010-2012) at ages 90+ years. Conclusions:The lower diagnostic verification of cancer at the highest ages suggests a lower diagnostic activity among the oldest-old. However, the proportion of suspected but not verified cancers did not increase with age, possibly partially due to lack of registration. The declining cancer incidence at oldest ages is probably partly due to lower diagnostic activity.

Increasing Incidence of Liposarcoma: A Population-Based Study of National Surveillance Databases, 2001–2016

“…Such an apparent over-estimation of liposarcoma rates was not observed among females (Supplemental Figure S1). Older males account for the majority of liposarcoma tumors; thus, such sex-age differences most likely drive the observed over-estimation of liposarcoma incidence by SEER as presented in Tables 1 and 2. The observed age-pattern of incidence presented a typical [24] increase followed by a plateau and a decrease at very old age (Figure 1 and Supplemental Figure S1). After age 75-80, cancer incidence is expected to decrease [25]; which may reflect age-related cellular senescence accompanied by suppression of cellular proliferation (the processes that should slow tumor growth) [25].…”

“…After age 75-80, cancer incidence is expected to decrease [25]; which may reflect age-related cellular senescence accompanied by suppression of cellular proliferation (the processes that should slow tumor growth) [25]. Alternatively, the drop in liposarcoma (or other cancers) incidence at older age reflects poorer cancer detection in the older population [24].…”

Assessing how routes to diagnosis vary by the age of patients with cancer: a nationwide register-based cohort study in Denmark

“…Despite patients aged 70 years or older constitute almost half of all patients with cancer in Denmark [ 42 ], our study shows that the oldest patients are less likely to get diagnosed after CPP referral from primary care. This may be related to the higher prevalence of comorbidity in older patients for two reasons: The existence of other morbidities may mislead clinicians to contribute signs and symptoms to the already existing morbidity rather than an underlying cancer [ 43 ].…”

Age-specific cancer rates: a bird's-eye view on progress

“…Except for the oldest old, high sensitivity and high positive predictive values over age and over calendar time have been demostrated [7]. Data used were cancer incidence and mortality by age for all sites (ICD-10 CXX.X+ D09.0-1+D30.1-9+D35.2-4+D41.1-9+D32-33+D42-43+D44.3-5+D45-46+D47.0-1, [3][4][5][6][7][8][9]. We analyzed data for persons aged 50 to 85+ in 5year age groups from 1990 until 2016 for the total population and separately by sex for each country.…”

“…The Nordic Cancer Registries are known for their completeness and accuracy through time [5,6]. Except for the oldest old, high sensitivity and high positive predictive values over age and over calendar time have been demostrated [7]. Data used were cancer incidence and mortality by age for all sites (ICD-10 CXX.X+ D09.0-1+D30.1-9+D35.2-4+D41.1-9+D32-33+D42-43+D44.3-5+D45-46+D47.0-1, [3][4][5][6][7][8][9].…”