Incidence-based cancer burden, 2004–2019
From 2004 to 2019, the total number of tumor diagnoses has increased from 61,524 to 80,524 new diagnoses (+ 31%). This is mainly due to the growth and ageing of the population; because, over the same period, the age-standardized incidence rates slightly increased from 649 to 702 new diagnoses per 100,000 (+ 8%). Similar trends are observed for the total number of cancer-associated YLDs, which have increased from 44,774 YLDs to 57,317 YLD (+ 25%), over a period of 15 years, and a slight increase in the age-standardized YLD rates, from 472 per 100,000 to 501 per 100,000 (+ 6%).
Cancer incidence and burden were higher in men compared to women, and the highest in the 65+ age group. The age-standardized cancer incidence and burden were the highest in the Walloon Region, followed by the Flemish and Brussels Capital Region. However, due to the larger and older population, the largest absolute cancer burden was attributed to the Flemish Region (Fig. 1).
Specific cancer types
Top 5 cancer types
In 2019, the highest number of cancer diagnoses among men were observed for prostate cancer, trachea, bronchus and lung cancer, non-melanoma skin neoplasms, colorectal cancer, and bladder cancer. The same cancers can be found in the top-5 ranking in terms of YLD burden. Prostate cancer remained at the first place followed by non-melanoma skin neoplasms, colorectal cancer, bladder cancer and trachea, bronchus and lung cancer. As shown in Fig. 2, almost all top 5 cancers showed a decrease in their YLD burden, with prostate cancer showing the largest decrease from 2004 (312 vs 254 age-standardized YLD per 100,000) followed by colorectal cancer (105 vs 84 age-standardized YLD per 100,000). Non-melanoma skin neoplasms showed a steady increase since 2004 (49 vs 111 age-standardized YLD per 100,000).
In 2019, the highest number of cancer diagnoses among women were for breast cancer, colorectal cancer, non-melanoma skin neoplasms, trachea, bronchus and lung cancer, and malignant melanoma of skin, corresponding also to cancers with the highest non-fatal burden. Figure 3 shows that different cancers types showed an important increase since 2004. The non-fatal burden of malignant melanoma of skin doubled passing from 9 to 19 age-standardized YLD per 100,000 and non-melanoma skin neoplasms more than doubled (15 vs 44 age-standardized YLD per 100,000). Trachea, bronchus and lung cancer also showed large increase (30 vs 54 age-standardized YLD per 100,000). Colorectal cancer was the only top-5 cancer to show a decrease in the observed period (66 vs 58 age-standardized YLD per 100,000).
When looking at both sexes, rankings across regions looked rather similar. However, prostate cancer has a higher burden in Flanders than in the two other regions, together with skin cancers. Breast, colorectal and lung cancer showed a higher non-fatal burden in Wallonia. For both sexes it is also noticeable the reduction in colorectal cancer cases of the last 4 years.
Along with the most burdensome cancers, it is worth mentioning some cancers that have particularly striking trends from 2004 to 2019. Liver and pancreas cancer respectively almost tripled and doubled in terms of incidence in the observed period. On the other hand, many gynecological cancers showed a reduction: uterus NOS (− 87%), ovarian (− 24%) and vaginal (− 13%). Nevertheless, the reduction in new diagnosis of uterus NOS cancer might be driven by a better quality of data reporting. Namely, cancer diagnosis are more correctly attributed to cervix and corpus uteri, leading to a reduction of cancers coded as uterus NOS.
Prevalence-based cancer burden, 2013–2019
From 2013 to 2019, the yearly prevalence has increased from 379,742 to 432,106 (14%). An increase of the age-standardized prevalence rates from 3581 to 3770 per 100,000 can also be seen over the same period (5%). A similar trend was observed for the total number of cancer associated prevalence-based YLD, with an increase from 45,887 to 51,464 YLD (12%), reflected in an increase in the age-standardized YLD rates from 435 per 100,000 to 449 per 100,000 (3%).
In 2019, the all-cancers age-standardized prevalence rate was higher in men than in women (4228 and 3527 per 100,000 persons respectively) and both sexes showed a considerable prevalence in the 65+ age group. Due to the larger and older population, the Flemish Region was responsible for the largest absolute cancer burden. However, when we look at the age-standardized rates, the Walloon Region had the highest prevalence and YLD per 100,000 rates (Fig. 4). We can also notice that Wallonia and Brussels showed an increase in prevalence (for both sexes) in the last five years.
Specific cancer types
Top 5 cancer types
In 2019, the most common cancers registered among men were prostate cancer (1248 per 100,000 persons), colorectal cancer (490 per 100,000 persons), non-melanoma skin cancer (472 per 100,000 persons), trachea, bronchus and lung cancer (224 per 100,000 persons), and malignant melanoma of skin (179 per 100,000 persons). The same cancers were identified as having the highest non-fatal burden, except for bladder cancer that passed to be within the top 5 (replacing malignant melanoma of skin). Figure 5 shows the trends of the top 5 cancers in men between 2013 and 2019. A decrease was observed in the age-standardized prevalence rate for prostate cancer (from 1515 to 1368). On the other hand, non-melanoma skin cancer showed an increase over the years with passing from 417 to 581 per 100,000 persons. The same trends are reflected in the non-fatal burden of these cancers.
In 2019, breast cancer was the most prevalent cancer in women (1501 per 100,000 persons), followed by colorectal cancer (387 per 100,000 persons), non-melanoma skin cancer (348 per 100,000 persons), malignant melanoma of skin (252 per 100,000 persons) and corpus uteri (174 per 100,000 persons). The same order was reflected for the ranking of the cancers with the highest non-fatal burden, apart from the fifth cancer that was replaced by lung cancer. As shown in Fig. 6, between 2013 and 2019 there has been a decrease in the age-standardized prevalence rate for colorectal cancer (from 372 to 355 per 100,000 persons) and corpus uteri cancer (from 175 to 161 per 100,000 persons). On the other hand, skin cancers showed an increase over the years with malignant melanoma passing from 179 to 247 per 100,000 persons and non-melanoma skin cancer from 202 to 303 per 100,000 persons. The same trends were reflected in the non-fatal burden of these cancers.
When looking at both sexes, the most prevalent cancer in Belgium in 2019 was breast cancer: 815 per 100,000 age-standardized persons in Brussels, 795 in Wallonia and 750 in Flanders. However, the cancer type with the highest non-fatal burden was prostate cancer in 2019: 109 per 100,000 age-standardized YLD in Flanders, 95 in Wallonia and 86 in Brussels.
When looking at the non-top 5 cancers, interesting changes in the 5-year time span can be observed. In 2019, thyroid gland (5 age-standardized YLD rate) and lip and oral cavity cancer (6 age-standardized YLD rate) were both among the cancers with the highest prevalence-based YLDs overall in Belgium, and from 2013 they showed an increase in prevalence of around 22 and 9%, respectively. In terms of prevalence, cancer of the uterus NOS showed the highest relative decrease from 2013: − 74%, probably attributed to the more specific registration of cervix and corpus uteri cancer, as explained above.
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