Demographic shift disproportionately increases cancer burden in an aging nation: current and expected incidence and mortality in Hungary up to 2030

Abstract

Background: Population aging is a common demographic pattern in developed countries, and aging increases the risk of cancer. The disproportionately high cancer burden, as a consequence, is especially pronounced in Central and Eastern European countries, including Hungary.

Methods: We summarized current and projected future cancer incidences and mortalities utilizing data from the last two decades. Predictions are based on cancer incidence and mortality collected between 1996 and 2015 in Hungary. In addition to the crude rates, data were age standardized to the European standard population (ESP) of 2013, ESP of 1976, and local census of 2011.

Results: The lifetime probability of developing cancer and cancer-related mortality has already reached 56.9% and 27.6% in men, respectively, and 51.9% and 21.7% in women. Between 2016 and 2030, the total population is expected to shrink by 6%, while the number of 60-year olds and above will grow by 18%. This will lead to a 35% increase in cancer incidence and 30% increase in cancer death among 65-85-year olds. Joinpoint regression identified the period 2007-2015 as starting point for this coming increase in new cases. In women, lung and breast cancer will increase yearly by 1.9% and 1.7%, respectively, between 2016 and 2030, while in men, the prostate and colorectal cancer rates will increase yearly by 3.6% and 2.1%.

Conclusion: In the aging population of Hungary, cancer incidence will increase considerably over previous projections. Although a large portion of the most rapidly rising cancers are avoidable by implementing public health programs, a substantial portion remains inevitably incurable.

Keywords: aging; biostatistics; breast cancer; cancer; colon cancer; lung cancer; prostate cancer.

Figure 1

Upcoming shift in population age distribution increases the number of new cancer cases. Note: Population age distribution in female (A) and male (B), cancer incidence rates in female (C) and male (D), and mortality in women (E) and men (F).

Figure 2

Standardized cancer rates remain steady while a positive gain in annual percent change (APC) leads to increasing crude rates. Notes: Trends in cancer incidence (A) and mortality (B). Male and female Hungarian crude rates of incidence and mortality are compared to age-standardized rates based on the 2013 European Standard population (ESP 2013). Solid lines represent actual data while dashed lines express data estimated by the age-period-cohort model. Every x-value represents a 5-year bin. Mean annual percent change in crude rates of male and female incidence (C) and mortality (D) modeled by joinpoint regression analysis. Positive APC values represent increase, negative values decrease in mortality rates. Abbreviation: n.s., not significant.

Figure 3

Trends in incidence (A and B) and mortality (C and D) in the five most common cancers by sex. Notes: Solid lines represent crude rates, dashed lines represent rates age-adjusted to the 2013 ESP. For 2020, 2025, 2030 data are estimated by the age-period-cohort model. Abbreviation: ESP, European Standard population.

Figure 4

Observed and projected tendencies of incidence and mortality in selected cancers in females (A) and males (B). Note: Solid lines are crude rates, dashed lines represent rates age-adjusted to the 2013 ESP (ASR ESP 2013). Abbreviations: ASR, age-standardized rate; ESP, European Standard Population.

Figure 4

Observed and projected tendencies of incidence and mortality in selected cancers in females (A) and males (B). Note: Solid lines are crude rates, dashed lines represent rates age-adjusted to the 2013 ESP (ASR ESP 2013). Abbreviations: ASR, age-standardized rate; ESP, European Standard Population.