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Declining Cancer Incidence in the Elderly: Decreasing Diagnostic Intensity or Biology?
Cecilia Radkiewicz1, Jessica Järkvik Krönmark2, Hans-Olov Adami3
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. cecilia.radkiewicz@ki.se.
Summary
Cancer incidence appears to decline in older adults, but this is likely due to reduced diagnostic testing, not a true biological decrease. Overall cancer rates actually increase with age.
Area of Science:
- Oncology
- Geriatric Medicine
- Epidemiology
Background:
- Advanced age is a known risk factor for cancer development.
- However, cancer incidence typically shows a decline in individuals over 75-85 years old for most solid tumors.
Purpose of the Study:
- To accurately determine the true age-incidence pattern of cancer.
- To investigate whether the observed decline in cancer incidence in the elderly is a genuine biological phenomenon or an artifact of diagnostic practices.
Main Methods:
- A population-based cohort study utilizing Swedish Cancer Register data from 1970-2014.
- Analysis of nine common adult cancers, categorized by diagnostic invasiveness (high, medium, low).
- Estimation of reported incidence and autopsy-detected cancers by age, with projection of corrected incidence assuming uniform autopsy findings.
Main Results:
- Registered cancer incidence decreased after peaking around ages 65-84, except for melanoma skin cancer.
- This decline was less pronounced when considering unexpected cancer findings in autopsy data.
- The projected total cancer incidence, including autopsy-detected cases, demonstrated a consistent increase with age.
Conclusions:
- The observed decrease in cancer incidence among the elderly is likely an artifact resulting from diminished diagnostic intensity.
- Biological factors driving a true cancer incidence decline in older adults are improbable.
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