Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation
Benjamin D. Smith, Grace L. Smith, Arti Hurria, Gabriel N. Hortobagyi, and Thomas A. Buchholz
From the Radiation Oncology Flight,Wilford Hall Medical Center, LacklandAir Force Base; Department of RadiationOncology, The University of TexasM. D. Anderson Cancer Center, Houston,TX; and the Department of MedicalOncology, City of Hope Cancer Center,Duarte, CA.
A B S T R A C T
Purpose：By 2030, the United States’ population will increase to approximately 365 million, including 72 million older adults (age \u0001 65 years) and 157 million minority individuals. Although cancer incidence varies by age and race, the impact of demographic changes on cancer incidence has not
been fully characterized. We sought to estimate the number of cancer patients diagnosed in the United States through 2030 by age and race.

Methods：

Results：From 2010 to 2030, the total projected cancer incidence will increase by approximately 45%, from 1.6 million in 2010 to 2.3 million in 2030. This increase is driven by cancer diagnosed in older adults and minorities. A 67% increase in cancer incidence is anticipated for older adults, compared with
an 11% increase for younger adults. A 99% increase is anticipated for minorities, compared with a 31% increase for whites. From 2010 to 2030, the percentage of all cancers diagnosed in older adults will increase from 61% to 70%, and the percentage of all cancers diagnosed in minorities will increase from 21% to 28%.

Conclusion：
Demographic changes in the United States will result in a marked increase in the number of cancer diagnoses over the next 20 years. Continued efforts are needed to improve cancer care for older adults and minorities.

J Clin Oncol 27. © 2009 by American Society of Clinical Oncology

INTRODUCTION
One of the most defining sociodemographic changes ongoing in the United States is the dramatic increase in the number of older adults and minorities. Specifically, thenumberof adults age 65 years or older increased from 25 million in 1980 to 35 million in 2000, and is further expected to increase to 72 million by 2030 as the baby boomer generation ages (Figs 1).Similarly, the number of minorities increased from 46 million in 1980 to 83 million in 2000, and is further expected to increase to 157 million in 2030 (Figs 1).1-3 As cancer occurs more commonly in older adults, the aging of the United States’ population is expected to markedly increase the number of cancer diagnoses. The increase in minorities is also likely to impact cancer care, particularly as prior evidence suggests that certain minorities have higher cancer incidence rates and lower cancer survival rates as compared with white people.In addition, minorities and older adults represent important populations that may be particularly vulnerable to suboptimal cancer care, because both groups have been under-represented in cancer clinical trials6 and are also subject to disparities in cancer treatment. These demographic shifts in our society are thus expected to exert a substantial stressor on the health care system, and they highlight the need to address shortcomings in cancer clinical trials and
disparities in cancer care. Quantifying the projected number of cancer cases in older and minority patients
is fundamental for defining the expected societal burden of cancer, and, accordingly, guiding research and health policy priorities. However, to the best of our knowledge, specific long-term incidence projections for cancer in the United States have not been fully quantified. To address this need, we used data from the Surveillance Epidemiology and End Results (SEER) project and the United States Census bureau to project the anticipatednumberof cancer cases by age, sex, race, and origin through 2030.

Fig 1. Population trends in the United States by age and race/origin, 1980 to 2030. Data for 1980 and 1990 are derived from the United States Census for these years.1,3 Data from 2000 onward are derived from the 2000 Census and projections for population growth thereafter