Abstract
Objectives
An estimated 33–37% of incident cancers in Canada are attributable to modifiable risk factors. Interventions targeting these risk factors would minimize the substantial health and economic burdens Canadians face due to cancer. We estimate the future health and economic burden of cancer in Canada by incorporating data from the Canadian Population Attributable Risk of Cancer (ComPARe) study into OncoSim, a web-based microsimulation tool.
Methods
Using the integrated OncoSim population attributable risk and population impact measures, we evaluated risk factor-targeted intervention scenarios implemented in 2020, assuming the targeted risk factor prevalence reduction would be achieved by 2032 with a 12-year latency period.
Results
We estimate that smoking will be the largest contributor to cancer-related costs, with a cost of CAD $44.4 billion between 2032 and 2044. An estimated CAD $3.3 billion of the cost could be avoided with a 30% reduction in smoking prevalence by 2022. Following smoking, the next highest cancer management costs are associated with inadequate physical activity and excess body weight, accounting for CAD $10.7 billion ($2.7 billion avoidable) and CAD $9.8 billion ($3.2 billion avoidable), respectively. Avoidable costs for other risk factors range from CAD $90 million to CAD $2.5 billion.
Conclusion
Interventions targeting modifiable cancer risk factors could prevent a substantial number of incident cancer cases and billions of dollars in cancer management costs. With limited budgets and rising costs in cancer care in Canada, these simulation models and results are valuable for researchers and policymakers to inform decisions and prioritize and evaluate intervention programs.
Résumé
Objectifs
Il est estimé que de 33 % à 37 % des cancers incidents au Canada sont imputables à des facteurs de risque modifiables. Des interventions ciblant ces facteurs de risque réduiraient le fardeau sanitaire et économique considérable du cancer dans la population canadienne. Nous avons estimé le futur fardeau sanitaire et économique du cancer au Canada en intégrant les données de l’étude ComPARe (Canadian Population Attributable Risk of Cancer) dans l’outil de microsimulation en ligne OncoSim.
Méthode
À l’aide des indicateurs d’impact dans la population et du risque attribuable dans la population intégrés dans OncoSim, nous avons évalué des scénarios d’intervention mis en œuvre en 2020 axés sur les facteurs de risque, en partant de l’hypothèse que la réduction de la prévalence des facteurs de risque ciblés serait atteinte d’ici 2032 avec une période de latence de 12 ans.
Résultats
Nous estimons que le tabagisme sera le facteur qui contribuera le plus aux coûts du cancer, avec un coût de 44,4 milliards $ CA entre 2032 et 2044. Il est estimé qu’une part de 3,3 milliards $ CA de ce coût pourrait être évitée en réduisant de 30 % la prévalence du tabagisme d’ici 2022. Après le tabagisme, les coûts de prise en charge du cancer les plus élevés sont associés à l’inactivité physique et au surpoids, qui représentent respectivement 10,7 milliard $ CA (dont 2,7 milliards $ évitables) et 9,8 milliards $ CA (dont 3,2 milliards $ évitables). Les coûts évitables pour d’autres facteurs de risque vont de 90 millions $ CA à 2,5 milliards $ CA.
Conclusion
Des interventions ciblant les facteurs de risque de cancer modifiables pourraient prévenir un nombre considérable de cas de cancers incidents et épargner des milliards de dollars en coûts de prise en charge du cancer. Avec les budgets serrés et la hausse des coûts des soins du cancer au Canada, ces modèles de simulation et leurs résultats permettent aux chercheurs et aux responsables des politiques d’éclairer les décisions et de hiérarchiser et d’évaluer les programmes d’intervention.
Similar content being viewed by others
Data availability
The OncoSim suite of models is available at https://www.partnershipagainstcancer.ca/tools/oncosim/. Access and use are available upon request.
References
Brenner, D. R., Friedenreich, C. M., Ruan, Y., Poirier, A. E., Walter, S. D., King, W. D., Franco, E. L., Demers, P. A., Villeneuve, P. J., Grevers, X., Nuttall, R., Smith, L. M., Volesky, K. D., O’Sullivan, D. E., & De, P. (2019). The burden of cancer attributable to modifiable risk factors in Canada: Methods overview. Preventive Medicine, 122, 3–8. https://doi.org/10.1016/j.ypmed.2019.03.007.
Brenner, D. R., Weir, H. K., Demers, A. A., Ellison, L. F., Louzado, C., Shaw, A., Turner, D., Woods, R. R., & Smith, L. M. (2020). Projected estimates of cancer in Canada in 2020. CMAJ, 192(9), E199–e205. https://doi.org/10.1503/cmaj.191292.
Brenner, D. R., Weir, H. K., Demers, A. A., Ellison, L. F., Louzado, C., Shaw, A., Turner, D., Woods, R. R., & Smith, L. M. (2020). Projected estimates of cancer in Canada in 2020. CMAJ, 192(9), E199–e205. https://doi.org/10.1503/cmaj.191292.
Çağlayan, Ç., Terawaki, H., Chen, Q., Rai, A., Ayer, T., & Flowers, C. R. (2018). Microsimulation modeling in oncology. JCO Clinical Cancer Informatics, 2, 1–11. https://doi.org/10.1200/CCI.17.00029.
de Oliveira, C., Pataky, R., Bremner, K. E., Rangrej, J., Chan, K. K. W., Cheung, W. Y., Hoch, J. S., Peacock, S., & Krahn, M. D. (2016). Phase-specific and lifetime costs of cancer care in Ontario, Canada. BMC Cancer, 16(1), 809. https://doi.org/10.1186/s12885-016-2835-7.
de Oliveira, C., Weir, S., Rangrej, J., Krahn, M. D., Mittmann, N., Hoch, J. S., Chan, K. K. W., & Peacock, S. (2018). The economic burden of cancer care in Canada: a population-based cost study. CMAJ Open, 6(1), E1–E10. https://doi.org/10.9778/cmajo.20170144.
Gauvreau, C. L., Fitzgerald, N. R., Memon, S., Flanagan, W. M., Nadeau, C., Asakawa, K., Garner, R., Miller, A. B., Evans, W. K., Popadiuk, C. M., Wolfson, M., & Coldman, A. J. (2017). The OncoSim model: development and use for better decision-making in Canadian cancer control. Current Oncology, 24(6), 401–406. https://doi.org/10.3747/co.24.3850.
International Agency for Research on Cancer (IARC). (2018). IARC monographs on the identification of carcinogenic hazards to humans. World Health Organization. https://monographs.iarc.fr/monographs-and-supplements-available-online/.
Krueger, H., Andres, E. N., Koot, J. M., & Reilly, B. D. (2016). The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada. Current Oncology, 23(4), 241–249. https://doi.org/10.3747/co.23.2952.
O’Sullivan, D. E., Brenner, D. R., Villeneuve, P. J., Walter, S. D., Demers, P. A., Friedenreich, C. M., & King, W. D. (2019). Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada. Preventive Medicine, 122, 81–90. https://doi.org/10.1016/j.ypmed.2019.03.012.
Pader, J., Ruan, Y., Poirier, A. E., Asakawa, K., Lu, C., Memon, S., Miller, A., Walter, S., Villeneuve, P. J., King, W. D., Volesky, K. D., Smith, L., De, P., Friedenreich, C. M., & Brenner, D. R. (2021). Estimates of future cancer mortality attributable to modifiable risk factors in Canada. Can J Public Health, 112. https://doi.org/10.17269/s41997-020-00455-7.
Poirier, A. E., Ruan, Y., Volesky, K. D., King, W. D., O’Sullivan, D. E., Gogna, P., Walter, S. D., Villeneuve, P. J., Friedenreich, C. M., & Brenner, D. R. (2019). The current and future burden of cancer attributable to modifiable risk factors in Canada: summary of results. Preventive Medicine, 122, 140–147. https://doi.org/10.1016/j.ypmed.2019.04.007.
Public Health Agency of Canada. (2019, Dec 9, 2019). Fact sheet: cancer in Canada. Statistics Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/fact-sheet-cancer-canada.html. Accessed 9 June 2020.
Smith, A., Baines, N., Memon, S., Fitzgerald, N., Chadder, J., Politis, C., Nicholson, E., Earle, C., & Bryant, H. (2019). Moving toward the elimination of cervical cancer: modelling the health and economic benefits of increasing uptake of human papillomavirus vaccines. Current Oncology, 26(2), 80–84. https://doi.org/10.3747/co.26.4795.
The Lancet. (2020). Global burden of disease. Elsevier. https://www.thelancet.com/gbd. Accessed 9 June 2020
Volesky, K. D., El-Zein, M., Franco, E. L., Brenner, D. R., Friedenreich, C. M., & Ruan, Y. (2019a). Cancers attributable to infections in Canada. Preventive Medicine, 122, 109–117. https://doi.org/10.1016/j.ypmed.2019.03.035.
Volesky, K. D., El-Zein, M., Franco, E. L., Brenner, D. R., Friedenreich, C. M., & Ruan, Y. (2019b). Estimates of the future burden of cancer attributable to infections in Canada. Preventive Medicine, 122, 118–127. https://doi.org/10.1016/j.ypmed.2019.04.006.
World Cancer Research Fund/American Institute for Cancer Research. (2018). Diet, nutrition, physical activity and cancer: a global perspective 3rd edition (Continuous Update Project, Issue. https://www.wcrf.org/dietandcancer/about.
Acknowledgements
This analysis is based on the Canadian Partnership Against Cancer’s OncoSim model. The assumptions and calculations underlying the simulation results were prepared by the authors, and the responsibility for the use and interpretation of these data and their reporting is entirely that of the authors.
Code availability
This study did not involve the use of codes. The OncoSim model used in the study is available at https://www.partnershipagainstcancer.ca/tools/oncosim. Access and use are available upon request.
Funding
This research is supported by a Canadian Cancer Society Partner Prevention Research Grant (grant #703106). OncoSim is led and supported by the Canadian Partnership Against Cancer, with model development by Statistics Canada, and is made possible through funding from Health Canada.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analyses were performed by Yibing Ruan, Abbey E. Poirier and Joy Pader. All authors contributed to, read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
This study did not require ethics approval as it did not involve human participants.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(XLSX 149 kb)
Rights and permissions
About this article
Cite this article
Ruan, Y., Poirier, A.E., Pader, J. et al. Estimating the future cancer management costs attributable to modifiable risk factors in Canada. Can J Public Health 112, 1083–1092 (2021). https://doi.org/10.17269/s41997-021-00502-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-021-00502-x