CA Cancer J Clin: 2020 U.S. Youth and Young Cancer Statistics Report

The U.S. National Cancer Institute defines adolescents and young adults (AYAs) cancer as cancer diagnosed between the ages of 15 and 39.
Patients with AYAs have a higher long-term and late-stage risk than older cancer patients, including infertility, sexual dysfunction, cardiovascular disease, and future secondary primary cancer, while children have a lower risk of severe advanced stage than childhood cancer survivors.
AYAs are usually aggregated, masking important heterogeneity.
the authors analyzed cancer morbidity and mortality rates among AYAs populations in the United States by age (15-19, 20-29 and 30-39 years), gender and race, and analyzed survival trends.
expected number of cases and deaths by 2020, AYAs in the United States will have about 89,500 new cancer cases and 9270 cancer deaths.
The top three cancers expected to have new cases by 2020 are thyroid, lymphoma, brain and other neurological cancers in the adolescent group;
it is worth noting that thyroid cancer accounts for the top three incidences at every age.
1.2012-2016, the incidence of AYAs major cancer types (%) increased with age, with the exception of ALL, bone tumors, and HL, which had the highest incidence among adolescents.
incidence of cancer in adolescents is similar in sex, but the incidence rate among women is 30 per cent higher than in the 20-29 age group and almost twice that among men in the 30-39 age group.
incidence of cancer has increased over the past decade, but may stabilize among men in their 20s.
the most significant increase in thyroid cancer among young women, and in fact, the incidence of thyroid cancer was stable in 2007-2016 when thyroid cancer was excluded from the overall trend.
by race, the highest incidence of cancer in AYAs was among non-Hispanic whites (83 per 100,000) and among Asians (54 per 100,000).
the period 2007-2016, the overall incidence of AYAs women increased among all ethnic groups except the United States, where the incidence rate of Indians remained stable.
, with the exception of Asians and Hispanics, whose incidence increased by 1.5 per cent and 0.8 per cent per year, the incidence rate was generally stable for men of all races.
2. The main causes of cancer mortality in AYAs cancer morbidity and mortality trends, by age and sex, varied considerably by age group from 1975 to 2017 (table 2).
2017, the leading causes of cancer death were leukemia and brain tumours, with the exception of women aged 30-39.
by race, non-Hispanic black adolescents had the highest cancer mortality rate (11 per 100,000), although the incidence was 25 percent lower than that of non-Hispanic whites.
Since 1975, cancer mortality has been declining steadily, by an average of about 1 per cent per year, but in recent years the mortality rate for women aged 30-39 has stabilized, indicating that breast cancer mortality has remained stable for more than 20 years, with the largest decline among non-Hispanic whites and blacks, while the mortality rate among Hispanic, American Indian and Asian women has remained stable.
Table 1. AYAs specific cancer incidence (2007-2016) and mortality (2008-2017) ten-year trend brain and other nervous system tumor brain cancer is the main cancer of AYAs incidence and death, AYAs male cancer death is the most common cause, and the second largest cause after breast cancer.
3,700 cases of brain cancer are expected to be diagnosed by 2020.
gliomas are the majority in AYAs, and the rest of the brain tumor subtypes have significant heterogeneity in age distribution: intracranial GCTs and other childhood-related brain tumors.
2007-2016, the incidence of brain cancer remained stable among adolescents and declined among adults aged 20-39.
5-year relative survival rate of malignant brain tumors (adolescents 77%, 30-39 years of age 66%), reflecting differences in the invasive nature of glioma subtypes of different ages.
of benign and junctional brain tumors accounted for a large proportion of brain tumors (adolescents 48%, 30-39 years old 63%).
relatively high five-year survival rate of benign and junctional tumors, about 97% among adolescents.
is the most common cancer among women aged 30-39, with 11,100 expected by 2020.
is the leading cause of cancer death in AYAs women, accounting for 22% of cancer deaths in 2017 (table 2).
14% higher incidence of AYAs among non-Hispanic blacks than among non-Hispanic whites ( 25.9 to 22.3/100,000).
the higher incidence of non-Hispanic blacks was limited to ER/PR(-) breast cancer patients;
, the difference in breast cancer mortality between blacks and whites in AYAs was large and decreased with age.
the mortality rate for non-Hispanic blacks nearly doubled compared to whites (2.0 to 3.9 per 100,000).
the incidence of breast cancer has increased by nearly 2% and 0.2% per year in women aged 20-29 and over 30 in the last decade, respectively, while the incidence rate among adolescents has been stable.
AYAs women's breast cancer mortality rate did not decline after more than 20 years of continuous decline.
in addition, the five-year relative survival rate of breast cancer in women is lower among young women than among older women (86% to 60%).
colorectal cancer is the fourth most common cancer among adults aged 30-39, with 4,100 cases expected by 2020.
2017, it was the leading cause of cancer death for men in this age group and the third leading cause of death for women (table 2).
The incidence of colorectal cancer in the 20-29 and 30-39 age groups increased by 0.9 per cent and 1.5 per cent per year, respectively, and the incidence and mortality rate of colorectal cancer increased by about 1 per cent per year in the 30-39 age group.
these patterns reflect the birth cohort effect, and the risk of colorectal cancer has increased for generations to come since 1950.
, the incidence of ≥ 65-year-old adults continues to decline rapidly.
five-year relative survival rate for patients aged 20-39 diagnosed between 2009 and 2015 was 68 per cent.
acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are the majority of leukemia, of which ALL is the majority in adolescents, AML has become the main subsype of acute leukemia in adults.
600 cases of ALL and AML are expected by 2020, and leukemia remains the leading cause of cancer death in the 15-29 age group (Table 2).
2007-2016, the incidence of ALL increased by 0.7% to 1.9% per year and the incidence of AML increased by 0.4% to 1.2% per year.
AYAs age group, the five-year relative survival rate of adolescents ALL and AML was significantly higher (74 per cent and 66 per cent, respectively).
lymphoma is expected to diagnose about 4,200 HL and 4,600 NHL cases in AYAs by 2020.
although the HL accounts for the majority of lymphoma diagnosed in the 15-29 age group, the NHL is more common in the 30-39 age group.
NHL includes a range of subsypes that vary by age.
, such as Burkett's lymphoma, is higher among adolescents than in the 30-39 age group (15 percent to 4 percent).
EBV-related HL peaked in 15-20 year old AIDS patients, while non-EBV-related HL was more common in AYAs.
the incidence of HL decreased by 0.2%-1% per year among different age groups, while the mortality rate decreased even more significantly (by 10%) per year.
AYAs total NHL mortality rate is declining.
94% and 83% of the five-year relative survival rates of the HL and NHL, respectively, with adolescents slightly higher than the rest of the AYAs age group.
melanoma is the third most common cancer among people aged 20-39.
is expected to have 7,900 cases by 2020.
are more common than men, but men are more likely to be older.
incidence of melanoma peaked in 2000-2005 and has since declined rapidly among adolescents (6.2 per cent per year) and adults in their 20s (3.5 per cent per year).
30-39 years of age, the incidence of melanoma remained stable in women and decreased slightly in men.
similar to morbidity, the mortality rate in AYAs drops rapidly by about 5% per year.
5-year relative survival rate of melanoma in AYAs is usually high (i.e., 94%), reflecting a high proportion (80%) of early diagnosis cases.
the rate of GCT in male glands is significantly higher than in females, and 6,500 testicular GCT cases are expected to be diagnosed in AYAs men by 2020.
testicular malignancies are the most common cancer among men aged 20-39 years, and the incidence peaks at 30-39 years (13 per 100,000).
testicular GCT incidence was highest among non-Hispanic whites (13 per 100,000), followed by Hispanics (10 per 100,000) and American Indians (10 per 100,000), and among non-Hispanic blacks (24 per 100,000).
the incidence of testicular GCT increased by 0.4%-1.1% per year, while the mortality rate remained stable.
in the United States and several Nordic countries, testicular GCT birth queue effect is strong, and its incidence is also rising.
five-year relative survival rate for testicular GCT is usually high, exceeding 95 per cent in all age groups.
thyroid cancer is the most common cancer in adolescents and people aged 20-29.
14,400 cases, mostly in women, are expected to be diagnosed by 2020.
, thyroid papyroid cancer accounts for the majority of AYAs cases of thyroid cancer.
incidence of thyroid cancer has risen rapidly over the past decade, while the mortality rate has fallen slightly by 0.5 per cent per year.
5-year relative survival rate of thyroid cancer is usually higher, exceeding 99% among adolescents aged 20-39 (Table 1).
3,800 cases of cervical cancer among women aged 20-39 between 2020 and 2020.
cervical cancer is the second leading cause of cancer death among women aged 30-39 and all AYAs.
the incidence of cervical cancer in women in their 20s fell by 1.6 per cent per year between 2007 and 2016, the incidence of cervical cancer in women in their 30s appears to have stabilized.
trend in women aged 30-39 partly reflects a decrease in the incidence of cervical squamous cancer, while the incidence of adenocarcinoma has increased slightly.
5-year relative survival rate of cervical cancer was 82% for 20-29 years and 82% for 30-39 years (Table 1).
nearly one-third (34%) of cases diagnosed with regional or distant transitions may reflect delayed screening or more invasive histological subtypes, especially among young AYAs women.
2018, cervical cancer screening rates were 74%, 90% and 86% for all age groups aged 21-29, 30-39 and 40-65.
2. Summary of major cancer deaths among adolescents by age and sex in 2017 concludes that AYAs cancer survivors face additional late-stage and long-term challenges, including social cognition, mental health and physical functioning, and financial resources.
Further progress can be made in reducing AYAs cancer morbidity and mortality through fairer access to health care, increased enrollment in clinical trials, expanded ethnopathology, basic biology and survival studies, and increased awareness of early symptoms and signs of cancer among clinicians and patients.
study of cancer in AYAs should also take into account the heterogeneity of cancer in this patient group.