The report “National Estimates of Cancer Incidence and Mortality in Metropolitan France Between 1990 and 2018” offers a nuanced analysis that significantly enhances our epidemiological understanding of these diseases. The result of a partnership between Santé publique France, the National Cancer Institute, the Francim cancer registry network, and the Biostatistics and Bioinformatics Department of the Hospices Civils de Lyon, it is updated every five years and represents a crucial step in the epidemiological surveillance and monitoring of cancers. The information in this new edition helps assess the preventive and curative measures recommended by the Cancer Plans and serves as a foundation for developing the future ten-year strategy to combat the disease.

Cancer subtypes and trends by age: new indicators for renewed epidemiological surveillance

The estimates presented in this report result from a major revision of the methodology used to estimate national incidence. It now relies solely on registry data and uses more sophisticated statistical models. This methodology thus makes it possible, for the first time, to estimate incidence for 74 cancer sites, compared to 34 previously; that is, 27 solid tumors and 22 subtypes, 24 malignant hematologic entities, and includes an “all cancers” category. It also allows for the presentation of trends by age. Mortality data is available for 19 solid tumors, non-Hodgkin lymphomas as a whole, and the “all cancers” category.
These findings contribute significantly to deepening our understanding of a very large number of cancers with different causes, prognoses, and treatments.

In the case of lung cancer, the estimates calculated for the first time by subtype provide new insights. Indeed, while the incidence of this cancer is relatively stable among men (-0.1% per year over the 1990–2018 period), the data indicate different trends by subtype: the incidence of adenocarcinomas is increasing (+3.9% per year), while that of squamous cell carcinomas and small cell cancers is decreasing (-2.9% per year and -0.9% per year). These differences could be explained by changes in the structure (the introduction of filters leading to deeper inhalation) and composition of cigarettes (increased concentration of nitrosamines).

This new methodology makes it possible, for the first time, to obtain estimates of the various cancer sites attributable to human papillomavirus (HPV) infection—cervical cancer, anal cancer, and, to a lesser extent, oropharyngeal cancer—by age group. Thus, while cervical cancer is declining overall (-1.8% per year), analysis by age group shows, conversely, a slowdown in this decline or even an increase in the incidence of this cancer among women aged 50 and 60 since 2010. This could be explained by sexual behaviors that pose a higher risk of HPV infection among these generations. Similarly, the incidence of anal cancer, which is primarily attributable to HPV, is increasing among women aged 50 to 60. This level of detail in the data will enable us to strengthen and better target prevention efforts.

Key findings for all cancers: the gap between men and women is narrowing, to the detriment of women

In 2018, the number of new cancer cases was estimated at 382,000 (54% in men, 46% in women), and the number of cancer deaths at 157,400 (57% in men, 43% in women).

The incidence of all cancers combined is stable among men (+0.1% per year) while it is increasing among women (+1.1% per year), reflecting an increased risk of cancer. The incidence (+5.3% per year) and mortality (+3.5% per year) of lung cancer show the sharpest increase among women: an increase linked to rising smoking rates.

Mortality from all cancers is declining, more sharply among men (-1.8% per year) than among women (-0.8% per year).

Key findings on solid tumors

Some of the most common cancers, with preventable risk factors, are on the rise, with no decline in mortality.

The rise in cancers with preventable risk factors calls for strengthened prevention efforts. Excessive alcohol and tobacco use, changes in dietary habits, and the growing prevalence of obesity or high blood pressure could explain:

• the continued increase in the incidence of pancreatic cancer (+3.8% per year in women and +2.7% per year in men) and the rise in mortality among women of +1.2% per year;

• the increase in the incidence of kidney cancer (+1.4% per year in women and +1.7% per year in men) with a recent trend toward rising mortality in men.

The incidence of skin melanoma, linked to exposure to natural and artificial ultraviolet (UV) radiation, has increased more markedly among men (+4.0% per year) than among women (+2.7% per year) since 1990, resulting for the first time in 2018 to an identical incidence rate among men and women, accompanied by a stagnation in mortality.

Earlier diagnoses and therapeutic advances contributing to a decline in mortality, particularly among the most common cancers

Changes in medical practices, the implementation of organized screening programs, earlier diagnoses, and therapeutic advances may be driving favorable trends for certain types of cancer, including:

• breast cancer, with mortality steadily declining since 1990 (-1.3% per year) while its incidence increased between 2010 and 2018 (+0.6% per year);

• colorectal cancer, with a combined decline in mortality and incidence among men and a decline in mortality alone among women;

• prostate cancer, with a decline in mortality (-3.7% per year between 2010 and 2015) and also in incidence (-3.5% per year between 2010 and 2015);

• cervical cancer, with a decline in mortality (-2.1% per year) and also in incidence (-1.8% per year), which, however, is not consistent over time and is lower among women aged 50 to 60.

An increase in malignant hematological diseases, the causes of which remain to be explored

In 2018, the number of new cases of malignant hematological diseases is estimated at 45,000 (approximately 12% of diagnosed cancers).
Their incidence varies considerably depending on the subtype. Five entities account for more than 50% of cases: multiple myeloma/plasmacytoma, diffuse large B-cell lymphoma, myelodysplastic syndromes, chronic lymphocytic leukemia/lymphocytic lymphoma, and acute myeloid leukemia.

The incidence of malignant hematologic diseases is increasing in both sexes (except for 3 subtypes that are stable and 4 others that are decreasing). Demographic shifts or changes in classification are insufficient to explain this increase, leaving ample room for etiological research into these diseases and the interactions between environmental and genetic factors.