Key findings highlighted in the first annual cancer report from the American College of Surgeons

The American College of Surgeons Cancer Program developed its first annual cancer report from the National Cancer Database (NCDB) 2021 Participant User File highlighting data on adult cancer diagnoses, patient demographics, and treatments.¹ Data on cancer cases from the NCDB are collected from approximately 1500 Commission on Cancer facilities and account for nearly 74% of newly diagnosed cancer cases nationally.

The report features key demographic information for the five most common cancers: breast, prostate, lung, colon, and melanoma. It also includes an in-depth look at treatments and outcomes of three select cancers: breast, pancreatic, and colorectal. Future annual reports will focus on other cancer types.

The senior author of the study, Judy C. Boughey, MD, a surgical oncologist and division chair of breast and melanoma surgical oncology at the Mayo Clinic in Rochester, Minnesota, says that the report was conducted to offer cancer providers information on cancer cases from the NCDB and to highlight the data over time along with patient outcomes.

“Overall, this is a report from a large database demonstrating the management of patients with certain solid tumors for physicians to be able to refer to regarding factors influencing outcome, current practice patterns, as well as hospital admission rates and morbidities associated with cancer surgery,” she says.

“This data is available for providers for their knowledge and to share with their patients,” she adds.

Overall, 1,328,131 adult cancers were diagnosed in 2021; this was a slight increase from the 1,277,700 adult cancers diagnosed in 2020. The data showed more cancer diagnoses in females than males (54.3% vs. 45.7%); in part, this shows the large number of women diagnosed with breast cancer (composing one-fifth or 19.9% of all adult cancers in 2021).

The data also include overall survival for patients diagnosed through 2020. Overall, 5-year survival was 63.99% for all tumor sites, with markedly better 5-year survival rates in women versus men (68.01% vs. 59.36%).

In 2021, 264,095 adults (99.2% women and 0.8% men) were diagnosed with breast cancer, as reported by 1276 NCDB-participating facilities; this figure represents an estimated 81.9% of all breast cancers diagnosed in the United States.² The median age at diagnosis was 63 years; most patients were White (74%), followed by Black (12.4%), Hispanic (6.1%), and Asian (5%). The stages at diagnosis were similar to what had been seen since 2018, with most patients presenting with stage I (47%) or stage II disease (24%); these stages were followed by ductal carcinoma in situ (18%), stage III disease (5%), and stage IV disease (5%). Most patients underwent lumpectomy (66.4%) followed by radiation therapy (80.6%). Among patients with stage I–III breast cancers, 37.4% received chemotherapy, and 14.4% received immunotherapy. Among those with ER+ tumors, 86.3% received endocrine therapy. The use of neoadjuvant endocrine therapy for ER+ breast cancer showed a sustained increase from 2018 (3.3%) to 2021 (5%).

Colon cancer was diagnosed in 70,774 adults (50% women and 50% men), as reported by 1273 NCDB-participating facilities; this figure represents an estimated 73% of all colon cancers diagnosed in the United States.² The median age at diagnosis was 68 years; most patients were White (73.9%), followed by Black (13.2%), Hispanic (6.7%), and Asian (3.9%). Most patients presented with stage II (27.1%) or stage III disease (27.5%), followed by stage I disease (19.7%). Most cancers were grade 2 with a biomarker distribution of MSI (77.8%), KRAS (43.3%), and CEA positive (51.6%). Most patients were treated with colectomy (81.1%); 35.4% of these patients underwent open resection, 39.7% underwent laparoscopic resection, and 24.9% underwent robotic-assisted resection. After surgery, the readmission rate was 5.3% with a median stay of 4 days; the 30-day mortality rate was 3.3%.

Pancreatic cancer was diagnosed in 40,817 adults (48% women and 52% men), as reported by 1249 NCDB-participating facilities; this figure represents an estimated 76.4% of all pancreatic cancers diagnosed in the United States.² The median age at diagnosis was 70 years; most patients were White (75.7%), followed by Black (12.7%), Hispanic (6.1%), and Asian (3.4%). Most patients presented with stage IV disease (49.2%), and most tumors were adenocarcinomas (81.5%), with 48.3% of the tumors located in the head of the pancreas. After surgery, the readmission rate was 7.5% in the first 30 days with a median stay of 6 days; the 30- and 90-day mortality rates after surgery were 2.3% and 4.5%, respectively.