Prevalence of cancer survivors in the United States

Abstract

Background

With aging of the population and improvements in diagnosis, treatment, and supportive care, the number of cancer survivors in the United States has increased; updated prevalence estimates are needed.

Methods

Cancer prevalence on January 1, 2022, was estimated using the Prevalence Incidence Approach Model, utilizing incidence, survival, and mortality. Prevalence by age decade, sex, and time from diagnosis was calculated. The percentage of cancer survivors in the projected US population by age and sex was calculated as the ratio of the sex-specific projected prevalence to the sex-specific projected US population.

Results

There were an estimated 18.1 million US cancer survivors as of January 1, 2022. From 2022 to 2030, the number of US cancer survivors is projected to increase to 21.6 million; by 2040, the number is projected to be 26 million. Long-term survivors are highly prevalent; in 2022, 70% of cancer survivors had lived 5 years or more after diagnosis, and 11% of cancer survivors had lived 25 years or more after diagnosis. Among all US females aged 40-54 years, 3.6% were cancer survivors; among females aged 65-74 years, 14.5% were cancer survivors; among females aged 85 years and older, 36.4% were cancer survivors. Among all US males aged 40-54 years, 2.1% were cancer survivors; among males aged 65-74 years, 16% were cancer survivors; and among those aged 85 years and older, 48.3% were cancer survivors.

Conclusions

Cancer survivors are growing in number. In the United States, most cancer survivors are long-term and very long-term survivors, representing a substantial proportion of the US population.

In the United States, more than 1 in 3 people will be diagnosed with cancer in their lifetime (1). This population, known as cancer survivors (2), is growing, in part because the underlying population is older now than in prior decades. The probability of developing invasive cancer is nearly 10 times higher for adults aged 70 years and older compared with those aged 49 years and younger (1). At the same time, improvements in screening, diagnosis, treatment, and supportive care have led to longer survival (3-5). As a result, the number of cancer survivors has been increasing steadily over the past 50 years—a trend that has been well documented and is expected to continue (6-8).

Cancer survivors represent a heterogeneous population with a variety of health-care needs. Cancer site, stage, and treatment inform the risks for long-term and late effects from treatment, while ongoing screening, surveillance, and follow-up care are necessary (8,9). Some of the most common late effects include fatigue, frailty, cognitive impairment, chemotherapy-induced peripheral neuropathy, ovarian failure or infertility, psychological distress, cardiotoxicity, and second cancers (10,11). In addition, the majority of cancer survivors are older adults for whom the ongoing need for survivorship care intersects with the demands of aging (8,12). Simultaneously, the oncology workforce is shrinking (13), and many regions of the United States represent health-care deserts (14). Several federal agencies are leading an effort to write survivorship standards, intended to represent expected or required elements of survivorship care. Yet, attainment of this type of care is difficult, inadequate, or incomplete (15-17). The survivor population is aging, growing in complexity, and living without access to risk-based follow-up care (6,18,19).

More than 10 years ago, a detailed description of the overall population of US cancer survivors was published, with updates since then emphasizing the proportion of survivors who are older adults. Therefore, an updated, detailed description of the population of cancer survivors living in the United States, including the estimated number of individuals and the expected trends in these statistics, is critically needed (7). In addition, the proportion of the US population represented by cancer survivors has not previously been calculated. The emphasis of this work is on the trends in long-term cancer survivorship and the public health implications of a proportion of the US population with a history of a diagnosis of cancer.

Methods

Statistical analysis

Cancer prevalence as of January 1, 2022, was estimated using the Prevalence Incidence Approach Model (PIAMOD). PIAMOD calculates prevalence from cancer survival, cancer incidence, and all-cause mortality data (20). Incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) Program, all-cause mortality data from the National Center for Health Statistics, and US Census Bureau population estimates were obtained from the SEER*Stat software (SEER*Stat Software v 8.3.9, version 8.3.5) and used in the calculation of prevalence estimates.

SEER-9 incidence rates from 1975 to 1999 and SEER-18 incidence rates from 2000 to 2018 were applied to US population estimates to obtain US incidence counts by calendar year, age (single-year and age 90 years and older), and cancer type. For each cancer site, counts were restricted to the first primary invasive case diagnosed in a person, except urinary bladder, which included in situ cases. Relative survival from 1975 to 2017 was obtained from SEER-9 registries by sex, age group (0-54, 55-64, 65-74, 75-84, 85-99 years), and year of diagnosis (1975-1984, 1985-1989, …, 2005-2009, 2010-2017). Survival estimates excluded cancers diagnosed through death certificate or autopsy and cases that were lost to follow-up at the month of diagnosis. Prevalence proportions for ages 85-89 years were used to estimate prevalence counts for the population aged 90 years and older. To ensure that PIAMOD estimates were consistent with other published prevalence figures (such as those in SEER*Explorer), which employ a simpler methodology with fewer assumptions and are more closely aligned with observed data, adjustment factors were applied to the PIAMOD estimates. These adjustment factors were calculated by comparing the 2018 prevalence estimates from SEER*Explorer and PIAMOD, broken down by cancer type and sex (21).

The 2017 US Census Bureau National Population Projections (22), which are based on the 2010 Census, were used to project US incidence and mortality for 2019-2040 by applying the 2016-2018 average rates by age, sex, and cancer site to the US population projections (8). Using PIAMOD, prevalence for each cancer site was projected from 2019 to 2040 using projected incidence and mortality, survival for the period 2010-2017 (future survival was assumed to remain constant), and US Census population projections. Prevalence projections for 2019 through 2040 were calibrated to 2018 complete prevalence by applying the cancer- and sex-specific adjustment factors.

Prevalence was quantified by age group (0-9, 10-19, …, 70-79, 80 years and older) and sex for each cancer site. PIAMOD also provides estimates of prevalence by years since diagnosis for each calendar year of diagnosis. In our analysis, we focused on survivors living 0 to less than 1 year, 1 to less than 5 years, 5 to less than 10 years, 10 to less than 15 years, 15 to less than 20 years, 20 to less than 25 years, and 25 years or more postdiagnosis. The percentage of cancer survivors in the projected US population by sex was calculated as the ratio of the sex-specific projected prevalence to the sex-specific projected US population.

Results

Current survivorship prevalence and projections through 2040

There were an estimated 18.1 million people in the United States diagnosed with cancer as of January 1, 2022. This represents a nearly fourfold increase compared with the mid-1970s. From 2022 to the end of the decade (2030), the number of survivors is projected to increase to 21.6 million; by 2040, the number of cancer survivors living in the United States is projected to be 26 million, representing a 43.6% increase compared with 2022 (Figure 1).

Figure 1.

Number of cancer survivors living in the United States by year and time since diagnosis in years (duration). M = million.

Among the current population of cancer survivors, 70% of cancer survivors have survived 5 years or more after diagnosis, 48% of cancer survivors have survived 10 years or more after diagnosis, 19% of cancer survivors have survived 20 years or more after diagnosis, and 11% of cancer survivors have survived 25 years or more after diagnosis.

These trends are estimated to continue. From 2022 to 2040, the number of survivors who are fewer than 5 years from diagnosis will increase from 5.5 million to 6.8 million (24%). During this same period, the number of survivors who are 5 or more years from diagnosis will increase from 12.6 million to 19.2 million (53%). From 2022 to 2040, survivors who are 5 or more years from diagnosis will grow to represent 74% of all survivors, with a corresponding decrease in relative proportion of survivors who are fewer than 5 years from diagnosis. The largest relative increase in number of cancer survivors by time since diagnosis is among people who are 15 or more years from diagnosis. Among this group, prevalence is expected to increase from 5.6 million (31%) of all survivors in 2022 to 10.4 million (40%) of all survivors in 2040.

Characteristics of cancer survivors in the United States

Table 1 describes survivorship prevalence by cancer site for the top 10 most common cancers among males and females, stratified by age and sex. The most prevalent cancer sites are breast (4 million survivors), prostate (3.5 million survivors), melanoma (1.5 million survivors), colorectal (1.4 million survivors), and thyroid (1.1 million survivors). For all sites, the number of survivors is higher with older age, while more than 78% of survivors currently living in the United States are age 60 years or older. Across cancer sites, a higher proportion of cancer survivors are females than males, except for adults ages 70-79 years among whom male survivors outnumber female survivors.

Table 1.

Estimated number of cancer survivors by age, gender, and cancer site for the 10 most common cancers as of January 1, 2022

		Age, y
Site	Sex	All ages	0-9	10-19	20-29	30-39	40-49	50-59	60-69	70-79	80 and older
All sites	Male	8 321 203	17 190	41 193	91 550	180 186	327 067	876 204	2 071 665	2 613 319	2 102 829
	Female	9 738 892	17 046	40 885	97 221	253 238	581 775	1 360 802	2 398 887	2 529 966	2 459 072
	Total	18 060 095	34 236	82 078	188 771	433 424	908 842	2 237 006	4 470 552	5 143 285	4 561 901
Bladder	Male	597 877	50	135	573	2293	8166	35 985	117 770	203 091	229 814
	Female	191 854	22	60	280	927	2879	11 371	35 213	58 369	82 733
	Total	789 731	72	195	853	3220	11 045	47 356	152 983	261 460	312 547
Breast	Male	—a	—	—	—	—	—	—	—	—	—
	Female	4 055 775	2	20	3271	44 053	204 968	570 793	1 030 059	1 109 526	1 093 083
	Total	4 055 775	2	20	3271	44 053	204 968	570 793	1 030 059	1 109  526	1 093  083
Colorectal	Male	729 071	8	306	2060	7923	26 177	85 075	179 741	216 975	210 806
	Female	710 673	23	452	2381	7645	23 300	70 652	145 691	190 395	270 134
	Total	1 439 744	31	758	4441	15 568	49 477	155 727	325 432	407 370	480 940
Kidney	Male	376 273	1531	2274	2425	5675	18 321	54 481	105 790	110 491	75 285
	Female	230 956	1571	2656	2969	5238	12 010	29 802	56 527	62 350	57 833
	Total	607 229	3102	4930	5394	10 913	30 331	84 283	162 317	172 841	133 118
Lung	Male	287 058	6	22	104	618	3956	23 565	74 534	107 424	76 829
	Female	367 568	24	55	225	990	5422	29 799	90 341	129 239	111 473
	Total	654 626	30	77	329	1608	9378	53 364	164 875	236 663	188 302
Melanoma	Male	760 638	53	483	4251	18 027	42 871	98 176	186 546	217 662	192 569
	Female	713 794	99	772	8277	33 089	65 618	118 187	174 323	162 267	150 802
	Total	1 474 432	152	1255	12 528	51 116	108 489	216 363	360 869	380 289	343 371
Prostate	Male	3 523 238	21	97	217	454	11 489	182 558	835 157	1 322 743	1 170 502
	Female	—	—	—	—	—	—	—	—	—	—
	Total	3 523 238	21	97	217	454	11 489	182 558	835 157	1 322 743	1 170 502
Corpus uteri	Male	—	—	—	—	—	—	—	—	—	—
	Female	891 553	1	15	585	6645	27 423	102 027	242 777	265 117	246 963
	Total	891 553	1	15	585	6645	27 423	102 027	242 777	265 117	246 963
Non-Hodgkin lymphoma	Male	451 366	797	3480	7905	16 304	30 382	63 903	112 610	122 736	93 249
	Female	394 185	400	1751	4998	10 997	20 455	46 279	89 502	107 042	112 761
	Total	845 551	1197	5231	12 903	27 301	50 837	110 182	202 112	229 778	206 010
Thyroid	Male	238 831	56	857	5511	16 604	29 683	48 207	63 286	49 612	25 015
	Female	823 801	65	2842	25 231	78 153	127 307	178 794	198 050	134 209	79 150
	Total	1 062 632	121	3699	30 742	94 757	156 990	227 001	261 336	183 821	104 165

^anot applicable.

Survivors as a proportion of the US population

With increasing age, the proportion of the US population represented by cancer survivors increases (Figure 2). For example, among US females aged 40-54 years, cancer survivors represent 3.6% of the population. Among females aged 65-74 years, survivors represent 14.5% of the population. Among females aged 85 years and older, more than one-third (36.4%) of the population is cancer survivors.

Figure 2.

Proportion of the population represented by cancer survivors living in the United States by age and calendar year for females (A) and males (B).

Among males, the proportion of the US population that is represented by cancer survivors is higher with older age (Figure 2, B). Among males aged 40-54 years, survivors represent 2.1% of the population, while among males aged 65-74 years, 16% were cancer survivors. In the oldest group, those aged 85 years and older, nearly half (48.3%) the population is cancer survivors.

When comparing estimates for 2022 to estimates for 2040, the percent of projected US population that are cancer survivors is very similar for males in every age group. However, among females, cancer survivors will make up a higher percentage of the US population in 2040 than in 2022—particularly among those aged 65 years and older (Figure 2, A). For example, in 2022, approximately 19.7% of females aged 75-84 years were cancer survivors. In 2040, this proportion is expected to increase to 22.5%.

Discussion

The prevalence of cancer survivors in the United States now reaches more than 18 million and is expected to continue to increase; in particular, survivors who are more than 25 years from diagnosis and survivors who are older adults are growing in number. Overall, cancer survivors represent a substantial proportion of the US population. These survivors represent a range of diagnosis and treatment histories, as well as a variety of life experiences and comorbid conditions, with a large number of poorly understood or unmet needs (23,24). Importantly, this population also includes those who are living with metastatic or advanced cancer (5,25).

The increasing number of survivors and the increasing proportion of the population that has a history of a diagnosis of cancer will continue to exert pressure on the US health-care system. Prior analysis of SEER-Medicare data showed that, compared with 2020 levels, the total number of survivors receiving care by medical oncologists is expected to increase 24% by 2030 and 42% by 2040, with the highest increase in use projected to occur among cancer survivors who survive 10 or more years following diagnosis between 2020 and 2030 (13). Yet, this model of oncologist-led survivorship care is unlikely to be sustainable—and may lead to harms (26).

At the same time, primary care providers often do not have access to cancer diagnosis and treatment information, or it may not be organized in a way that represents actionable data. Primary care providers’ lack of exposure to cancer treatment algorithms and limited involvement in care during the active treatment phase may limit their comfort level with managing posttreatment sequela in survivors (26,27). Electronic health records are not designed to fill these gaps, which likely worsen as time from treatment increases. Models that are designed to overcome these barriers are still lacking evidence, which has slowed our progress toward optimal survivorship care delivery (26). The result is fragmented care, which may contribute to undertreatment or oversight of surveillance, treatment-related late effects, and other survivorship needs (26,28). As the number of survivors in the United States continues to grow, especially those populations of older adults and long-term cancer survivors, better survivorship care delivery is urgently needed (29). Ideally, survivorship care should be implemented at diagnosis and tailored to survivors’ needs, some of which are not well described. In addition, given the substantial increases in the number of survivors more than 10 years from diagnosis, evaluating and revisiting or reassessing the needs of very long-term survivors is critical.

Our findings further emphasize the growing population of older adult cancer survivors. These survivors remain at risk of long-term adverse effects, including cognitive impairment, cardiovascular disease, and premature and accelerated aging resulting from their cancer treatments, yet are not well represented in research (10,12,30). Oncology continues to be underprepared for this demographic shift because of the historic exclusion of older adults from treatment trials (31). Despite the US Food and Drug Administration’s efforts to increase inclusion of older adults in clinical trials (32), the underrepresentation of this population has led to a paucity of data for establishing efficacy and safety of new therapies (31), which may lead to continued use of expensive treatments that confer higher toxicity and smaller benefit. Care for older adults with cancer is complex and multifaceted. Before older adults are diagnosed with cancer, many will have had major health challenges requiring informal caregiving (33). Older adults are more likely to experience cancer treatment–related toxicities (34) due to a loss of physiologic resilience and capacity with age (34,35) and are less likely to be offered chemotherapy because of concerns of tolerability (36). Although the field of geriatric oncology has been around for decades (37,38), the specialty, practice, and principals of caring for older adults with cancer need be routinely adopted, given the large and growing population. Thus, it will become important for oncology to become more multidisciplinary to strengthen the evidence base, address systemic biases, and adequately address the complex care needs of older adults (37).

These findings demonstrate that nearly half of US cancer survivors have lived 10 or more years after diagnosis, while 19% have lived 20 or more years. A recent publication of the prevalence of cancer survivors in Europe reflects similar patterns of diagnosis and survivorship, although the incidence rates for some cancers, such as melanoma, vary widely between countries. As in the United States, the number of very long-term survivors (20 or more years after diagnosis) in Europe is growing (39). This long-term survivorship population has not been well characterized (40). A recent portfolio analysis of the National Institutes of Health funded studies reflects the low number of studies representing long-term survivorship (41). In addition, a report from the 2019 National Cancer Institute Cancer Survivorship Workshop that explored survivorship care called out research on long-term survivors an evidence gap (29). Lack of research can be attributed to limited inclusion or documentation of this population in clinical trials, minimal epidemiological studies capturing 10 or more years of cancer-related outcomes data, and fragmentation within medical care delivery systems. To adequately serve this population, it will be critical to study the characteristics and needs and examine clinician knowledge and treatment patterns for and understand health-care access and utilization of this growing population. Existing data resources that may support preliminary characterization, needs assessment, and health-care utilization of long-term survivorship populations include SEER-Medicare linked data resource (21) and large population-based surveys (eg, National Health and Aging Trends Survey) (42), as well as electronic medical record systems within established health networks. As existing clinical settings develop and implement learning health-care systems for cancer, additional documentation of treatment exposures, time-varying diagnoses, and patient-reported outcomes will be necessary to further characterize the needs of this population (43). Careful methodological approaches must be considered to capture the intersection of the development and progression of long-term and late effects of cancer with survivors’ precancer health profiles (44). The outcomes of this foundational research can support the development of long-term survivorship care planning, prepare workforce needs in terms of survivorship care delivery, and assess potential policy-related changes that support long-term survivors, their health-care providers, and related health systems (44).

Some limitations of this work should be acknowledged. These estimates utilize cancer incidence and survival data from the SEER registries, which do not include the entire United States. Prevalence projections are based on incidence and survival trends while reflecting the dynamic aging effect on the prevalence estimates. Although prevalence estimates are robust, they do not account for new cancer control policies or interventions that may arise during the study period. In addition, these findings do not include information on stage at diagnosis or the prevalence of cancer survivors living with advanced or metastatic cancer (5).

Finally, it is important to acknowledge a group of people who are not accounted for in this work. The growth in the number of cancer survivors, including those living beyond and those living with their cancer, means that there is also an increased number of people serving as informal cancer caregivers. There are currently an estimated 3 million cancer caregivers in the United States (45). Cancer caregivers provide unpaid support to their family, friends, or loved ones with cancer, including instrumental, emotional, and medical task support (46). Research has demonstrated that cancer caregivers experience substantial burden and have substantial needs for psychosocial support, financial assistance, and medical or nursing skills training to support their loved ones (2). Given the critical role that caregivers play, and the changing landscape of survivorship, future research should aim to examine and mitigate the trajectory of needs for cancer caregivers.

As the population of long-term survivors continues to grow so will the need to design health-care delivery to meet the needs of this population. A strong research and practice agenda, informed by survivorship science, is needed to continue to optimize survivorship care and patient outcomes.

Data availability

These data and software, along with detailed tutorials, are publicly available at https://seer.cancer.gov/seerstat/.

Author contributions

Emily S. Tonorezos, MD, MPH (Conceptualization; Data curation; Investigation; Methodology; Supervision; Visualization; Writing—original draft; Writing—review & editing), Theresa Devasia, PhD (Formal analysis; Investigation; Methodology; Software; Writing—original draft; Writing—review & editing), Angela B Mariotto, PhD (Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Writing—original draft; Writing—review & editing), Michelle A Mollica, PhD, MPH, RN, OCN (Conceptualization; Investigation; Writing—original draft; Writing—review & editing), Lisa Gallicchio, PhD (Conceptualization; Investigation; Writing—original draft; Writing—review & editing), Paige Green, PhD (Conceptualization; Investigation; Visualization; Writing—original draft; Writing—review & editing), Michelle Doose, PhD, MPH (Conceptualization; Investigation; Visualization; Writing—original draft; Writing—review & editing), Rachelle Brick, PhD, MSPH, OTR/L (Conceptualization; Investigation; Writing—original draft; Writing—review & editing), Brennan Streck, PhD, RN, MPH (Conceptualization; Investigation; Writing—original draft; Writing—review & editing), Crystal Reed, MHA (Investigation; Writing—original draft; Writing—review & editing), and Janet S de Moor, PhD, MPH (Conceptualization; Data curation; Investigation; Methodology; Supervision; Visualization; Writing—original draft; Writing—review & editing).

Funding

Not applicable. This manuscript was prepared as part of the authors’ official duties as employees of the US federal government. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute.

Conflicts of interest

None.