🇨🇦 Cancer in Canada

The 2026 projections, published in CMAJ on 13 April 2026 by the Canadian Cancer Statistics Advisory Committee with the Canadian Cancer Society, Statistics Canada and the Public Health Agency of Canada, put lung cancer at 32,900 new cases and 19,300 deaths (the news release says 19,200), causing one cancer death in five. Breast follows at 32,700 cases, prostate at 29,300 and colorectal at 25,300; pancreatic cancer, eleventh by cases at 7,500, is projected to be the third leading cause of cancer death at 6,500, behind lung and colorectal. The age-standardised incidence rate for all cancers is 591.4 per 100,000 and the mortality rate 200.0, both on the 2021 Canadian standard population and both projected to fall; the incidence rate is 16 per cent higher in males (642.2 against 553.9) and the mortality rate 36 per cent higher (235.8 against 172.8). The release adds that cancer caused about one in four deaths in Canada in 2023 and remains the leading cause of death. In the 2025 report, 93 per cent of new cases in males and 87 per cent in females were expected in people aged 50 and over.

The news release accompanying the 2026 CMAJ article lists among its key findings that "more females than males are projected to be diagnosed with lung cancer in 2026". The authors write that "a higher proportion of lung cancers among females are not explained by tobacco consumption", and suggest that other exposures, among them lifestyle factors, radon and air pollution, may need to be addressed to reduce incidence further. Lung cancer remains the leading cause of cancer death in both sexes. The same release notes that many provinces have now started lung cancer screening programmes at various stages of implementation. Colorectal cancer runs the other way: it is projected to be 32 per cent lower in males and 29 per cent lower in females than in the early 2000s, and the 2025 report attributes part of the decline since 2011 to organised colorectal screening, which Yukon and every province except Quebec introduced between 2007 and 2016.

The 2025 report gives predicted five-year net survival for all cancers combined of 64 per cent for diagnoses in 2015 to 2017, ages 15 to 99, Canada excluding Quebec; ten-year net survival is 58 per cent. It was 66 per cent in females and 62 per cent in males. Survival has improved since the early 1990s for every cancer reported except those of the central nervous system, intrahepatic bile duct, uterus and soft tissues, with some of the largest gains in blood cancers; acute myeloid leukaemia remains at 23 per cent against 86 per cent for chronic lymphocytic leukaemia. Among the provinces studied, five-year survival for all cancers is highest in Ontario (64 per cent) and lowest in Nova Scotia (61 per cent). Mortality rates for all cancers combined peaked in 1988 and have fallen since, with lung, colorectal and bladder cancer death rates falling by more than 3 per cent a year in recent years, while the number of deaths keeps rising with a growing and ageing population. These survival figures are now about a decade old: the 2026 cancer-specific table still quotes survival for cases diagnosed in 2015 to 2017.

The 2025 report projects the highest age-standardised incidence rates in Quebec, 727.4 per 100,000 in males and 618.4 in females, reflecting the highest projected rates for lung, breast and prostate cancer; prostate ranges from 137.0 per 100,000 in New Brunswick to 169.7 in Quebec, and female breast from 125.5 in New Brunswick to 166.1 in Quebec. Colorectal cancer is projected to be highest in Newfoundland and Labrador (116.8 per 100,000 in males and 71.4 in females) and lowest in Alberta for males (64.0) and Saskatchewan for females (42.6). Mortality follows the same gradient: lower in the western provinces and Ontario, higher in Quebec and the Atlantic provinces. The report attributes the differences to risk factors such as smoking and obesity and also to diagnostic practice, data collection and data availability, noting that "projections for Quebec are based on data up to 2017, while data up to 2019 were available for other provinces and territories, which could have influenced Quebec's ranking." Melanoma rates are highest in Nova Scotia and Prince Edward Island.

Statistics Canada's survey description (record 3207, data release 27 February 2026, detailed information for reference year 2023) describes the Canadian Cancer Registry as a person-based, population-based registry holding every new primary cancer diagnosed among Canadian residents since 1992, governed by the Canadian Council of Cancer Registries, a collaboration between the 13 provincial and territorial cancer registries and Statistics Canada's Centre for Population Health Data. "Ultimate authority and responsibility for the completeness and the quality of the data resides with the provinces and territories while StatCan is the custodian of the CCR." Each registry finds cases from cancer clinic files, radiotherapy and haematology reports, hospital and outpatient records, pathology and laboratory reports, imaging, and death registrations. The national statistics are then produced from this registry and from the Canadian Vital Statistics Death Database by the Canadian Cancer Statistics Advisory Committee, which publishes a full report every second year and, in between, projections and a special report.

The 2025 report explains that its incidence data run to 2021 but that 2020 was excluded from projections because the pandemic disrupted screening and diagnosis, so incidence projections rest on data to 2019; Quebec's cases diagnosed from 2018 onward had not been submitted to the Canadian Cancer Registry at the time of analysis, so Quebec was projected from 2017, and Nova Scotia's data were available only to 2019. Lifetime-probability tables therefore cover Canada excluding Quebec and Nova Scotia, and survival covers Canada excluding Quebec. The 2026 cancer-specific table labels its case projections "based on data to 2019" and its death projections "based on data to 2022", while the CMAJ abstract says registry data were used "until 2022". The article's methods explain the difference: incidence data from 1997 to 2022, with 2020 left out, were used for every jurisdiction except Quebec and Nova Scotia, whose cases diagnosed after 2017 and after 2019 respectively had not reached the registry, so the table's label appears to describe only part of the data. Statistics Canada's own description adds that cancer incidence data are currently not available for Nova Scotia for diagnosis years 2020 onward, and that cross-provincial de-duplication of records was last completed to the end of 2022 for all provinces and territories except Quebec, where it "has not yet been completed and is ongoing", and Nova Scotia, where it stops at 2019.

The 2025 report states that incidence and mortality rates "are now standardized to the 2021 Canadian standard population, whereas they were standardized to the 2011 Canadian standard population in previous editions (2016 to 2024)", that the age-standardised rates "will generally appear higher than those reported in previous editions", and that they "should not be compared to previous editions, nor should they be compared to rates standardized to different populations (e.g., between countries that use different standard populations)." Its "all cancers" includes in situ bladder cancer and excludes non-melanoma skin cancer; bladder trends are modelled with a jump at 2010 because Ontario began registering in situ bladder carcinoma that year. Statistics Canada adds that Quebec's registry changed its sources in 2011 to 2013, adding pathology reports and then local hospital cancer registries to the hospital-discharge data it had relied on, so Quebec counts before 2011 are underestimates, most for prostate cancer and melanoma.

A 2022 review of the pathway for new cancer drugs in Current Oncology sets out the split. British Columbia, Alberta and Saskatchewan fund and administer all cancer drugs, oral and intravenous. Manitoba and Ontario also have cancer agencies, but funding and administration vary with the type of drug. In Ontario and eastern Canada, oral therapies are dispensed by community pharmacies and paid through the provincial public drug programmes, while intravenous cancer drugs given in hospital are paid by the cancer programmes. Quebec pays for intravenous cancer drugs from individual hospital budgets, reimbursed by the provincial health ministry. Federal plans that belong to the pan-Canadian Pharmaceutical Alliance cover particular groups: Non-Insured Health Benefits, Correctional Service Canada and Veterans Affairs Canada. The same review cites the Patented Medicine Prices Review Board's finding that annual spending on cancer drugs tripled to $3.9 billion in 2019, 14.6 per cent of the drug market against 7.1 per cent in 2009. OnCo has not read each province's current take-home drug rules and lists that as a gap.

Cancer drug reviews were run from Ontario for the other provinces (the Joint Oncology Drug Review) between 2007 and 2010, then by the pan-Canadian Oncology Drug Review from July 2011, which was later absorbed into CADTH, now Canada's Drug Agency (CDA-AMC); the 2022 review describes its pCODR Expert Review Committee as making the final funding recommendation for every cancer drug reviewed through that process, for every province except Quebec. A study of 88 cancer indications approved between 2003 and 2014 in nine provinces found that after pCODR began the median time from Health Canada's Notice of Compliance to provincial funding fell from 522 to 393 days, and that agreement between provinces on what to fund rose (a Brennan-Prediger coefficient of 0.54 before and 0.78 after). The 2022 review reports that CADTH's target is about 200 days from screening to final recommendation, that the pan-Canadian Pharmaceutical Alliance "does not publish formal review or negotiation timelines, nor the criteria used in decision-making", and that studies found the time from a pCODR recommendation to publication of the negotiation outcome for cancer drugs took as long as 371 days in 2016. The Patented Medicine Prices Review Board, created in 1987, sets ceiling prices for patented medicines; the price a province actually pays is the confidential negotiated one.

Between July 2011 and February 2020 pCODR issued 104 final recommendations on cancer drugs for solid tumours: 78 (75.0 per cent) were positive, of which 72 (92.3 per cent) were conditional. Positive recommendations were more likely for phase 3 randomised evidence (92.3 against 53.8 per cent) and for substantial benefit on the ESMO Magnitude of Clinical Benefit Scale (61.5 against 19.2 per cent), but only 39 of the 78 positively recommended submissions had shown an overall survival benefit, with a median gain of 3.7 months. For the Project Orbis approvals of May 2019 to November 2023, CADTH conditionally recommended 44 of the 49 it reviewed (90 per cent), and its median time from regulatory approval to decision rose from 97 days (one drug, 2020) to 202 days in 2023. A 2025 comparison of reimbursement in Australia, Canada, England and China notes that for manufacturers submitting to CADTH or Australia's PBAC "the cost-effectiveness threshold is uncertain", unlike NICE's explicit one. OnCo could not read CDA-AMC's own methods guidance to state the willingness-to-pay value it uses in its reanalyses; see gaps.

The Council of the Federation records that the alliance began in August 2010 as the pan-Canadian Pricing Alliance, created by the premiers through their Health Care Innovation Working Group; it was formalised under its present name in 2015 with an office hosted and staffed by the Government of Ontario, became a standalone corporation in late 2022 and completed the transition in 2023. Its members are the public drug plans of all ten provinces and three territories, plus Non-Insured Health Benefits, Correctional Service Canada and Veterans Affairs Canada. Its stated objectives are to increase access to clinically effective and cost-effective treatment, achieve consistent and lower drug costs, reduce duplication and improve consistency of decisions between jurisdictions. The 2022 review in Current Oncology adds that drugs "rejected by the participating plans (i.e., pCPA or individual plans decline to participate in negotiations or negotiations do not result in agreement) are generally not eligible for public funding even though they have been approved by HC." The alliance's own site did not answer OnCo's requests, so its negotiation database was not read.

A 2025 brief report examined the nine cancer drugs granted a Notice of Compliance with conditions between 1 January 2023 and 31 December 2024. Three of them had received provincial listings (glofitamab, niraparib with abiraterone, and epcoritamab), with a median of 509 days from licence to first provincial listing (interquartile range 306 to 544). Epcoritamab was the only one to take the new time-limited recommendation and temporary access route; compared with glofitamab, which has a similar profile and took the ordinary route, it reached its first listing more than 200 days sooner. The authors found that the gain came from the alliance processing the file in parallel with the review rather than afterwards, not from either agency reviewing faster; CDA-AMC review times for all three fell within its target of 180 days or less. When the report was written a second drug had been announced as entering the route: a new indication for trastuzumab deruxtecan, whose conditional licence and the alliance's letter of intent were both dated 17 January 2025.

INESSS, the Institut national d'excellence en santé et en services sociaux, was created on 19 January 2011, succeeding the Conseil du médicament and the Agence d'évaluation des technologies et des modes d'intervention en santé. Its drug evaluation page describes its mandate as evaluating listing requests for drugs and drug-delivery devices "dans le but de faire des recommandations au ministre de la Santé" when the lists of covered drugs are updated, and it keeps a separate category of exceptional drugs in oncology (médicaments d'exception, oncologie) and publishes cancer treatment algorithms. The 2022 review in Current Oncology says the Quebec process is modified to consider "societal factors", that "in Quebec, individual citizens can also submit their feedback to INESSS", and that the province has "a more generous and separately adjudicated individual patient review program, which may provide access to medicines that are rejected by INESSS." Quebec still joins the pan-Canadian Pharmaceutical Alliance for price negotiation.

Health Canada's priority review guidance sets a performance target of 215 calendar days for screening and review of an original priority submission (10 days processing, 25 days screening, 180 days review) and 125 days for the response to a notice of non-compliance; priority status is for serious, life-threatening or severely debilitating conditions where no drug is marketed in Canada or the new drug brings a significant improvement in benefit and risk. Submissions filed for advance consideration under the Notice of Compliance with conditions policy have a review target of 200 calendar days plus 10 days processing and 25 days screening; the guidance explains that the longer target reflects the limited data on which such licences are often based. The 2022 review in Current Oncology gives Health Canada's general commitment for a standard decision as 300 days. OnCo did not measure how long Health Canada actually takes for cancer drugs against the FDA or the European Medicines Agency; see gaps.

Health Canada issued its first Notice of Compliance with conditions policy in May 1998 and revised it in November 2002; sponsors must sign a letter of undertaking to carry out confirmatory trials, and the guidance describes enhanced post-market surveillance of conditionally authorised products. An analysis of Health Canada and pCODR records for 2010 to 2017 found that 22 of 105 unique drug and indication pairs reviewed by pCODR (21 per cent) had conditional authorisation, all on preliminary surrogate-endpoint data; 36 per cent had no updated data, 36 per cent had data meeting Health Canada's conditions and 27 per cent met some but not all. None received an unconditional positive funding recommendation; 11 (50 per cent) were conditionally recommended and 6 (27 per cent) not recommended for insufficient evidence. In the period studied Health Canada never revoked a conditional authorisation for failure to meet its conditions.

Health Canada's page says it has been a partner "since its inception in May 2019", worked with the FDA and Australia's TGA on the first Orbis submission, and that this "led to Health Canada's timely approval of a treatment for women with advanced endometrial cancer in September 2019". Eligible products are new active substances or new indications in oncology that meet the FDA's priority review criteria and qualify for Health Canada's priority review or advance consideration for a conditional licence. Three collaboration types exist: Type A when the sponsor files with a partner within 30 days of the FDA, Type B when later, and Type C when the FDA has already approved and shares its completed review. Health Canada states that its service standards do not change for Orbis submissions, though it may decide faster, and that each partner decides independently. A 2024 analysis in Lancet Oncology found 81 of 244 FDA cancer approvals between May 2019 and November 2023 went through Orbis; of the 49 reviewed by CADTH, 44 were conditionally recommended, and CADTH's median time from approval to decision rose to 202 days in 2023.

The group's 2025 annual report records 113,290 patients accrued since 1980, of whom 82,627 were in Canada, 20,260 in the United States and 10,403 elsewhere; an accrual panel giving 3,304 patients accrued globally in 2025, 3,053 of them in Canada, while the report's highlights text says "in total, 1,359 patients were accrued" (the report does not reconcile the two); 166 trials in the portfolio (72 led by CCTG, 60 led by the United States National Clinical Trials Network, 11 network trials led by CCTG and 22 led by other international groups), 56 open to accrual and seven newly activated; 78 abstracts and 50 publications; and a network of 86 Canadian centres working with 680 international centres in 20 countries. The report calls CO.21 CHALLENGE a world-first trial that "showed that a structured exercise program significantly improves survival for patients with stage III colon cancer by reducing recurrence and new primary cancers", over 17 years, and describes ME.17 as "one of the largest randomized trials investigating fecal microbiota transplantation with immune checkpoint blockade for advanced melanoma". Earlier trials of the group under its former name, the NCIC Clinical Trials Group, including JBR.10, CO.17 and MA.20, are in the trial list below.

The Marathon of Hope Cancer Centres Network's own history says Terry Fox was diagnosed with osteogenic sarcoma at 18 and had his right leg amputated 15 centimetres above the knee in 1977; he started his run in St. John's, Newfoundland, on 12 April 1980, ran close to 42 kilometres a day, and stopped on 1 September after 143 days and 5,373 kilometres; he died on 28 June 1981 at 22. The federal budget tabled on 18 March 2019 committed up to $150 million to the Terry Fox Research Institute to establish the network; the contribution agreement with Health Canada requires member institutes, cancer centres and philanthropic partners to match it dollar for dollar, for $300 million in new funds. Its central project is the MOHCCN Gold Cohort, paired clinical and genomic data from 15,000 Canadian cancer patients, generated through five regional consortia and more than 30 partner institutions under standards set by eleven working groups.

The Partnership describes itself as "funded by the federal government" to accelerate pan-Canadian action under the Canadian Strategy for Cancer Control, a 10-year plan with eight priorities, and as having served as a catalyst for cancer care since 2007. Its lung screening page states that Ontario has a lung screening programme at four sites, British Columbia a province-wide programme at 36 sites, and Quebec a pilot project, with other provinces working to set programmes up; the page is undated and OnCo has not checked each province's current status. It also states that First Nations adults are 35 per cent less likely than non-Indigenous adults to survive lung cancer five years after diagnosis. Its cervical cancer page gives about 1,300 diagnoses and over 400 deaths a year and describes moves to raise HPV vaccination, switch screening from the Pap test to HPV primary testing with self-sampling, and improve follow-up of positive tests.

The websites of BC Cancer, the Saskatchewan Cancer Agency and CancerCare Manitoba each list provincial screening programmes and a provincial cancer registry, and CancerCare Manitoba calls itself "the provincial cancer authority responsible for setting strategic priorities and long-term planning for cancer and blood disorders for the province"; OnCo did not check the same for Cancer Care Alberta. The 2022 review in Current Oncology records that the three westernmost fund and administer all cancer drugs, oral and intravenous, while Manitoba and Ontario have agencies whose funding role varies with the type of drug. Each provincial and territorial registry is the source of record for the national figures, which is why a delay in one province's submission, as with Quebec and Nova Scotia, removes it from the national incidence tables. The agencies are in OnCo's institution list below.

Missing as a result: the agency's own statement of the cost-effectiveness threshold or willingness-to-pay value it uses when it reanalyses a manufacturer's model, the price reductions it has asked for on recent cancer drugs, its current review timelines and the date and terms of its change of name from CADTH. The Internet Archive was offline when OnCo tried it. Each figure in the payment cards is attributed to the published study it came from; none is the agency's own.

The Council of the Federation's archive page, which points readers to the alliance's own site, was used for its history and membership. A holding page may be a fault on the day rather than a lapsed domain, so OnCo has not changed the alliance links held elsewhere in the corpus; it is recorded here so that a later reader can check.

The Registre québécois du cancer is run by the province; the national reports say Quebec's cases from 2018 onward had not reached the Canadian Cancer Registry at the time of analysis, and Statistics Canada says cross-provincial de-duplication for Quebec is ongoing. Nova Scotia has a similar gap from 2020. These are the two places to look first for a fuller national picture.

Sources exist for most of these and were not read in this pass: Health Canada's annual drug submission performance reports; provincial formularies and the Canadian Cancer Society's advocacy material on take-home cancer drugs (the address OnCo tried returned not found); Statistics Canada's Health Reports on five-year survival by stage (Ellison and Saint-Jacques, 2023, cited in the 2025 report but not read); and the Canadian Partnership Against Cancer's First Nations, Inuit and Métis indicators. A ClinicalTrials.gov count of interventional cancer studies with a Canadian site, of the kind on the Russia page, was not run.