title: Recent declines in cancer incidence: related to the Great Recession?
abstract: In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions.
  
  
  
  Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression.
  
  
  
  Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index.
  
  
  
  Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA. scarlett@cpic.org.|Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA. scarlett@cpic.org.|Stanford Cancer Institute, Stanford, USA. scarlett@cpic.org.
authors.forename: Scarlett Lin
authors.initials: SL
authors.lastname: Gomez
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Canchola
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.|Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Nelson
authors.affiliation: Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.|Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.|Stanford Cancer Institute, Stanford, USA.
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.|Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, USA.
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.
authors.forename: Mindy
authors.initials: M
authors.lastname: DeRouen
authors.affiliation: School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Catalano
authors.affiliation: School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Satariano
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Davidson-Allen
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA.|Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA.|Stanford Cancer Institute, Stanford, USA.
authors.forename: Sally L
authors.initials: SL
authors.lastname: Glaser
mesh_terms: D002140:California / Q000453:epidemiology; D057172:Economic Recession; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D014478:Unemployment
keywords: Case counts; Economy; Recession; Unemployment