Background: The extreme elderly (EE; > 84. years) are among the fastest growing segments of the population and bear a substantial cancer burden. We examined cancer incidence and cancer specific mortality changes among the EE during the implementation of cancer screening from the 1980s to 2000s. Methods: We examined incidence and mortality rates for breast, colon, prostate, and lung cancer by age group between 1973 and 2009 in the SEER database. We compared incidence/mortality between EE and middle aged (MA; age 50-69) patients. Results: Prostate cancer incidence and mortality rose and then, in the early 1990s, declined (- 3.61%/year and - 2.91%/year, respectively) among EE. Prostate cancer incidence rose steadily throughout the study period for MA. Breast cancer incidence rose and then declined for both MA and EE, with the decline starting in 1990 for EE (- 1.34%/year), and 1998 for MA (- 1.24%/year). Both age groups experienced an increase and then decrease in colon cancer incidence. The decrease in colon cancer mortality over the last decade was profound for all patients (- 2.88%/year MA, and - 3.29%/year EE). Lung cancer incidence (+. 2.35%/year to 2005) and mortality (+. 1.25%/year from 1995) increased for EE. Lung cancer incidence and mortality increased and then decreased (- 2.54%/year for mortality from 1990) for MA. Conclusion: Recent trends in incidence and mortality for screened cancers (breast, colon, prostate) show substantial gains for the extreme elderly, likely due in part to the effect of screening. Incidence and mortality from lung cancer, with no recommended screening during the study period, have continued to worsen for the extreme elderly, despite improvements in younger patient populations.