Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis

Marc Arbyn, Elisabete Weiderpass, Laia Bruni, Silvia de Sanjosé, Mona Saraiya, Jacques Ferlay, Freddie Bray, Marc Arbyn, Elisabete Weiderpass, Laia Bruni, Silvia de Sanjosé, Mona Saraiya, Jacques Ferlay, Freddie Bray

Abstract

Background: The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative.

Methods: For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis.

Findings: Approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed.

Interpretation: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem.

Funding: Belgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Geographical distribution of world age-standardised incidence of cervical cancer by country, estimated for 2018
Figure 2
Figure 2
Geographical distribution of world age-standardised mortality rate of cervical cancer by country, estimated for 2018
Figure 3
Figure 3
World age-standardised incidence and mortality rate for cervical cancer, estimates for 2018, ordered by country and ranked in descending order of mortality
Figure 3
Figure 3
World age-standardised incidence and mortality rate for cervical cancer, estimates for 2018, ordered by country and ranked in descending order of mortality
Figure 3
Figure 3
World age-standardised incidence and mortality rate for cervical cancer, estimates for 2018, ordered by country and ranked in descending order of mortality
Figure 3
Figure 3
World age-standardised incidence and mortality rate for cervical cancer, estimates for 2018, ordered by country and ranked in descending order of mortality
Figure 4
Figure 4
Ranking of cervical cancer incidence burden in 2018 relative to all other cancer sites in women of all ages (A) and aged 15–44 years (B)
Figure 5
Figure 5
Age-specific incidence of cervical cancer worldwide and in terms of the four-tier HDI The four tiers of HDI are the following: very high (HDI ≥0·8), high (HDI
All figures (8)

References

    1. Arbyn M, Castellsagué X, de Sanjosé S. Worldwide burden of cervical cancer in 2008. Ann Oncol. 2011;22:2675–2686.
    1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans Human papillomaviruses. IARC Monogr Eval Carcinog Risks Hum. 2007;90:1–636.
    1. Arbyn M, Xu L, Simoens C, Martin-Hirsch PP. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev. 2018;5
    1. de Sanjose S, Quint WG, Alemany L. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11:1048–1056.
    1. Bzhalava D, Guan P, Franceschi S, Dillner J, Clifford G. A systematic review of the prevalence of mucosal and cutaneous human papillomavirus types. Virology. 2013;445:224–231.
    1. Joura EA, Giuliano AR, Iversen OE. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372:711–723.
    1. IARC . vol 10. IARC Press; Lyon: 2005. Cervix cancer screening—IARC handbooks of cancer prevention.
    1. de Kok IM, van der Aa MA, van Ballegooijen M. Trends in cervical cancer in the Netherlands until 2007: has the bottom been reached? Int J Cancer. 2011;128:2174–2181.
    1. Arbyn M, Ronco G, Anttila A. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012;30(suppl 5):F88–F99.
    1. Ronco G, Dillner J, Elfström KM. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383:524–532.
    1. Smith RA, Andrews KS, Brooks D. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019;69:184–210.
    1. von Karsa L, Arbyn M, De Vuyst H. European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Res. 2015;1:22–31.
    1. WHO WHO Director-General calls for all countries to take action to help end the suffering caused by cervical cancer. 2018.
    1. WHO . World Health Organization; Geneva: 2008. 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases.
    1. de Sanjosé S, Diaz M, Castellsagué X. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007;7:453–459.
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
    1. Ferlay J, Colombet M, Soerjomataram I. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144:1941–1953.
    1. Arbyn M, Raifu AO, Weiderpass E, Bray F, Anttila A. Trends of cervical cancer mortality in the member states of the European Union. Eur J Cancer. 2009;45:2640–2648.
    1. Loos AH, Bray F, McCarron P, Weiderpass E, Hakama M, Parkin DM. Sheep and goats: separating cervix and corpus uteri from imprecisely coded uterine cancer deaths, for studies of geographical and temporal variations in mortality. Eur J Cancer. 2004;40:2794–2803.
    1. Dyba T, Hakulinen T. Comparison of different approaches to incidence prediction based on simple interpolation techniques. Stat Med. 2000;19:1741–1752.
    1. UN Development Programme Human development report 2016: human development for everyone. 2016.
    1. Waterhouse JAH, Muir CS, Shanmugaratnam K. 4th edn. International Agency for Research on Cancer; Lyon: 1976. Cancer incidence in five continents.
    1. Kleinbaum DG, Kupper LL, Morgenstern H. Van Nostrand Reinhold; New York: 1982. Epidemiologic research: principles and quantitative methods.
    1. Arbyn M, Raifu AO, Autier P, Ferlay J. Burden of cervical cancer in Europe: estimates for 2004. Ann Oncol. 2007;18:1708–1715.
    1. Allemani C, Matsuda T, Di Carlo V. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023–1075.
    1. Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer. 2001;37(suppl 8):S4–S66.
    1. Fitzmaurice C, Allen C, Barber RM. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2016;3:524–548.
    1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
    1. Vaccarella S, Laversanne M, Ferlay J, Bray F. Cervical cancer in Africa, Latin America and the Caribbean and Asia: regional inequalities and changing trends. Int J Cancer. 2017;141:1997–2001.
    1. Yang BH, Bray FI, Parkin DM, Sellors JW, Zhang Z-F. Cervical cancer as a priority for prevention in different world regions: an evaluation using years of life lost. Int J Cancer. 2004;109:418–424.
    1. Knaul MF, Gralow JR, Atun R, Bhadelia A. Harvard University Press; Cambridge: 2012. Closing the cancer divide: an equity imperative.
    1. Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP. Reducing social inequalities in cancer: evidence and priorities for research. CA Cancer J Clin. 2019;68:324–326.
    1. Walboomers JM, Jacobs MV, Manos MM. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–19.
    1. IARC Monograph Working Group . IARC Press; Lyon: 2007. IARC monographs on the evaluation of carcinogenic risks to humans. Vol 90: human papillomaviruses.
    1. Bruni L, Diaz M, Castellsagué X. Cervical HPV prevalence in five continents: meta-analysis on one million women with normal cytology. J Infect Dis. 2010;202:1789–1799.
    1. Plummer M, Herrero R, Franceschi S. Smoking and cervical cancer: pooled analysis of the IARC multi-centric case-control study. Cancer Causes Control. 2003;14:805–814.
    1. Smith JS, Muñoz N, Herrero R. Evidence for Chlamydia trachomatis as a human papillomavirus cofactor in the etiology of invasive cervical cancer in Brazil and the Philippines. J Infect Dis. 2002;185:324–331.
    1. Bower M, Mazhar D, Stebbing J. Should cervical cancer be an acquired immunodeficiency syndrome-defining cancer? J Clin Oncol. 2006;24:2417–2419.
    1. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol. 2012;13:790–801.
    1. Dhillon PK, Yeole BB, Dikshit R, Kurkure AP, Bray F. Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976–2005: an age-period-cohort analysis. Br J Cancer. 2011;105:723–730.
    1. Badwe RA, Dikshit R, Laversanne M, Bray F. Cancer incidence trends in India. Jpn J Clin Oncol. 2014;44:401–407.
    1. Castanon A, Sasieni P. Is the recent increase in cervical cancer in women aged 20-24 years in England a cause for concern? Prev Med. 2018;107:21–28.
    1. McDonald SA, Qendri V, Berkhof J, de Melker HE, Bogaards JA. Disease burden of human papillomavirus infection in the Netherlands, 1989-2014: the gap between females and males is diminishing. Cancer Causes Control. 2017;28:203–214.
    1. Dillner J, Sparen P, Andrae B, Strander B. Cervical cancer has increased in Sweden in women who had a normal cell sample. Lakartidningen. 2018;115 E9FD (in Swedish).
    1. Gustafsson L, Pontén J, Bergström R, Adami H-O. International incidence rates of invasive cervical cancer before cytological screening. Int J Cancer. 1997;71:159–165.
    1. WHO Global Health Observatory (GHO) data: HIV/AIDS. 2019.
    1. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010;19:1893–1907.
    1. Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS One. 2010;5
    1. Watson M, Saraiya M, Benard V. Burden of cervical cancer in the United States, 1998–2003. Cancer. 2008;113(suppl 10):2855–2864.
    1. Bray F, Loos AH, McCarron P. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev. 2005;14:677–686.
    1. Cox B, Skegg DC. Projections of cervical cancer mortality and incidence in New Zealand: the possible impact of screening. J Epidemiol Community Health. 1992;46:373–377.
    1. Vaccarella S, Franceschi S, Engholm G, Lönnberg S, Khan S, Bray F. 50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence. Br J Cancer. 2014;111:965–969.
    1. Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet. 2004;364:249–256.
    1. Laukkanen P, Koskela P, Pukkala E. Time trends in incidence and prevalence of human papillomavirus type 6, 11 and 16 infections in Finland. J Gen Virol. 2003;84:2105–2109.
    1. O'Brien KM, Sharp L. Trends in incidence of, and mortality from, cervical lesions in Ireland: baseline data for future evaluation of the national cervical screening programme. Cancer Epidemiol. 2013;37:830–835.
    1. Mendes D, Mesher D, Pista A, Baguelin M, Jit M. Understanding differences in cervical cancer incidence in Western Europe: comparing Portugal and England. Eur J Public Health. 2018;28:343–347.
    1. Arbyn M, Antoine J, Mägi M. Trends in cervical cancer incidence and mortality in the Baltic countries, Bulgaria and Romania. Int J Cancer. 2011;128:1899–1907.
    1. Bray F, Lortet-Tieulent J, Znaor A, Brotons M, Poljak M, Arbyn M. Patterns and trends in human papillomavirus-related diseases in Central and Eastern Europe and Central Asia. Vaccine. 2013;31(suppl 7):H32–H45.
    1. Miller AB, Visentin T, Howe GR. The effect of hysterectomies and screening on mortality from cancer of the uterus in Canada. Int J Cancer. 1981;27:651–657.
    1. WHO. Arbyn M, Blumenthal P, Cain J. WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention. In: Broutet N, editor. WHO. World Health Organisation; Geneva: 2013. pp. 1–40.
    1. Arbyn M, Smith SB, Temin S, Sultana F, Castle P. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ. 2018;363
    1. Drolet M, Bénard É, Pérez N. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394:497–509.
    1. Guo F, Cofie LE, Berenson AB. Cervical cancer incidence in young u.s. females after human papillomavirus vaccine introduction. Am J Prev Med. 2018;55:197–204.
    1. Luostarinen T, Apter D, Dillner J. Vaccination protects against invasive HPV-associated cancers. Int J Cancer. 2018;142:2186–2187.
    1. WHO Global strategy towards the elimination of cervical cancer as a public health problem. 2019.
    1. Simms KT, Steinberg J, Caruana M. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncol. 2019;20:394–407.
    1. Goodman T, EPI Team/IVB Update on HPV vaccine introduction and programmatic perspectives. 2018.
    1. Bruni L, Diaz M, Barrionuevo-Rosas L. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016;4:e453–e463.
    1. Rodriguez NM, Wong WS, Liu L, Dewar R, Klapperich CM. A fully integrated paperfluidic molecular diagnostic chip for the extraction, amplification, and detection of nucleic acids from clinical samples. Lab Chip. 2016;16:753–763.
    1. Toliman PJ, Kaldor JM, Badman SG. Evaluation of self-collected vaginal specimens for the detection of high-risk HPV infection and the prediction of high-grade cervical intraepithelial lesions in a high-burden, low-resource setting. Clin Microbiol Infect. 2019;25:496–497.
    1. Hu L, Bell D, Antani S. An observational study of deep learning and automated evaluation of cervical images for cancer screening. J Natl Cancer Inst. 2019;111:923–932.
    1. WHO . World Health Organization; Geneva: 2019. WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions.
    1. Ogilvie G, Nakisige C, Huh WK, Mehrotra R, Franco EL, Jeronimo J. Optimizing secondary prevention of cervical cancer: Recent advances and future challenges. Int J Gynaecol Obstet. 2017;138(suppl 1):15–19.
    1. Holme F, Kapambwe S, Nessa A, Basu P, Murillo R, Jeronimo J. Scaling up proven innovative cervical cancer screening strategies: challenges and opportunities in implementation at the population level in low- and lower-middle-income countries. Int J Gynaecol Obstet. 2017;138(suppl 1):63–68.
    1. Knaul FM, Farmer PE, Krakauer EL. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018;391:1391–1454.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel