Global, regional, and national burden of cervical cancer for 195 countries and territories, 20072017: findings from the Global Burden of Disease Study…

Incidence counts, age-standardized incidence rates per 100,000 population, and percentage changes by countries and territories

In 2017, approximately 601,186 incident cases of cervical cancer were reported globally (95% UI, 554,455 to 625,402), with an 18.9% (12.8% to 23.0%) increase since 2007 (Additional file 1: Table S1). The age-standardized incidence rate of cervical cancer was 14.5 (13.4 to 15.1) per 100,100person-years in 2017, with a2.8% (7.8% to 0.6%) decrease since 2007 (Fig.1A, B).

Age-standardized rates for incidence (A), DALYs (C), and death (E) of cervical cancer in 2017, and percentage change of age-standardized rates for incidence (B), DALYs (D), and death (F) of cervical cancer between 2007 and 2017, globally, by SDI quintile and by 21 GDB regions. DALYs disability-adjusted life-years, SDI socio-demographic index

In 2017, the highest age-standardized incidence rates of cervical cancer were observed in the low SDI quintile (23.5 [21.3 to 26.0] per 100,000 person-years), whereas the lowest rate was observed in the high SDI quintile (9.2 [8.8 to 9.5]) (Fig.1A). The age-standardized incidence rates decreased in all the SDI quintiles from 2007 to 2017, with the highest decrease in the high SDI quintile (6.7% [10.1% to3.5%]) and the lowest decrease in the middle SDI quintile (2.0% [11.0% to 3.3%]) (Fig.1B).

Regionally, the highest age-standardized incidence rates of cervical cancer were found in Oceania (47.6 [34.8 to 62.8] per 100,000 person-years), Central Sub-Saharan Africa (42.9 [31.5 to 52.8]), and Eastern Sub-Saharan Africa (34.9 [29.8 to 41.4]), while the lowest incidence rates were found in North Africa and Middle East (5.6 [4.9 to 6.2] per 100,000 person-years), Australasia (6.3 [5.3 to 7.4]), and Western Europe (8.3 [7.8 to 8.8]) (Fig.1A). During 2007 to 2017, an increase in incidence rates was noted only in East Asia (17.6% [10.9% to 27.8%]), South Asia (4% [4.3% to 12.5%]) and high-income North America (2.2% [3.8% to 8.7%]), but the increase was not significant. Southern Sub-Saharan Africa had the largest decrease in age-standardized incidence rate (32.3% [41.6% to24.0%]), followed by Eastern Europe (21.1% [26.0 to15.5%]) and Central Europe (19.6% [24.1% to14.8%]) (Fig.1B).

The 2017 global map of the age-standardized incidence rates of cervical cancer is presented in Fig.2A. In 2017, the highest age-standardized incidence rates were found in Kiribati (89.6 [65.5 to 118.6] per 100,000 person-years), Somalia (56.6 [37.4 to 82.1]), and Eritrea (56.2 [39.4 to 78.5]). On the contrary, the lowest incidence rates were found in Kuwait (2.6 [2.2 to 3.1] per 100,100person-years), Iraq (2.7 [2.3 to 3.3]), and Egypt (3.2 [2.5 to 4.0]). During 2007 to 2017, the largest increases in age-standardized incidence rates were noted in Georgia (27.9% [10.6% to 48.3%], China (19.7% [10.3% to 30.5%]) and Costa Rica (15.2% [2.3% to 35.7%]), and the largest decreases were noted in Kuwait (44.7% [53.8% to33.8%]), Lithuania (42.0% [50.2% to31.6%]), and Jordan (36.2% [50.8% to14.2%])(Additional file 2: Table S2).

Age-standardize rates for incidence (A), DALYs (B) and death (C) of cervical cancer across 195 countries and territories, 2017. This figure was drawn using the extracted data by the authors. DALYs disability-adjusted life-years

The 2017 age-specific (15 to>80years) incidence rates of cervical cancer worldwide and by all the SDI quintile are presented in Additional File 3: Fig. S1A. Globally, the incidence rates of cervical cancer increased after the age of 25years, peaked at the age of 5054years, and decreased slightly thereafter. Generally, the peak incidence rate was earlier in the lower SDI quintiles such as at the age of 5054years in the low SDI quintile and at 6569years in the high-middle SDI quintile. In the high SDI quintile, the incidence rate increased until the age of 3539years and was stable thereafter until a further rise after the age of 75years and more.

Figure3A, B illustrate the age distribution of cervical cancer incident cases in 2007 and 2017. In 2017, the lower the SDI, the higher the proportion of incident cases among younger women (44years), with the highest proportion of incident cases among younger women in Oceania (58.9%), Southern Latin America (48.7%), and Western Sub-Saharan Africa (48.5%). During 2007 to 2017, a slight decrease was noted in the proportion of incident cases among younger women worldwide, in all the SDI quintiles and in most regions, except for South and Tropical Latin America, Eastern Europe, and Eastern Sub-Sahara Africa.

Age-distribution for incident, DALYs, and death cases of cervical cancer by 21GBD regions, 2007 and 2017. A Incident cases of cervical cancer in 2007. B Incident cases of cervical cancer in 2017. C DALYs cases s of cervical cancer in 2007. D DALYs cases of cervical cancer in 2017. E Death cases of cervical cancer in 2007. F Death cases of cervical cancer in 2017. DALYs disability-adjusted life-years, SDI socio-demographic index

Figure4A illustrates the secular trend in age-standardized incidence rate of cervical cancer across the SDI quintiles by regions from 1990 to 2017 and the expected levels based only on the SDI values of the global regions. We found that the expected values of the age-standardized incidence rate decreased with an increase in the SDI value. Most regions generally saw a steady decrease in incidence rate with an increase in the SDI value, with values close to the expected line. In addition, the highest observed value was corresponded to an SDI of 0.58 in Southern Sub-Saharan Africa, and, observed values largely decreased with increasing SDI value after 2007 in this region. East Asia exhibited a slight increase in the observed age-standardized incidence rate with increasing SDI value. Eastern sub-Saharan Africa exhibited the largest decrease in incidence rate with an increase in the SDI value.

The trend in age-standardized incidence (A), DALYs (B), and death (C) rates of cervical cancer in 21 GBD regions by SDI, 19902017. For each region, points from left to right depict estimates from each year from 1990 to 2017. The black line represents the average expected relationship between SDI and burden estimates rates for T2DM based on values from each geographical region over the 19902017 estimation period. DALYs disability-adjusted life-years, SDI socio-demographic index

In 2017, cervical cancer was responsible for 8,061,667 [7,527,014 to 8,401,647] DALYs globally, representing a 15.2% [9.5% to 19.2%] increase in DALYs since 2007 (Additional file 1: Table S1). The 2017 age-standardized DALYs rate was 193.0 [180.2 to 201.2] per 100,000 person-years, which had declined by7.1% [11.8% to3.9%] from 2007 to 2017 (Fig.1C, D).

In 2017, the low SDI quintile had the highest age-standardized DALYs rate (391.2 [352.7 to 431.5] per 100,000 person-years), whereas the high SDI quintile had the lowest DALYs rate (84.7 [81.9 to 87.8]) (Fig.1C). The age-standardized DALYs rates decreased in all the SDI quintiles from 2007 to 2017, with the largest decrease in the high-middle SDI quintile (12.5% [22.7% to8.2%]) and the lowest decrease in the middle SDI quintile (8.3% [16.5% to3.8%]) (Fig.1D).

A substantial difference was noted in the age-standardized DALYs rates across regions, ranging from the highest rates in Central Sub-Saharan Africa (730.8 [544.9 to 900.8] per 100,000 person-years), Oceania (676.0 [507.9 to 867.4]), and Eastern Sub-Saharan Africa (605.8 [514.8 to 722.7]) to the lowest rates in Australasia (65.4 [56.8 to 75.1] per 100,000 person-years), Western Europe (74.7 [70.6 to 79.0]), and North Africa and Middle East (75.7 [65.1 to 83.9]) (Fig.1C). During 2007 to 2017, an increase in age-standardized DALYS rates were observed only in high-income East Asia (7.2% [19.7% to 15.8%]) and high-income North America (0.2% [4.7% to 5.6%]). In this period, the largest decreases in the age-standardized DALYs rates were noted in Southern Sub-Saharan Africa (32.7% [40.4% to25.9%]), Eastern Europe (28.3% [31.0% to25.5%]), and Central Europe (23.3% [27.0% to19.3%]) (Fig.1D).

The global map of age-standardized DALYs rates of cervical cancer in 2017 is presented in Fig.2B. The 2017 age-standardized DALYs rates varied by nearly 50 times across countries, with the highest DALYs rates in Kiribati (1400.7 [1040.1 to 1828.6] per 100,000 person-years), Central African Republic (1064.6 [638.6 to 1487.8]), and Somalia (1062.1 [716.1 to 1546.9]), while the lowest DALYs rates in Kuwait (29.1 [25.4 to 33.2] per 100,000 person-years), Iraq (39.0 [32.5 to 46.6]), and Egypt (42.4 [33.8 to 52.1]) (Fig.2B). From 2007 to 2017, the largest increases in the age-standardized DALYs rates were noted in Georgia (25.5% [11.8% to 41.1%]), Tajikistan (10.5% [11.2% to 34.6%]), Jamaica (10.2% [13.3% to 41.0%]). On the contrary, the largest decreases were noted in Kuwait (48.7% [55.5% to40.7%]), Lithuania (44.1% [36.2% to50.6%]), and Jordan (40.5% [20.8% to53.9%]) (Additional file 2: Table S2).

The 2017 age-specific (15 to>80years) DALYs rates of cervical cancer worldwide and by the SDI quintile are presented in Additional file 3: Fig. S1B. The DALYs rates peaked at the age of 5054years globally as well as in the most SDI quintiles and at 5559years in the high SDI quintile.

Figure3C, D illustrate the age distribution of DALYs for cervical cancer in 2007 and 2017. In 2017, the proportion of DALYs increased in younger women (44years) with a decrease in the SDI value, with the highest proportion of DALYs among younger women in Oceania (50.5%), Western Sub-Saharan Africa (47.4%), and Eastern Sub-Saharan Africa (36.3%). During 2007 to 2017, a slight decrease was noted in the proportion of DALYs among younger women worldwide, in all the SDI quintiles and in most regions, except for South Latin America and Eastern Sub-Sahara Africa.

Figure4B demonstrates the secular trend in the age-standardized DALYs rate across the SDI quintiles by region from 1990 to 2017 and the expected levels based only on the SDI values of the global regions. The correlation of the SDI with age-standardized DALYs rate yielded a pattern similarly to that with the age-standardized incidence rate. What is different is that, the highest observed value was corresponded to an SDI of 0.23 in Eastern Sub-Saharan Africa, while the decrease trend in observed values slowed down with increasing SDI value after 2007 in this region.

In 2017, cervical cancer caused 259,671 [241,128 to 269,214] deaths globally, with an age-standardized death rate of 6.2 [5.7 to 6.4] per 100,000 person-years (Additional file 1: Table S1). An 18.8% [12.9% to 22.8%] increase in death cases and a6.9% [11.5% to3.7%] decrease in the age-standardized death rate were observed between 2007 and 2017 (Fig.1E, F).

In 2017, the low SDI quintile had the highest age-standardized death rate (12.4 [11.3 to 13.8] per 100,000 person-years), whereas the high SDI quintile had the lowest death rate (2.8 [2.8 to 2.9]) (Fig.1E). Between 2007 and 2017, all the SDI quintiles exhibited a decrease in the age-standardized death rate, with the largest decrease in the high SDI quintile (12.2% [14.8% to9.6%]) and the lowest decrease in the middle SDI quintile (7.7% [15.7% to3.5%]) (Fig.1F).

In 2017, the highest age-standardized cervical cancer death rates were found in Central Sub-Saharan Africa (24.3 [18.0 to 30.0] per 100,000 person-years), Oceania (20.3 [16.1 to 25.1]), and Eastern Sub-Saharan Africa (20.0 [16.8 to 23.8]), while the lowest death rates were found in Australasia (2.3 [2.0 to 2.7] per 100,000 person-years), Western Europe (2.6 [2.5 to 2.7]), High-income Asia Pacific (2.6 [2.5 to 2.7]), and North Africa and Middle East (2.6 [2.3 to 2.8]) (Fig.1E). Only East Asia exhibited an increase in the age-standardized death rate during 2007 to 2017 (8.9% [17.5% to 17.6%]). Among the other 20 regions with decreased death rates from 2007 to 2017, the largest decreases were noted in Southern Sub-Saharan Africa (28.5% [35.2% to21.0%]), Eastern Europe (27.5% [30.0% to24.8%]), and Central Europe (21.1% [24.8% to17.2%]), and the lowest decreases were noted in high-income North America (0.1% [4.5% to 4.5%]) and South Asia (0.5% [7.9% to 7.2%]) (Fig.1F).

The global map of the age-standardized cervical cancer death rates in 2017 is presented in Fig.2C. Globally, the 2017 age-standardized death rates varied nearly 50 times across countries. To be specific, the highest age-standardized death rates were found in Kiribati (47.1 [35.3 to 59.6] per 100,000 person-years), Central African Republic (33.9 [20.9 to 45.5]), and Somalia (34.3 [23.4 to 49.9]). On the contrary, the lowest rates were found in Kuwait (1.0 [0.9 to 1.1] per 100,000 person-years), Iraq (1.4 [1.2 to 1.6]), and Saudi Arabia (1.4 [1.2 to 1.8]). From 2007 to 2017, Georgia (27.1% [14.5% to 41.0%]), Guam (11.7% [5.9% to 30.7%]) and Tajikistan (11.2% [9.3% to 34.5%]) showed the largest increases in the age-standardized death rate. Contrarily, Kuwait (48.2% [54.6% to40.3%]), Lithuania (41.5% [47.8% to33.6%]), and Ukraine (38.0% [43.4% to31.0%]) had the largest decreases in the age-standardized death rate (Additional file 2: Table S2).

The 2017 age-specific (15 to>80years) death rates of cervical cancer worldwide and by the SDI quintile are presented in Additional file 3: Fig. S1C. The death rate increased with an in-crease in age globally and in all the SDI quintiles.

Figure3E, F illustrate the age distribution of cervical cancer death cases in 2007 and 2017. In 2017, the proportion of death cases in younger women (44years) in-creased with a decrease in the SDI, with the highest proportion of death cases in younger women in Oceania (38.1%), Western Sub-Saharan Africa (24.2%), and Central Sub-Saharan Africa (23.9%). During 2007 to 2017, a slight decrease was noted in the proportion of death cases in younger women (44years) worldwide, in all SDI quintiles and in most regions, except for South Latin America.

Figure4C demonstrates the secular trend in the age-standardized death rates across the SDI quintiles by regions from 1990 to 2017 and the expected levels based only on the SDI values of the global regions. The correlation of the SDI with the age-standardized death rate yielded a pattern similarly to that with the age-standardized DALYs rate.

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Global, regional, and national burden of cervical cancer for 195 countries and territories, 20072017: findings from the Global Burden of Disease Study...