Health at a Glance

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Trends in the incidence and mortality of female reproductive system cancers

Statistics Canada Catalogue no. 82-624-X by Tanya Navaneelan

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• Highlights
• Uterine cancer incidence at its highest level since 1992; ovarian and cervical cancer incidence decreasing
• Ovarian cancer risk increases with age; uterine and cervical cancer risk rises and falls over the life span
• Ovarian and cervical cancer mortality rates declining over time; uterine cancer mortality rates on the rise in recent years
• Mortality from ovarian and uterine cancers tends to increase with age; cervical cancer mortality more evenly distributed across age groups
• Summary
• What you need to know about this study
• Notes
• Related material for this article

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There were 82,885 new cases of cancer in Canadian women in 2010. Reproductive system cancers accounted for 12.0% of these new cases. The most common types of female reproductive system cancers were cancers of the uterus, ovary and cervix — 9 out of 10 cases developed in one of these three sites (Table 1).

This article presents incidence (new cases) and mortality (deaths) data on uterine, ovarian and cervical cancers. The main data sources are the Canadian Cancer Registry (CCR) and the Canadian Vital Statistics – Death Database.

Table 1 Incidence of female reproductive system cancers, Canada, 2010 Table summary This table displays the results of Incidence of female reproductive system cancers. The information is grouped by Cancer (appearing as row headers), New cases, Incidence rate (per 100,000 women) and Percent of all new cancers in women (appearing as column headers). Cancer New cases Incidence rate (per 100,000 women) Percent of all new cancers in women All reproductive system 9,957 58.0 12.0 Uterus 5,191 30.3 6.3 Uterus, specified 5,044 29.4 6.1 Uterus, NOS* 147 0.8 0.2 Ovary 2,465 14.4 6.6 Cervix 1,390 8.1 1.7 Vagina 127 0.7 0.2 Vulva 487 2.8 0.6 Other gynecological cancers 297 17.3 0.4 Note: NOS = not otherwise specified Source: Canadian Cancer Registry, Statistics Canada

Uterine cancer incidence at its highest level since 1992; ovarian and cervical cancer incidence decreasing

In 2010, uterine cancer was the most commonly diagnosed female reproductive system cancer in Canada, with an incidence rate of 30.3 new cases per 100,000 women (Table 2). Between 1992 and 2005 there was no significant change in the rate of uterine cancer; however between 2005 and 2010 there was an increase of 2.5% per year.Note 1,Note 2 This increase resulted in uterine cancer hitting its highest level since 1992, the earliest year captured in the CCR (Chart 1).

Table 2 Incidence and mortality summary statistics, Canada, 2010 Table summary This table displays the results of Incidence and mortality summary statistics. The information is grouped by Type of cancer (appearing as row headers), Incidence and Mortality (appearing as column headers). Type of cancer Incidence Mortality New cases Rate per 100,000 women Median age at diagnosis Deaths Rate per 100,000 women Median age at death Uterus 5,191 30.3 62 919 5.4 72 Ovary 2,465 14.4 62 1,637 9.5 72 Cervix 1,390 8.1 47 372 2.2 59 Source: Canadian Cancer Registry, Statistics Canada; Vital Statistics – Death Database, Statistics Canada.

Ovarian cancer was the second most commonly diagnosed reproductive system cancer. The rate of ovarian cancer was 14.4 new cases per 100,000 women (Table 2). Between 1992 and 2010 the rate of ovarian cancer decreased by 0.8% annually (Chart 1).

Description for Chart 1

Cervical cancer was the third most commonly diagnosed reproductive system cancer with a rate of 8.1 new cases per 100,000 women (Table 2). Like ovarian cancer, the incidence of cervical cancer has declined over time, falling by 2.1% annually between 1992 and 2005. However, this decrease has leveled off in recent years and, between 2005 and 2010, there was no significant change in the rate (Chart 1).

Research into the decline in the rate of cervical cancer indicates that this is most likely the result of cervical cancer screening programs.Note 3,Note 4,Note 5 These programs have helped to increase the number of pre-cancerous conditions caught before they develop into invasive cancer.

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Ovarian cancer risk increases with age; uterine and cervical cancer risk rises and falls over the life span

A woman’s age can affect her risk of developing each type of reproductive system cancer. Women in their sixties and early seventies had the highest risk of uterine cancer (Chart 2). The peak was in women between the ages of 60 to 64, who had a rate of 99.0 new cases per 100,000 women. Around this peak, incidence rates increased with age for women aged 25 to 59 while they decreased with age for women 65 and older.

Over time, the highest levels of uterine cancer risk have shifted to younger women. In 2010, the medianNote 8 age of diagnosis with uterine cancer was 62 years. In contrast, in 1992, the median age of diagnosis was 66 years and women in their seventies had the highest incidence rate.

Unlike uterine cancer, ovarian cancer rates tended to increase with age. Ovarian cancer was relatively rare in women aged 25 to 29, who had a rate of 2.4 new cases per 100,000. In comparison, incidence was more than 20 times higher in women aged 85 and older who had a rate of 46.1 new cases per 100,000 women (Chart 2). Although risk increased with age, 6.4% of ovarian cancer cases were diagnosed in women under the age of 40 compared with 2.6% of uterine cancer cases. Similar to uterine cancer, the median age of diagnosis with ovarian cancer was 62 years.

Description for Chart 2

Women in their early forties had the highest risk of cervical cancer. Women aged 40 to 44 had a cervical cancer incidence rate of 16.6 new cases per 100,000 women. Similar to uterine cancer, rates were lower on either side of this peak, although the risk was more evenly distributed across the age groups (Chart 2).

Compared with the other two main reproductive cancers, cervical cancer was more likely to affect younger women with 28.7% of cases occurring in women under the age of 40. Despite cervical cancer having the lowest overall incidence, women aged 25 to 45 had a higher rate of cervical cancer than of uterine or ovarian cancer. Additionally, the median age at which women were diagnosed with cervical cancer was 47 years, considerably lower than for the other two cancers.

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Ovarian and cervical cancer mortality rates declining over time; uterine cancer mortality rates on the rise in recent years

While incidence figures represent the number of new cases of a disease, mortality data reflect the number of deaths from that disease. Cancer was the leading cause of death for women in 2010,Note 12 and reproductive cancers accounted for 9.2% of these deaths.

Although uterine cancer was the most commonly diagnosed reproductive cancer, ovarian cancer caused the greatest number of deaths. In 2010, the mortality rate from ovarian cancer was 9.5 deaths per 100,000 women (Table 2). Despite the relatively high mortality rate, the risk of death due to ovarian cancer has decreased over time. Between 1974 and 2010, the rate decreased by 0.7% annually (Chart 3).Note 1

Ovarian cancer mortality was higher than mortality from other reproductive cancers largely because most women are not diagnosed with ovarian cancer until it is at an advanced stage and the cancer has already spread beyond the ovaries. This is mainly because ovarian cancer lacks clearly identifiable early symptoms.Note 13,Note 14

The mortality rate for uterine cancer was 5.4 deaths per 100,000 women, making it the second deadliest form of reproductive cancer (Table 2). While uterine cancer mortality saw declines of 1.4% per year between 1974 and 2000, these declines came to an end between 2000 and 2010, when the rate increased by 0.9% annually (Chart 3).

Description for Chart 3

Cervical cancer deaths were the lowest of the three main reproductive cancers with a rate of 2.2 deaths per 100,000 women (Table 2). Not only has mortality from cervical cancer been relatively low but the rate has also been declining over time. Mortality in 2010 was less than a third of what it was in 1974, a decline of 3.2% annually (Chart 3). The decline in deaths from cervical cancer, like the decline in new cases, is likely a result of cervical cancer screening programs.Note 6,Note 7

Mortality from ovarian and uterine cancers tends to increase with age; cervical cancer mortality more evenly distributed across age groups

A woman’s risk of death from reproductive cancer, like her risk of diagnosis, is affected by her age. Death from ovarian cancer increased steadily with age, with women 85 and older having the highest mortality at a rate of 58.7 deaths per 100,000 women (Chart 4). This is similar to the pattern seen with new cases of ovarian cancer, which also tended to increase with age (Chart 2).

Similarly, deaths from uterine cancer also increased with age, peaking in the oldest age group. Women aged 85 and older had a uterine cancer mortality rate of 44.6 deaths per 100,000 women (Chart 4). By comparison, diagnosis with uterine cancer peaked among women in their early sixties.

Description for Chart 4

Deaths from cervical cancer were more evenly distributed across the life span than ovarian or uterine cancer deaths, however there was still a general trend of increasing mortality with increasing age (Chart 4). The highest mortality was in women aged 80 to 84 years (7.9 per 100,000 women), followed by women aged 85 and older (6.9 per 100,000 women).Note 15 Like uterine cancer, cervical cancer mortality peaked at a later age than diagnosis, which was highest among women in their early forties.

Even though cervical cancer had a relatively low mortality rate, it presented a greater risk of death for younger women than ovarian or uterine cancer. In women under 45 years of age, the risk of death from cervical cancer was greater than death from either of the other two cancers (Chart 4).

Like the median age at diagnosis, the median age of death was the same for women with uterine and ovarian cancer, and was significantly younger for women with cervical cancer (Table 2). In addition, while the median age of death from uterine and ovarian cancer has risen over time, the median age has decreased for cervical cancer. The median age of death from cervical cancer in 2010 was 59 years, a decrease of one and a half years since 1974. In comparison, over the same period, the median age at death from ovarian cancer increased by nine and a half years and by three and a half years for uterine cancer. The decline in the median age at death from cervical cancer occurred because the greatest declines in mortality have been made in older women. For example, there was a 76.6% decrease in the rate of death from cervical cancer in women aged 70 to 74 compared with a 32.0% decrease in women aged 35 to 39.

Summary

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Cancers of the reproductive system accounted for 12.0% of all newly diagnosed cancer cases in Canadian women in 2010. Uterine cancer was the most commonly diagnosed with 30.3 new cases per 100,000 women, its highest rate since 1992. While the risk of death from ovarian cancer was almost twice that of uterine cancer, ovarian cancer mortality has been steadily decreasing since 1974. On the other hand, the rate of death from uterine cancer increased between 2000 and 2010. Cervical cancer had the fewest new cases and deaths, but was also the most likely to affect younger women, with the lowest median age of diagnosis and death.

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Tanya Navaneelan is an analyst with the Health Statistics Division.

The author wishes to acknowledge Gregory Christ, Larry Ellison and Dianne Zakaria for their contributions.

Notes

Footnote 1.

All trend analyses were performed using age-standardized incidence and mortality rates. Rates were standardized to the 1991 Canadian population.

Return to note 1 referrer

Footnote 2.

The annual changes in incidence and mortality rates reported in this article are the annual percent change (APC). The calculation involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year. The significance level was set at p < 0.05.

Return to note 2 referrer

Footnote 3.

Saraiya, Mona, Marc Steben, Meg Watson and Lauri Markowitz. 2013. “Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians.” Preventive Medicine. Vol. 57, no. 5, 426-433.

Return to note 3 referrer

Footnote 4.

Peirson, Leslea, Donna Fitzpatrick-Lewis, Donna Ciliska and Rachel Warren. 2013. “Screening for cervical cancer: a systematic review and meta-analysis.” Systematic Reviews. Vol. 2, no. 35, 14-35.

Return to note 4 referrer

Footnote 5.

Duarte-Franco, Eliane and Eduardo L. Franco. 2004. “Cancer of the uterine cervix.” BMC Women’s Health. Vol. 4, no. Suppl 1, S1-13.

Return to note 5 referrer

Footnote 6.

Franco, Eduardo L., Eliane Duarte-Franco and Alex Ferenczy. 2001. “Cervical cancer: epidemiology, prevention and the role of human papillomavirus in infection.” Canadian Medical Association Journal. Vol. 164, no. 4, 1017-1025.

Return to note 6 referrer

Footnote 7.

Statistics Canada. Canadian Community Health Survey, 2012. For more information: http://www23.statcan.gc.ca:81/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2.

Return to note 7 referrer

Footnote 8.

Median refers to the midpoint of a distribution of numbers sorted by size.

Return to note 8 referrer

Footnote 9.

Sasieni, P.D., J. Shelton, N. Ormiston-Smith, C.S. Thomson and P.B. Silcocks. 2011. “What is the lifetime risk of developing cancer?: the effect of adjusting for multiple primaries.” British Journal of Cancer. Vol. 105, no. 3, 460-465.

Return to note 9 referrer

Footnote 10.

Lifetime risk was calculated using the AMP (adjusted for multiple primaries) method. This method corrects for the inclusion of multiple primaries in the incidence data and prevents overestimating the risk of developing cancer.

Return to note 10 referrer

Footnote 11.

Since lifetime risk is based on current incidence and mortality rates, it is calculated on the assumption that the current rates – at all ages – will remain constant during the life of the newborn child. While lifetime risk is a useful summary of risk in the population, a wide range of lifestyle and genetic factors can affect the risk of cancer and the risk for every individual is different.

Return to note 11 referrer

Footnote 12.

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Statistics Canada. 2014. CANSIM Table 102-0561 – Leading causes of death, total population, by age group and sex, Canada, annual.

Return to note 12 referrer

Footnote 13.

Permuth-Wey, Jennifer and Thomas A. Sellers. 2009. “Epidemiology of ovarian cancer.” Methods in Molecular Biology. Vol. 472, no. 4, 413-437.

Return to note 13 referrer

Footnote 14.

Gubbels, Jennifer A.A., Nick Claussen, Arvinder A. Kapur, Joseph P. Connor and Manish S. Patankar. 2010. “The detection, treatment, and biology of epithelial ovarian cancer.” Journal of Ovarian Research. Vol. 3, no.8, 1-11.

Return to note 14 referrer

Footnote 15.

Given the relatively small number of cervical cancer deaths in each age group, differences in mortality by age group should be interpreted with caution, although previous years of data confirm the 2010 finding.

Return to note 15 referrer

Footnote 16.

World Health Organization. 2000. “ICD-O: International Classification of Diseases for Oncology.” Third ed. Geneva: World Health Organization.

Return to note 16 referrer

Footnote 17.

World Health Organization. 1992. “ICD-10: International Statistical Classification of Diseases and Related Health Problems.” Vol. 1. Geneva: World Health Organization.

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Footnote 18.

World Health Organization. 1975. “Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, Ninth Revision.” Vol. 1. Geneva: World Health Organization.

Return to note 18 referrer

Footnote 19.

World Health Organization. “Eighth Revision International Classification of Diseases, Adapted for Use in the United States.” Vol. 1. Washington, D.C.: U.S. Department of Health, Education and Welfare.

Return to note 19 referrer

Footnote 20.

International Agency for Research on Cancer, World Health Organization, International Association of Cancer Registries, European Network of Cancer Registries. 2004. “International Rules for Multiple Primary Cancers, ICD-O Third Edition, Internal Report no.2004/02.” Lyon: International Agency for Research on Cancer.

Return to note 20 referrer

Footnote 21.

Joinpoint Regression Program. Version 4.0.4 – May 2013. Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute.

Return to note 21 referrer

Footnote 22.

Statistics Canada. 2005. “Comparability of ICD-10 and ICD-9 for mortality statistics in Canada.” Statistics Canada catalogue no. 84-548-XIE.

Return to note 22 referrer

Footnote 23.

Anderson, Robert N., Arialdi M. Miniño, Donna L. Hoyert and Harry M. Rosenberg. 2001. “Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimates.” National Vital Statistics Reports. Vol. 49, no. 2.

Return to note 23 referrer

Footnote 24.

National Center for Health Statistics. 1980. “Estimates of selected comparability ratios based on dual coding of 1976 death certificates by the Eighth and Ninth Revisions of the International Classification of Diseases.” Monthly Vital Statistics Report. Vol. 28, no. 11.

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