Insights in Gynecologic Oncology
Open Access

Types of gynecologic cancers and their global incidence

Gynecologic cancers vary widely in incidence, with cervical, ovarian, and uterine cancers being the most common globally:

• Cervical cancer: The fourth most common cancer among women worldwide, cervical cancer is primarily caused by persistent infection with high-risk human papillomavirus (HPV) [1]. Over 90% of cervical cancer cases occur in low- and middle-income countries (LMICs), where access to HPV vaccination, screening, and early treatment is limited.
• Ovarian cancer: Known as a “silent killer” due to its subtle symptoms and frequent late-stage diagnosis, ovarian cancer has high mortality rates across the globe. Incidence rates vary widely, with higher rates in Europe and North America and lower rates in Asia and Africa.
• Uterine (Endometrial) cancer: The most common gynecologic cancer in high-income countries, uterine cancer has seen rising incidence rates, particularly in developed countries. Contributing factors include aging populations and increasing rates of obesity and diabetes, both significant risk factors.
• Vaginal and vulvar cancers: These cancers are rarer but carry significant morbidity. Like cervical cancer, they are often associated with HPV infection. Although less common, their incidence has shown a slight increase in some regions.

2. Global trends and patterns in incidence and mortality

The global burden of gynecologic cancers is shaped by several factors, including geography, socioeconomic status, and healthcare infrastructure.

Cervical cancer trends

Efforts to prevent cervical cancer have had varying degrees of success worldwide. In high-income countries, where HPV vaccination and regular screening (such as Pap smears and HPV testing) are more accessible, the incidence of cervical cancer has significantly declined. For instance, countries like Australia and the United Kingdom have implemented successful national HPV vaccination programs, which have led to reduced rates of cervical cancer [2-4].

However, in LMICs, cervical cancer remains one of the leading causes of cancer death among women due to limited access to preventive services. The World Health Organization (WHO) has set a goal to eliminate cervical cancer globally through increased vaccination, screening, and treatment initiatives. Achieving this goal, however, requires substantial investment and international cooperation.

Ovarian cancer trends

Ovarian cancer continues to be associated with poor survival rates globally due to the difficulty of early diagnosis. Unlike cervical cancer, there is currently no widely effective screening method for ovarian cancer. Advances in genetic testing and awareness of hereditary risk factors, such as BRCA mutations, have improved outcomes for some patients, particularly in high-income regions where such testing is available. However, the global disparity in survival rates remains stark, with LMICs having significantly higher mortality rates than high-income countries.

Uterine cancer trends

Uterine cancer is on the rise in several high-income countries, largely due to lifestyle factors such as obesity and physical inactivity. The shift toward an aging population also contributes to the increasing incidence of uterine cancer. While the survival rates for uterine cancer are generally favorable when diagnosed early, disparities in access to timely diagnosis and treatment contribute to poorer outcomes in LMICs [5].

3. Risk factors and socioeconomic influences

The incidence and outcomes of gynecologic cancers are closely linked to several risk factors, many of which are influenced by socioeconomic status.

• Hpv infection: HPV infection is the primary risk factor for cervical, vaginal, and vulvar cancers. While HPV vaccination has proven effective in reducing HPV-related cancers, access to vaccination remains limited in LMICs.
• Lifestyle and metabolic factors: Obesity, diabetes, and low physical activity levels are risk factors for uterine cancer and some types of ovarian cancer. These risk factors are on the rise in both high- and low-income countries, leading to an increased incidence of related gynecologic cancers.
• Access to screening and treatment: High-income countries often have established screening programs and early detection methods for gynecologic cancers, leading to earlier diagnoses and better outcomes. In contrast, LMICs frequently lack the infrastructure and resources for routine screenings, resulting in delayed diagnoses and advanced disease at presentation.

4. Advances and challenges in treatment and survival

The treatment landscape for gynecologic cancers has evolved significantly, with innovations ranging from targeted therapies and immunotherapies to minimally invasive surgical techniques [6]. However, treatment options and outcomes vary widely around the world.

Treatment advances

• Targeted therapy and immunotherapy: Advances in molecular biology have led to the development of targeted therapies, such as PARP inhibitors for BRCA-mutated ovarian cancers, and immunotherapies that enhance the body’s ability to fight cancer. However, these treatments are often costly and largely inaccessible in low-resource settings.
• Minimally invasive surgery: In high-income countries, minimally invasive surgical techniques have improved recovery times and reduced complications for many gynecologic cancers. Access to specialized surgeons and technology, however, remains limited in LMICs.

Survival outcomes

Survival outcomes vary considerably between high- and low-income countries. For example, cervical cancer five-year survival rates in high-income countries like the United States can exceed 60%, while in LMICs, this figure may be less than 40%. Uterine cancer has relatively high survival rates when diagnosed early, yet delayed diagnosis in low-resource settings negatively impacts survival.

5. A global call to action: the future of gynecologic cancer care

Improving the global landscape of gynecologic cancer care requires coordinated international efforts. The WHO’s initiative to eliminate cervical cancer is a landmark goal, emphasizing HPV vaccination, increased screening, and accessible treatment [7]. Building on this, international health organizations, governments, and non-profits are working to improve access to preventive care and treatment for all gynecologic cancers through strategies like:

• Investing in hpv vaccination: Expanding HPV vaccination programs in LMICs to reduce cervical and other HPV-related cancers.
• Strengthening Screening Programs: Developing cost-effective and accessible screening programs for cervical cancer and potentially other gynecologic cancers.
• Improving Treatment Access: Increasing the availability of affordable treatments, including targeted therapies, in LMICs and improving training for healthcare providers.

Conclusion

The epidemiology of gynecologic cancers highlights a critical area of global health in need of attention, resources, and innovation. Reducing the incidence and improving the outcomes of gynecologic cancers requires a multifaceted approach that addresses prevention, early detection, and equitable access to treatment. By focusing on these areas and fostering global cooperation, we can reduce the burden of gynecologic cancers and improve outcomes for women worldwide.

References

1. Spirer HF, Spirer L (1991)Death and numbers: Semmelweis the statistician. Phy Social Resp Quarterly 1: 43-52.

Google Scholar

2. Biasucci G, Rubini M, Riboni S, Morelli L, Bessi E, et al. (2010)Mode of delivery affects the bacterial community in the newborn gut. Early Human Dev 86: S13-S15.

Indexed at, Google Scholar, Crossref

3. Dogra S, Sakwinska O, Soh S, Ngom-Bru C, Bruck WM, et al. (2015) Dynamics of infant gut microbiota are influenced by delivery mode and gestational duration and are associated with subsequent adiposity. mBio 6: e02419-e02414.

Indexed at, Google Scholar, Crossref

4. McCabe ERB, Carrino GE, Russell RB, Howse JL (2014)Fighting for the next generation: US prematurity in 2030. Pediatrics 134: 1193-1199.

Indexed at, Google Scholar, Crossref

5. RW Loftin, M Habli, CC Snyder, CM Cormier, DF Lewis, et al. (2010)Late preterm birth. Rev Obstet Gynecol 3: 10-19.

Indexed at, Google Scholar

6. McCormick MC (1985)The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312: 82-90.

Indexed at, Google Scholar, Crossref

7. RE Behrman, AS Butler (2007) Committee on Understanding Premature Birth and Assuring Healthy Outcomes, Preterm Birth: Causes, Consequences, and Prevention, National Academies Press, Washington, DC, USA.

Indexed at, Google Scholar

8. Harrison W, Goodman D (2015)Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr 169: 855-862.

Indexed at, Google Scholar, Crossref