Female breast cancer
During the past 30 years worldwide, the incidences of female breast cancer increased from 867.62 × 103 (95 %CI 840.4 × 103~894.76 × 103) to 1977.21 × 103 (95 %CI 1807.61 × 103~2145.21 × 103) cases (Table S1). At the same time, the deaths of female breast cancer increased from 375.02 × 103 (95 %CI 358.98 × 103~390.82 × 103) to 688.56 × 103 (95 %CI 635.32 × 103~739.57 × 103) cases (Table S2), and the DALYs of female breast cancer increased from 11526.68 × 103 (11021.13 × 103~12107.83 × 103) to 20310.19 × 103 (95 %CI 18744.8 × 103~21866.65 × 103) years (Table S3). Globally, from 1990 to 2019, the incidences, deaths, and DALYs of female breast cancer were gradually increased (Fig. 1a). For age-standardized rates, the ASIR of female breast cancer rose from 40.12 (95 %CI 38.78 ~ 41.33) in 1990 to 45.86 (95 %CI 41.91 ~ 49.76) in 2019, with EAPCASIR: 0.36 (95 %CI 0.31 ~ 0.42) (Fig. 1b). The ASDR of female breast cancer decreased from 17.76 (95 %CI 16.93 ~ 18.51) in 1990 to 15.88 (95 % CI 14.66 ~ 17.07) in 2019, with EAPCASDR: -0.51 (95 %CI -0.57~-0.46). The age-standardized DALY rate of female breast cancer decreased from 524.87 (95 %CI 501.78 ~ 551.15) in 1990 to 473.83 (95 %CI 437.3 ~ 510.51) in 2019, with EAPCage−standardized DALY rate: -0.51 (95 %CI -0.57~-0.45).
The burden of female breast cancer varied in different regions. In 2019, the incidence number of female breast cancer was highest in high SDI region (673.15 × 103, 95 %CI 601.27 × 103~747.67 × 103). However, the ASIR of female breast cancer was stable in high SDI region (79.3 with 95 %CI 77 ~ 80.87 in 1990; 79.22 with 95 %CI 70.83 ~ 87.7 in 2019; EAPCASIR: -0.12, 95 %CI -0.22~-0.01). In contrast, the ASIR of female breast cancer was rapidly increased in middle SDI region (20.81 with 95 %CI 19.25 ~ 22.45 in 1990; 35.52 with 95 %CI 31.47 ~ 39.81 in 2019; EAPCASIR: 1.87, 95 %CI 1.84 ~ 1.9). Relative to ASIR, at the same time, the ASDR and age-standardized DALY rate were significantly declined in high SDI region: EAPCASDR: -1.36, 95 %CI -1.41~-1.31; EAPCage−standardized DALY rate: -1.41, 95 %CI -1.47~-1.36.
In 1990, the USA, China, Germany were the top three countries with the most incidence cases. In 2019, China, the USA, and India were the countries with the most incidence cases (368.37 × 103, 251.53 × 103, 144.09 × 103; respectively) (Fig. 2a). In 2019, China, India, and the USA were the countries with the most deaths (93.50 × 103, 82.10 × 103, 54.40 × 103; respectively) (Fig. 2b) and most DALYs (2877.24 × 103, 2659.24 × 103, 1387.67 × 103; respectively) (Fig. 2c). Monaco was the country with the highest ASIR in 2019 (149.60, 95 %CI 108.67 ~ 193.81). The ASIR was relatively high in the USA in 2019 (94.21, 95 %CI 77.35 ~ 115.12) (Figure S1a). Solomon Islands was the country with the highest ASDR and age-standardized DALY rate in 2019 (75.04, 95 %CI 59.00 ~ 94.48; 2635.74, 2026.64 ~ 3377.14; respectively). Pakistan had a relatively high ASDR and age-standardized DALY rate in 2019 (51.94, 95 %CI 39.03 ~ 69.76; 1570.06, 1177.2 ~ 2135.47; respectively) (Figure S1b and Figure S2c).
Cervical cancer
Globally, the incidence cases of cervical cancer increased from 335.64 × 103 (95 %CI 300.35 × 103~393.89 × 103) in 1990 to 565.54 × 103 (95 %CI 481.52 × 103~636.43 × 103) (Table S4). In the same period, the deaths of cervical cancer increased from 184.53 × 103 (95 %CI 164.84 × 103~218.94 × 103) to 280.48 × 103 (95 %CI 238.86 × 103~313.93 × 103) (Table S5), and the DALYs of cervical cancer increased from 6176.25 × 103 (95 %CI 5437.67 × 103~7316.93 × 103) to 8955.01 × 103 (95 %CI 7547.73 × 103~9978.46 × 103) (Table S6). The incidences, deaths, and DALYs of cervical cancer kept steadily increased from 1990 to 2019 in the world (Fig. 1a). However, the global incidence rate and mortality rate gradually decreased in the past three decades: EAPCASIR: -0.38, 95 %CI -0.41~-0.34; EAPCASDR: -0.93, 95 %CI -0.98~-0.88; EAPCage−standardized DALY rate: -0.95, 95 %CI -1.00~-0.89 (Fig. 1b).
Middle SDI region had the highest cervical cancer burden in 2019: 183.34 × 103 (95 %CI 144.49 × 103~208.86 × 103) incidence cases, 90.1 × 103 (95 %CI 71.33 × 103~103.2 × 103) deaths, and 2817.25 × 103 (2223.19 × 103~3217.72 × 103) DALYs. Low SDI region had the highest incidence rate and mortality rate in 2019: ASIR: 23.21, 95 %CI 18.31 ~ 28.76; ASDR: 15.05, 95 %CI 11.92 ~ 18.46; age-standardized DALY rate: 477.53, 95 %CI 374.33 ~ 591.38. High SDI region had the lowest incidence rate and mortality rate in 2019: ASIR: 8.91, 95 %CI 7.74 ~ 9.99; ASDR: 2.9, 95 %CI 2.6 ~ 3.1; age-standardized DALY rate: 89.72, 95 %CI 81.88 ~ 95.85. Besides, high SDI region had the most rapid decline in incidence rate and mortality rate: EAPCASIR: -0.95, 95 %CI -1.06~-0.85; EAPCASDR: -1.57, 95 %CI -1.68~-1.46; EAPCage−standardized DALY rate: -1.62, 95 %CI -1.75~-1.49.
China, India, Brazil were top three countries with the most incidence cases in 2019 (109.76 × 103, 84.98 × 103, 22.65 × 103, respectively) (Fig. 3a), followed by the USA (19.11 × 103, ranking fourth). Similarly, China, India, Brazil were top three countries with the most deaths and DALYs in 2019 (deaths: 53.44 × 103, 45.45 × 103, 11.07 × 103, respectively; DALYs: 1622.24 × 103, 1554.49 × 103, 348.42 × 103, respectively), followed by the USA (deaths: 7.99 × 103, ranking fifth; DALYs: 224.78 × 103, ranking sixth) (Fig. 3b and c). Kiribati had the highest age-standardized rates of incidence, death, and DALY in 2019 (ASIR: 108.8, 95 %CI 78.79 ~ 140.73; ASDR: 69.52, 95 %CI 51.09 ~ 88.92; age-standardized DALY rate: 2143.06, 95 %CI 1534.43 ~ 2781.26). In general, the incidence rate and mortality rate were low in China (ASIR: 11.01, ASDR: 5.13, age-standardized DALY rate: 157.5), India (ASIR: 13.1, ASDR: 7.38, age-standardized DALY rate: 239.49), and the USA (ASIR: 8.67, ASDR: 3.05, age-standardized DALY rate: 98.77) (Figure S2).
Ovarian cancer
Relative to incidence cases of female breast cancer and cervical cancer, the incidence cases of ovarian cancer were much lower worldwide. In 2019, the incidence of ovarian cancer was 294.42 × 103 (95 %CI 260.65 × 103~329.73 × 103) worldwide (Table S7). The deaths of ovarian cancer were 198.41 × 103 (95 %CI 175.36 × 103~217.66 × 103), and the DALYs of ovarian cancer were 5359.74 × 103 (4692.95 × 103~5954.99 × 103) in 2019 globally (Table S8 and Table S9). From 1990 to 2019, the incidence and mortality rates of ovarian cancer remained stable at the global level (EAPCASIR: 0.11, EAPCASDR: -0.11, EAPCage−standardized DALY rate: -0.08).
Although high SDI region had the highest ovarian cancer burden and mortality from 1990 to 2019, the age-standardized rates of incidence, death, and DALY in high SDI region were promptly decreased: EAPCASIR: -0.87, 95 %CI -0.96~-0.78; EAPCASDR: -1.1, 95 %CI -1.17~-1.02; EAPCage−standardized DALY rate: -1.27, 95 %CI -1.34~-1.2. In contrast, despite having a relatively low ovarian cancer burden and mortality, low-middle SDI region and low SDI region had the most rapid increase in age-standardized rates of incidence, death, and DALY (Table S8 and Table S9).
China, India, and the USA were the top three countries with the most ovarian cancer incidence cases (China: 45.48 × 103, India: 31.02 × 103, the USA: 26.79 × 103) (Fig. 4a), deaths (China: 29.09 × 103, India: 22.35 × 103, the USA: 19.5 × 103) (Fig. 4b), and DALYs (China: 835.06 × 103, India: 657.74 × 103, the USA: 426.5 × 103) in 2019 (Fig. 4c). Monaco had the highest ASIR (22.75, 95 %CI 16.73 ~ 28.89) and ASDR (13.67, 95 %CI 9.78 ~ 17.24), and Pakistan had the highest age-standardized DALY rate (348.37, 95 %CI 182.72 ~ 562.44) in 2019. Among China, India, and the USA, the USA had a relatively high age-standardized rates of incidence, death, and DALY in 2019 (Figure S3).
Uterine cancer
Around the world, the incidence cases of uterine cancer elevated from 187.19 × 103 (174.63 × 103~196.03 × 103) in 1990 to 435.04 × 103 (397.02 × 103~479.73 × 103) in 2019 (Table S10). In the same period, the global deaths increased from 56.13 × 103 (95 %CI 51.1 × 103~60.2 × 103) to 91.64 × 103 (95 %CI 82.39 × 103~101.5 × 103), and the global DALYs increased from 1483.29 × 103 (95 %CI 1317.51 × 103~1612.75 × 103) to 2329.07 × 103 (95 %CI 2092.95 × 103~2560.89 × 103) (Table S11 and Table S12). At the global level, the incidence rate of uterine cancer was increased, but the mortality rate was decreased during the past three decades (EAPCASIR: 0.69, 95 %CI 0.57 ~ 0.81; EAPCASDR: -0.85, 95 %CI -0.93~-0.76; EAPCage−standardized DALY rate: -0.84, 95 %CI -0.93~-0.75).
High SDI region had the most uterine incidence cases (168.02 × 103, 95 %CI 148.61 × 103~188.55 × 103) in 2019 and the most rapidly increased ASIR (EAPCASIR: 1.37, 95 %CI 1.28 ~ 1.46) from 1990 to 2019. Also, high SDI region had the most deaths (26.63 × 103, 95 %CI 24 × 103~28.14 × 103) and the highest ASDR (2.52, 95 %CI 2.32 ~ 2.64) and age-standardized DALY rate (65.31, 95 %CI 60.99 ~ 69.65) in 2019.
The USA, China, and Russia were the top three countries with the most incidence cases (80.07 × 103, 66.74 × 103, 42.71 × 103, respectively) in 2019, followed by India (15.26 × 103, ranking sixth) (Fig. 5a). China, the USA, India had the most deaths (12.22 × 103, 10.26 × 103, 7.04 × 103, respectively) and DALYs (364.28 × 103, 249.56 × 103, 180.91 × 103) in 2019 (Fig. 5b and Fig. 5c). Northern Mariana Islands had the highest ASIR (32.77, 95 %CI 21.3 ~ 42.36), Grenada had the highest ASDR (11.3, 95 %CI 9.79 ~ 12.99), and American Samoa had the highest age-standardized DALY rate (285.41, 95 %CI 185.19 ~ 370.95) in 2019. Compared to China and India, the USA had a higher age-standardized rates of incidence, death, and DALY in 2019 (Figure S4). The age-standardized rates of women’s cancers in all countries or territories were summarized on Table S13.
The incidence, death, and DALY of women’s cancers and demographic
In 2019, there were rare women’s cancer patients aged less than 25 worldwide (Figure S5a). For breast cancer, the global incidence case and death number reached the peak at the age of 50 ~ 70. Besides, the death number of breast cancer reached the second peak at the age older than 80, and the DALY of breast cancer reached the peak at the age of 50 ~ 55. The ASIR and ASDR of breast cancer increased with age, reaching the peak at the age older than 80 (Figure S5b). The age-standardized DALY rate elevated with age as well, but it reached the plateau after the age of 55.
The global incidence of cervical cancer was in peak at the age of 40 ~ 55 (Figure S5a). The global death of cervical cancer reached a peak at the age of 50 ~ 60. The global DALY of cervical cancer peaked at the age of 50 ~ 55. The global ASIR of cervical cancer reached the plateau after the age of 40, and the global ASDR of cervical cancer increased with age. The global age-standardized DALY rate peaked at the age of 55 ~ 60 (Figure S5b).
The global incidence of ovarian cancer reached a plateau after the age of 50 (Figure S5a). The global death of cervical cancer climbed the first peak at the age of 65 ~ 70 and reached the second peak after 80. The global DALY of ovarian cancer was in peak at the age of 50 ~ 65. The global ASIR and ASDR of ovarian cancer increased with age. The global age-standardized DALY rate of ovarian cancer peaked at the age of 65 ~ 75 (Figure S5b).
The global incidence of uterine cancer was in peak at the age of 55 ~ 65 (Figure S5a). The global death of uterine cancer reached the first peak at the age of 65 ~ 70 and reached the second peak after the age of 80. The global DALY of uterine cancer peaked at the age of 60 ~ 65. The global ASIR and age-standardized DALY rate of uterine cancer were in peak at the age of 70 ~ 75 (Figure S5b). The global ASDR of uterine cancer increased with age.
Generally, the demographic characteristics of women’s cancer patients were similar in regions with different SDI values except for the ratio of patients aged older than 80 (Figure S6, S7, S8, S9, S10, S11, S12, S13, S14, S15). In high SDI region, there was a much higher ratio of patients aged older than 80, especially compared to the data of low SDI region.
The correlations between SDI and rates of incidence and mortality
The ASIRs of breast cancer were significantly positively correlated with SDI value (ρ: 0.79, P < 0.0001) (Fig. 6). The ASDR and age-standardized DALY rate of breast cancer exhibited non-linear correlations with SDI value. When SDI value was greater than 0.7, the ASDR and age-standardized DALY rate of breast cancer sharply decreased with the increase of SDI. In contrast, for cervical cancer, the age-standardized rates of incidence, death, and DALY were negatively correlative with SDI value (ρ: -0.61, P < 0.0001; ρ: -0.76, P < 0.0001; ρ: -0.76, P < 0.0001; respectively).
For ovarian cancer, generally, the age-standardized rates of incidence, death, and DALY were positively correlative with SDI value (ρ: 0.86, P < 0.0001; ρ: 0.74, P < 0.0001; ρ: 0.73, P < 0.0001; respectively). However, when SDI was more than 0.7, the ASIR, ASDR and age-standardized DALY rate rapidly declined with SDI increase. For uterine cancer, the ASIR was significantly positively correlated with SDI value (ρ: 0.79, P < 0.0001). The correlation between mortality rate and SDI in uterine cancer was similar to that in ovarian cancer.