title: Incidence and mortality of gynaecological cancers: Secular trends in urban Shanghai, China over 40 years.
abstract: Appraisal of cancer trends is essential for future cancer control, but relevant studies in China are scarce due to a lack of long-term data. With 40-years of cancer registry data, we sought to evaluate secular time trends in incidence and mortality of gynaecological cancers in an urban Chinese population.
  
  
  
  Data on incidence and mortality of invasive cervical, uterine and ovarian cancer were collected by the Shanghai Cancer Registry. Age-standardised incidence and mortality rates were calculated for women aged 20-84 in urban Shanghai between 1973 and 2012. Age-period-cohort Poisson regression models were used to evaluate age, period and cohort effects. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models.
  
  
  
  Overall, cervical cancer incidence and mortality substantially decreased (EAPC = -4.5% and -5.5%, respectively); however, an upward trend was apparent among younger women (age <60). Uterine cancer incidence increased slightly (EAPC = 1.8%), while mortality decreased over time (EAPC = -2.4%). Ovarian cancer incidence and mortality both increased, although the increase in incidence (EAPC = 1.8%) was larger than mortality (EAPC = 0.6%). While cohort effects were most evident for cervical cancer incidence and mortality, significant age, period, and cohort effects were found for all three gynaecological cancers evaluated.
  
  
  
  These secular trends in incidence and mortality of gynaecological cancers in Shanghai likely reflect changing risk factor profiles and improved cancer prognosis over time, and suggest new priorities and call for additional efforts for gynaecological cancer prevention and control for women in China.
authors.affiliation: Institute of Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China.
authors.forename: Zhezhou
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Institute of Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China. Electronic address: zhengying@scdc.sh.cn.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37203-1738, USA.
authors.forename: Wanqing
authors.initials: W
authors.lastname: Wen
authors.affiliation: Institute of Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Wu
authors.affiliation: Institute of Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China.
authors.forename: Pingping
authors.initials: P
authors.lastname: Bao
authors.affiliation: Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China.
authors.forename: Chunfang
authors.initials: C
authors.lastname: Wang
authors.affiliation: Institute of Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, People's Republic of China.
authors.forename: Weijian
authors.initials: W
authors.lastname: Zhong
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai 200032, People's Republic of China.
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai 200032, People's Republic of China.
authors.forename: Fan
authors.initials: F
authors.lastname: Jin
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Shanghai 200032, People's Republic of China.
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Xiang
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37203-1738, USA.
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37203-1738, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Beeghly-Fadiel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000401:mortality; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult
keywords: Cervical cancer; Gynaecological cancers; Incidence; Mortality; Ovarian cancer; Time trends; Uterine cancer