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Temporal trends of cervical cancer between 1990 and 2019, in Asian countries by geographical region and socio-demographic index, and comparison with global data

  • Zohre Momenimovahed , Afrooz Mazidimoradi , Sanaz Amiri , Zeinab Nooraie , Leila Allahgholi and Hamid Salehiniya EMAIL logo
Published/Copyright: March 9, 2023
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Oncologie
From the journal Oncologie Volume 25 Issue 2

Abstract

Objectives

Cervical cancer is the fourth most common cancer in women and one of the most important health challenges in the world. Although the epidemiological statistics of cervical cancer seem to be varied in Asia, no study has evaluated the trend of this disease and the changes in its incidence and epidemiology in recent decades. Therefore, this study was conducted to determine the temporal trend of cervical cancer between 1990 and 2019 in Asian countries based on geographic region and socio-demographic index (SDI), and also compare it with global data.

Methods

We collected cervical cancer data from the 2019 Global Burden of Disease (GBD) study from 1990 to 2019 in 49 Asian countries and territories. In this study, data were extracted in different classifications of Asian countries based on an SDI, and five GBD categories for Asian countries from 1990 to 2019 and compared with global data. Data were reported in values with a confidence interval (CI) of 95%. We used relative difference (%) between years to show the comparative changes in incidences, prevalence, deaths, and disability-adjusted life years (DALY) age-standardized rates. Average annual percentage change (AAPC) and its 95% CI in the 30-year past period for each location were calculated by using age-standardized rates (ASR) and with Joinpoint version 4.9.1.0 software.

Results

In Asia, the number of cervical cancer incidences, prevalence, death, and DALYs increased to 1.94, 2.26, 1.7, and 1.5-fold, respectively; while globally, these numbers increased by 1.67, 1.89, 1.52, and 1.45 times, respectively. In Asia, the AAPC of cervical cancer age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), the age-standardized death rate (ASDR), and DALYs age-standardized rates (DALYs ASRs) were −0.3, 0.5, −1.0, and −1.0 respectively. The AAPC of these indicators worldwide was −0.4, 0.2, −0.9, and −0.9, respectively. South Asia and Southeast Asia experienced the highest decrease in ASIR of cervical cancer from 1990 to 2019. In 2019, all GBD regions of Asia experienced a decreasing trend in ASDR and DALYs ASRs of cervical cancer. In 2019, the highest ASIR, ASPR, ASDR, and DALYs ASR of cervical cancer belonged to Brunei Darussalam, Brunei Darussalam, Mongolia, and Mongolia, respectively, and the lowest in all above categories was related to the Syrian Arab Republic, Syrian Arab Republic, Kuwait, and Kuwait; respectively.

Conclusions

Although the epidemiological statistics of cervical cancer in Asia have started to decline, this disease is still one of the most important causes of death for women in this region. So it seems in addition to improving screening coverage and management, we need to implementation of educational and awareness-raising interventions regarding cervical cancer, eliminate misconceptions related to testing results, and emphasize the preventable nature of this cancer by early detection using screening methods.

Keywords: Asia; burden; cervical cancer; incidence; mortality; prevalence

Introduction

Cervical cancer is the fourth most common cancer in women and one of the most important health challenges in the world [1]. The main cause of cervical cancer is persistent infection with oncogenic types of human papillomavirus (HPV) [2]. Screening and vaccination programs are two effective strategies in disease prevention [3]. In 2020, more than half a million new cases of cervical cancer were diagnosed and about 340,000 deaths due to this disease were recorded worldwide [1].

Despite recent advances in the prevention, screening, diagnosis, and treatment of cervical cancer, significant regional and global differences in these variables are still evident [4]. Variations in screening programs and socioeconomic status are responsible for most of the racial-ethnic disparities [5]. In some countries, cytological screening programs, Pap smear tests, early detection, and treatment of cervical precancerous lesions have reduced the advanced cases of cervical cancer. However, due to poor access to screening programs or lack thereof, the burden of cervical cancer is high in some geographical areas such as Asian countries [6].

Cervical cancer mortality is different in distinct geographical locations, which is caused by diagnosis in the advanced stages of the disease, inefficiency of treatment systems, and weak insurance and support systems [7]. In order to better control the disease, it is necessary to identify areas with the largest population and the highest diversity in terms of epidemiological statistics. Although the incidence and mortality of cervical cancer seem to be varied in Asia, no study has evaluated the trend of this disease and the changes in its epidemiology in recent decades. Most of the existing studies are regional studies that cannot be generalized to other countries [8], [9], [10]. Therefore, this study was conducted to determine the temporal trend of cervical cancer between 1990 and 2019 in Asian countries based on geographic region and SDI, and also compare it with global data.

Methods and materials

Source data

The annual number an age-standardized rates (ASRs) on incidence, prevalence, death, and the burden imposed by cervical cancer on Asian countries (49 countries and territories included) according to the International Classification of Diseases 10 code (C53) were extracted from the online Global Burden of Disease (GBD) database 2019. This year is the calendar year in which the most recent data for epidemiological indices are available at the online data source Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool) [11].

GBD studies are based on data obtained from by the Institute for Health Metrics and Evaluation (IHME). IHME is part of the University of Washington and an independent global health research foundation responsible for maintaining and exchanging comprehensive registry data, surveys, censuses, and other health-related data to produce various disease estimates [12]. GBD estimates all available epidemiological indicators to provide a comparative evaluation of health losses attributable to 364 diseases in 204 countries and territories between 1990 and 2019 [13, 14]. These indicators include incidence, mortality, prevalence, year of life lost (YLL), year lived with disability (YLD), and disability-adjusted life years (DALY) of each disease and injury by time, location, sex, and age group [11, 12, 14].

In this study, data were extracted in different classifications of Asian countries based on the SDI, and six GBD categories for Asian countries from 1990 to 2019 and compared with global data. By GBD classification, Asian countries are divided into six regions: Central Asia, East Asia, High-Inia Pacific, North Africa and Middle East, South Asia, and Southeast Asia. Based on this classification, 6 countries out of 26 countries in North Africa and the Middle East region and 2 countries in the Southeast Asia region belong to the Asian continent. But considering that most of the countries in these two regions belonged to the Asian continent, we specifically used these data as Asian regions.

SDI is the geometric average of three indicators including income per capita, average educational attainment of people aged 15 years and older, and the total fertility rate in people aged <25 years. According to the SDI values, countries and territories were classified into low SDI (<0.45), low-middle SDI (≥0.45 and <0.61), middle SDI (≥0.61 and <0.69), high-middle SDI (≥0.69 and <0.80), and high SDI (≥0.80) groups [15, 16].

The study was approved by the Ethics Committee of the Birjand University of Medical Sciences in Iran by the Code of Ethics: IR.BUMS.REC.1400.316. Considering that anonymous online data set was used in this study, informed consent was not required. All procedures were performed in accordance with applicable guidelines and regulations, therefore no identification information has been made public.

Statistical analysis

Data were reported in values with a confidence interval (CI) of 95%. Incidence, prevalence, deaths, DALYs, and age-standardized rates were expressed on a per 100,000 population basis to eliminate the influence of the various composition of age groups in populations. The selected epidemiological indicators were presented separately for the different classifications.

The relative changes (%) between years were used to show comparative changes in incidences, prevalence, deaths, and DALY age-standardized rates in three time periods from 1990 to 2010, 2010 to 2019 and 1990 to 2019. The relative changes are equal to the value of the absolute difference divided by the value in the original year, and then we multiplied it by 100 [17].

To show the epidemiological trend of cervical cancer based on the desired indicators, the average annual percentage change (AAPC) and its 95% CI in the 30-year past period for each location were calculated by using age-standardized rates (ASR) and the joinpoint regression analysis with Joinpoint regression program version 4.9.1.0 software.

If the AAPC and the lower boundary of 95% CI are both higher than 0, the index is considered to have an upward trend. If both the AAPC and the upper limit of 95% CI are less than 0, the estimated value is considered to have a downward trend. Otherwise, indicators are considered stable for a long time [18]. Figures was designed with Excel 2016.

All definitions used are available https://www.healthdata.org/terms-defined and https://www.healthdata.org/gbd/.

Results

Incidence rate of cervical cancer in Asia

In 2019 approximately 52% (297,402 of 565,541) of cervical cancer cases happened in Asia countries. In Asia, the number of cervical cancer incidence increased from 153,146 (95% CI: 127,056–203,339) in 1990–297,402 (95% CI: 238,273–343,878) in 2019, which is over a 1.94-fold increase; while globally, this number increased 1.67 times. During this period in Asia, the age-standardized incidence rate (ASIR) of cervical cancer with relatively 8% change and AAPC −0.3 (95% CI: −0.5 to 0.1), decreased from 12.73 (95% CI: 10.59–16.95) per 100.000 in 1990 to 11.7 (95% CI: 9.38–13.51) per 100.000 in 2019, while in the same time, this rate globally decreased relatively by 10% and AAPC −0.4 (95% CI: −0.5 to 0.3).

In 1990, the highest ASIR of cervical cancer was observed in Southeast Asia (18.75 (95% CI: 14.3–23.63) per 100.000 people) and Central Asia (18.58 (95% CI: 17.37–19.85) per 100.000 people) but while experienced a decreasing trend from 1990 to 2019, in 2019 also have highest ASIR (7.36 (95% CI: 6.03–10.33) and 7.58 (95% CI: 6.68–8.7), respectively). In contrast, East Asia countries experienced a significant increase trend from 1990 to 2019 (24% increase with AAPC 0.7 (95% CI: 0.6–0.9)), and in South Asia countries increasing trend started from 2010. Generally, South Asia and Southeast Asia experienced the highest decrease in ASIR of cervical cancer from 1990 to 2019 (23% decrease) with AAPC −0.9 (95% CI: −1.4 to 0.4) and −0.9 (95% CI: −1.0 to 0.8), respectively (Figure 1).

Figure 1: Temporal trend of incidence, prevalence, death and DALYs age standard rates (per 100.000 population) of cervical cancer in ASIA comparison with global data from 1990 to 2019.
Figure 1:

Temporal trend of incidence, prevalence, death and DALYs age standard rates (per 100.000 population) of cervical cancer in ASIA comparison with global data from 1990 to 2019.

In 2019, among high SDI Asian countries, Brunei Darussalam (25.04) has the highest ASIR of cervical cancer, and Kuwait (3.62) has the lowest rate. While Singapore experienced the highest decreasing trend (60% decrease) with AAPC –3.0 (95% CI: −3.4 to 2.7), Saudi Arabia reported an increasing trend (36% increase) with AAPC 1.0 (95% CI: 0.7–1.3) from 1990 to 2019, and decreasing trend from 2010 cannot compensate increasing trend in 1990–2010.

Among high-middle SDI Asian countries, Kazakhstan (18.48), Malaysia (17.92), and Georgia (17.18) have the highest ASIR of cervical cancer, and Jordan (4.03) has the lowest rate. While Jordan experienced the highest decreasing trend (33% decrease) with AAPC −1.4 (95% CI: −1.8 to 1.1), Sri Lanka reported an increasing trend (2% increase) from 1990 to 2019, and decreasing trend from 2010 cannot compensate increasing trend in 1990–2010. The AAPC for Sri Lanka between 1990 and 2019 was not statistically significant (p=0.701).

Among middle SDI Asian countries, Viet Nam (17.77) and Uzbekistan (17.26) have the highest ASIR of cervical cancer, and Syrian Arab Republic (3.25) has the lowest rate. While Thailand experienced the highest decreasing trend (41% decrease) with AAPC −1.8 (95% CI: −2.2 to 1.3), China reported an increasing trend (31% increase) with AAPC 0.9 (95% CI: 0.8–1.1), from 1990 to 2019.

Among low-middle SDI Asian countries, Mongolia (20.97) has the highest ASIR of cervical cancer, and Palestine (4.66) has the lowest rate. All of these countries experienced a decreasing trend in ASIR of cervical cancer from 1990 to 2019 and Maldives presented the highest decreasing trend (60%) with AAPC −3.2 (95% CI: −3.5 to 2.8).

Among low SDI Asian countries, Nepal (13.91) has the highest ASIR of cervical cancer, and Yemen (6.39) has the lowest rate. While Nepal experienced the highest decreasing trend (37% decrease) with AAPC −1.6 (95% CI: −1.7 to 1.4), Pakistan reported an increasing trend (11% increase) with AAPC 0.4 (95% CI: 0.3–0.4), from 1990 to 2019, and decreasing trend from 2010 cannot compensate increasing trend in 1990–2010.

Among Asian countries, 40 countries experienced a significant decrease in the cervical cancer morbidity rate between 1990 and 2019, but the greatest decrease was detected in Maldives and Singapore. Viet Nam, Sri Lanka, Israel, Turkmenistan, Japan, Pakistan, Uzbekistan, China, and Saudi Arabia had increasing trends in cervical cancer incidence from 1990 to 2019.

In 2019, the highest ASIR of cervical cancer was reported in Brunei Darussalam (25.04), Mongolia (20.97), Kazakhstan (18.48), Democratic People’s Republic of Korea (18.46), and Kyrgyzstan (18.27). The lowest ASIR of cervical cancer was reported in Syrian Arab Republic (3.25), Kuwait (3.62), Iran (Islamic Republic of) (3.99), Jordan (4.03), Iraq (4.61).

Results with details was presented in Table 1, Figures 2 and 3.

Table 1:

The incidence rates of cervical cancer in Asian countries in 1990, 2010 and 2019 and the temporal trends between 1990 and 2019, by geographical region and SDI.

Location SDI 2019 1990 2010 % change 1990–2010 2019 % change 2010–2019 % change 1990–2019 AAPC
Number ASR per 1,000,000 Number ASR per 1,000,000 Number ASR per 1,000,000 AAPC p-Value
Global 335,642 14.91 476,523 13.49 −0.09 565,541 13.35 −0.01 −0.10 −0.4 <0.001
(300,354–393,893) (13.37–17.55) (422,622–520,508) (11.99–14.76) (−0.19 to 0.02) (481,524–636,435) (11.37–15.03) (−0.1 to 0.08) (−0.24 to 0.01) (−0.5 to −0.3)
Asia 153,146 12.73 243,180 11.74 −0.08 297,402 11.70 0.00 −0.08 −0.3 0.006
(127,056–203,339) (10.59–16.95) (205,536–263,600) (9.95–12.8) (−0.26 to 0.09) (238,273–343,878) (9.38–13.51) (−0.13 to 0.13) (−0.31 to 0.14) (−0.5 to 0.1)
Countries by geographical location
Central Asia 5,274 18.58 6,911 17.61 −0.05 7,666 7.58 −0.09 −0.14 −0.5 <0.001
(4,897–5,629) (17.37–19.85) (6,537–7,307) (16.69–18.68) (−0.11 to 0.02) (6,647–8,830) (6.68–8.7) (−0.19 to 0.04) (−0.24 to 0.02) (−0.7 to −0.3)
East Asia 45,257 9.00 95,980 10.98 0.22 115,377 5.18 0.02 0.24 0.7 <0.001
(35,384–79,361) (7.08–15.63) (66,232–11,0041) (7.63–12.58) (−0.37 to 0.61) (64,346–147,115) (3.09–6.59) (−0.25–0.31) (−0.49 to 0.81) (0.6–0.9)
High-income Asia Pacific 12,466 11.65 15,048 11.09 −0.05 15,061 2.70 −0.07 −0.11 −0.4 <0.001
(11,636–14,357) (10.81–13.42) (12,786–16,029) (9.15–11.83) (−0.27 to 0.02) (11,908–17,961) (2.22–2.96) (−0.22 to 0.11) (−0.36 to 0.08) (−0.6 to −0.2)
North Africa and Middle East 7,032 6.90 11,339 5.95 −0.14 14,626 3.15 −0.03 −0.16 −0.6 <0.001
(5,028–8,027) (4.92–7.88) (8,784–13,013) (4.67–6.78) (−0.22 to 0.09) (11,139–17,632) (2.47–3.69) (−0.12 to 0.08) (−0.27 to 0.18) (−0.7 to −0.6)
South Asia 56,356 16.04 74,744 11.94 −0.26 100,020 7.01 0.04 −0.23 −0.9 0.001
(44,209–68,594) (12.64–19.66) (64,787–93,890) (10.35–15.06) (−0.36 to −0.06) (80,106–12,4770) (5.66–9.21) (−0.15 to 0.27) (−0.39 to 0.02) (−1.4 to −0.4)
Southeast Asia 31,127 18.75 45,507 15.75 −0.16 52,062 7.36 −0.08 −0.23 −0.9 <0.001
(23,520–38,684) (14.3–23.63) (37,383–57,762) (13.04–20.2) (−0.26 to −0.03) (41,929–68,668) (6.03–10.33) (−0.21 to 0.08) (−0.36 to −0.02) (−1 to −0.8)
Countries by SDI 2019 high SDI
Brunei Darussalam 0.823 30 38.78 40 24.85 −0.36 53 25.04 0.01 −0.35 −1.5 <0.001
(21–38) (28.48–48.5) (33–50) (20.95–30.89) (−0.5 to −0.14) (40–70) (19.58–32.57) (−0.19 to 0.23) (−0.51 to 0.12) (−1.7 to −1.4)
Cyprus 0.841 32 7.61 52 7.30 −0.04 61 6.49 −0.11 −0.15 −0.5 0.018
(25–46) (6.06–10.98) (41–61) (5.74–8.6) (−0.33 to 0.22) (42–74) (4.56–8) (−0.29 to 0.1) (−0.46 to 0.19) (−0.9 to −0.1)
Israel 0.803 158 6.39 293 6.90 0.08 345 6.65 −0.04 0.04 0.2 0.154
(141–186) (5.69–7.51) (236–326) (5.54–7.7) (−0.26 to 0.27) (244–454) (4.63–8.83) (−0.29 to 0.29) (−0.32 to 0.42) (−0.1 to 0.4)
Japan 0.87 9,048 10.48 11,300 11.73 0.12 11,105 11.17 −0.05 0.07 0.2 0.039
(8,515–10,080) (9.86–11.62) (9,173–12,057) (8.79–12.56) (−0.22 to 0.22) (8,101–14,016) (7.66–14.29) (−0.25 to 0.2) (−0.3 to 0.38) (0–0.4)
Kuwait 0.851 25 6.32 40 4.65 −0.27 64 3.62 −0.22 −0.43 −1.9 <0.001
(20–30) (5.08–7.49) (34–45) (3.94–5.19) (−0.4 to −0.09) (47–93) (2.69–5.1) (−0.39 to −0.08) (−0.58 to −0.19) (−2.4 to −1.4)
Qatar 0.83 6 9.47 18 10.31 0.09 33 8.34 −0.19 −0.12 −0.4 0.11
(5–9) (7.14–12.92) (14–24) (8.09–12.96) (−0.21 to −0.48) (23–47) (6.26–11.04) (−0.36 to −0.03) (−0.36 to 0.27) (−0.9 to 0.1)
Republic of Korea 0.878 3,110 15.02 3,450 10.27 −0.32 3,597 9.08 −0.12 −0.40 −1.7 <0.001
(2,588–3,641) (12.84–18.23) (2,926–4,302) (8.73–12.77) (−0.4 to −0.18) (2,787–4,661) (6.98–11.85) (−0.29 to −0.1) (−0.54 to −0.19) (−2.2 to −1.3)
Saudi Arabia 0.805 115 3.65 416 5.28 0.45 638 4.95 −0.06 0.36 1.0 <0.001
(78–195) (2.57–6.11) (334–554) (4.4–6.63) (−0.05 to −1.12) (440–920) (3.65–6.79) (−0.28 to −0.21) (−0.16 to 1.18) (0.7–1.3)
Singapore 0.861 278 19.08 259 8.95 −0.53 306 7.70 −0.14 −0.60 −3.0 <0.001
(237–308) (16.31–21.03) (232–302) (8.04–10.43) (−0.59 to −0.43) (236–400) (5.91–10.05) (−0.32 to 0.11) (−0.69 to −0.46) (−3.4 to −2.7)
Taiwan (Province of China) 0.868 2,470 28.82 2,308 14.77 −0.49 2,472 13.09 −0.11 −0.55 −2.7 <0.001
(2,149–2,629) (25.38–30.63) (2,109–2,893) (13.53–18.52) (−0.54 to −0.31) (1,852–3,473) (9.72–18.42) (−0.33 to 0.18) (−0.66 to −0.35) (−3 to −2.3)
United Arab Emirates 0.88 32 16.83 89 18.29 0.09 190 10.82 −0.41 −0.36 −1.5 <0.001
(22–44) (11.34–23.71) (68–127) (11.88–22.62) (−0.25 to 0.58) (130–283) (7.66–14.68) (−0.54 to −0.23) (−0.57 to −0.01) (−2 to 0.9)
High-middle SDI
Bahrain 0.751 8 7.80 20 6.33 −0.19 29 5.65 −0.11 −0.28 −1.2 <0.001
(7–11) (6.35–10.13) (16–26) (5.13–8) (−0.36 to 0.06) (22–39) (4.29–7.4) (−0.28 to 0.11) (−0.46 to 0.01) (−1.5 to −0.8)
Georgia 0.702 775 23.52 489 18.09 −0.01 445 17.18 −0.05 −0.27 −1.1 <0.001
(592–880) (18–26.8) (420–560) (15.42–20.87) (−0.11 to 0.09) (346–543) (13.15–21.12) (−0.25 to 0.22) (−0.44 to −0.08) (−1.7 to −0.6)
Jordan 0.731 52 6.04 92 4.21 −0.30 160 4.03 −0.04 −0.33 −1.4 <0.001
(38–67) (4.56–7.8) (66–111) (3.15–5.03) (−0.47 to −0.05) (111–215) (2.88–5.36) (−0.25 to 0.21) (−0.52 to 0) (−1.8 to 1.1)
Kazakhstan 0.723 1,678 21.28 1978 22.05 0.04 1,939 18.48 −0.16 −0.13 −0.5 0.015
(1,523–1,868) (19.4–23.58) (1,800–2,159) (20.1–24.06) (−0.08 to 0.16) (1,608–2,349) (15.33–22.34) (−0.31 to 0.02) (−0.28 to 0.05) (−0.8 to −0.1)
Lebanon 0.708 94 7.32 133 6.06 −0.17 177 6.08 0.00 −0.17 −0.6 <0.001
(66–122) (5.24–9.43) (95–178) (4.31–8.07) (-0.38–0.17) (118–249) (4.06–8.52) (−0.22 to 0.28) (−0.4 to 0.3) (−0.7 to −0.5)
Malaysia 0.737 1,240 21.85 1,761 15.56 −0.29 2,602 17.92 0.15 −0.18 −0.8 <0.001
(831–1435) (14.51–25.15) (1,524–2,144) (13.48–18.61) (−0.4 to −0.03) (1,849–3,446) (12.6–23.65) (−0.14 to 0.51) (−0.39 to 0.13) (−1 to −0.6)
Oman 0.783 29 7.73 55 8.34 0.08 63 5.94 −0.29 −0.23 −0.9 <0.001
(20–40) (5.28–10.54) (41–65) (6.17–9.64) (−0.24 to 0.58) (45–82) (4.46–7.43) (−0.42 to −0.12) (−0.46 to 0.25) (−1.1 to −0.7)
Sri Lanka 0.69 511 7.69 942 8.34 0.09 1,077 7.84 −0.06 0.02 0.1 0.701
(427–692) (6.48–10.6) (684–1,074) (6.13–9.46) (−0.21 to 0.32) (729–1,499) (5.34–10.94) (−0.32 to 0.3) (−0.33 to 0.51) (−0.4 to 0.6)
Turkey 0.748 1,458 6.91 1,869 4.98 −0.28 2,202 4.67 −0.06 −0.32 −1.4 <0.001
(914–1,841) (4.39–8.65) (1,355–2,214) (3.62–5.88) (−0.44 to 0.1) (1,529–2,828) (3.23–5.99) (−0.27 to 0.23) (−0.52 to 0.07) (−1.6 to 1.1)
Middle SDI
Armenia 0.689 315 19.15 380 19.18 0.00 323 15.61 −0.19 −0.18 −0.7 0.003
(282–351) (17.25–21.52) (309–413) (15.66–20.91) (−0.22 to 0.14) (260–399) (12.47–19.13) (−0.35 to 0.02) (−0.36 to 0.03) (−1.2 to −0.2)
Azerbaijan 0.683 440 13.94 640 13.27 −0.05 705 11.88 −0.10 −0.15 −0.5 <0.001
(373–531) (11.94–17.05) (534–824) (11.16–17.25) (−0.21 to 0.15) (518–987) (8.77–16.66) (−0.32 to 0.15) (−0.37 to 0.14) (−0.8 to 0.3)
China 0.686 40,681 8.41 90,664 10.75 0.28 109,760 11.01 0.02 0.31 0.9 <0.001
(30,920–73,182) (6.44–15) (61,235–104,557) (7.31–12.39) (−0.36 to 0.74) (58,189–141,539) (5.87–14.22) (−0.26 to 0.33) (−0.5 to 0.97) (0.8–1.1)
Indonesia 0.66 10,404 15.86 15,725 14.47 −0.09 17,054 12.81 −0.12 −0.19 −0.7 <0.001
(6,474–15,389) (10.02–23.65) (10,228–22,948) (9.69–21.54) (−0.27 to 0.14) (11,395–26,818) (8.63–20.42) (−0.33 to 0.2) (−0.39 to 0.14) (−0.8–0.7)
Iran (Islamic Republic of) 0.67 835 5.36 1,220 3.80 −0.29 1,680 3.99 0.05 −0.26 −1.0 <0.001
(581–977) (3.78–6.38) (927–1,325) (2.84–4.15) (−0.39 to −0.09) (1,222–1,933) (2.87–4.57) (−0.05 to 0.18) (−0.38 to 0.07) (−1.1 to 0.9)
Iraq 0.671 216 4.65 469 4.50 −0.03 689 4.61 0.02 −0.01 −0.1 0.491
(155–303) (3.39–6.46) (333–664) (3.25–6.21) (−0.32 to 0.38) (480–969) (3.25–6.33) (−0.24 to 0.36) (−0.35 to 0.53) (−0.2 to 0.1)
Philippines 0.623 3,358 16.44 5,368 13.92 −0.15 6,776 13.90 0.00 −0.15 −0.6 <0.001
(2,473–3,984) (12.72–19.81) (4,392–6,210) (11.76–16.42) (−0.3 to 0.05) (4,723–9,141) (9.78–18.89) (−0.28 to 0.34) (−0.42 to 0.2) (−0.8 to −0.3)
Syrian Arab Republic 0.619 126 3.87 206 3.30 −0.15 219 3.25 −0.02 −0.16 −0.6 0.004
(87–170) (2.74–5.11) (157–266) (2.58–4.17) (−0.38 to 0.26) (155–313) (2.33–4.61) (−0.29 to 0.35) (−0.42 to 0.34) (−1 to −0.2)
Thailand 0.687 6,505 27.56 8,125 18.97 −0.31 8,335 16.27 −0.14 −0.41 −1.8 <0.001
(4,705–7,766) (20.26–32.65) (6,722–10,379) (15.67–24.21) (−0.46 to −0.07) (5,835–12,253) (11.26–24.12) (−0.41 to 0.23) (−0.6 to 0.1) (−2.2 to −1.3)
Turkmenistan 0.67 184 14.79 331 15.79 0.07 390 15.59 −0.01 0.05 0.2 0.66
(166–203) (13.27–16.35) (259–367) (12.65–17.38) (−0.15 to 0.21) (276–521) (11.08–20.66) (−0.25 to 0.32) (−0.24 to 0.4) (−0.7 to 1.2)
Uzbekistan 0.631 1,071 15.26 2,119 17.62 0.15 2,704 17.26 −0.02 0.13 0.5 0.03
(958–1,200) (13.69–16.92) (1,899–2,313) (16–19.22) (0.03–0.3) (2,101–3,347) (13.49–21.22) (−0.21 to 0.21) (−0.12 to 0.41) (0–0.9)
Viet Nam 0.617 4,250 17.58 7,975 18.46 0.05 9,966 17.77 −0.04 0.01 0 0.638
(3,147–5,548) (13.09–23.22) (5,847–10,067) (13.48–23.2) (−0.24 to 0.47) (6,956–13,158) (12.52–23.37) (−0.23 to 0.22) (−0.31 to 0.5) (−0.1 to 0.1)
Low-middle SDI
Bangladesh 0.483 5,371 19.35 5,592 10.69 −0.45 7,407 10.07 −0.06 −0.48 −2.2 <0.001
(2,393–7,045) (8.73–25.15) (3,145–8,033) (5.94–14.83) (−0.6 to −0.04) (4,071–11,533) (5.5–15.46) (−0.28 to 0.2) (−0.66 to −0.03) (−2.4 to −1.9)
Bhutan 0.455 32 20.04 33 13.05 −0.35 41 12.94 −0.01 −0.35 −1.5 <0.001
(15–46) (9.16–28.38) (19–49) (7.78–19.42) (−0.56–0.22) (24–66) (7.61–20.35) (−0.23 to 0.26) (−0.6 to 0.27) (−1.7 to −1.4)
Cambodia 0.469 740 22.72 1,061 17.71 −0.22 1,378 17.82 0.01 −0.22 −0.8 <0.001
(412–1,054) (12.85–32.33) (726–1,515) (12.29–25.85) (−0.42 to 0.16) (972–2,073) (12.77–27.14) (−0.2 to 0.29) (−0.46 to 0.26) (−0.9 to −0.7)
Democratic People’s Republic of Korea 0.558 2,106 19.77 3,008 19.63 −0.01 3,146 18.46 −0.06 −0.07 −0.2 <0.001
(1,359–3,588) (13.05–33.65) (1,917–4,437) (12.42–29.09) (−0.33 to 0.39) (1,992–4,673) (11.61–27.49) (−0.27 to 0.24) (−0.41 to 0.41) (−0.3 to −0.1)
India 0.566 47,409 16.65 63,361 12.47 −0.25 84,982 13.10 0.05 −0.21 −0.8 0.005
(37,134–60,574) (13.2–21.45) (54,635–83,002) (10.69–16.4) (−0.37 to −0.06) (65,942–11,0276) (10.18–17.09) (−0.16 to 0.34) (−0.4 to 0.02) (−1.4 to −0.2)
Kyrgyzstan 0.596 415 23.24 497 20.21 −0.13 550 18.27 −0.10 −0.21 −0.9 <0.001
(355–457) (20.05–25.54) (447–538) (18.41–21.79) (−0.22 to −0.02) (438–660) (14.68–21.87) (−0.26 to 0.08) (−0.35 to −0.05) (−1.2 to −0.6)
Lao People’s Democratic Republic 0.49 337 25.47 377 17.09 −0.33 451 15.69 −0.08 −0.38 −1.7 <0.001
(172–503) (13.6–38.45) (211–566) (9.58–26.08) (−0.53 to 0.02) (275–671) (9.64–23.64) (−0.28 to 0.21) (−0.59 to 0.07) (−1.7 to −1.6)
Maldives 0.562 12 22.18 11 9.65 −0.56 15 8.78 −0.09 −0.60 −3.2 <0.001
(5–17) (9.36–31.64) (9–14) (8.07–11.87) (-0.69–0.06) (12–20) (6.85–11.47) (−0.28 to 0.15) (−0.74 to 0.01) (−3.5 to −2.8)
Mongolia 0.606 181 29.05 280 23.87 −0.18 347 20.97 −0.12 −0.28 −1.1 <0.001
(141–242) (22.7–38.61) (216–375) (18.63–30.74) (−0.39 to 0.14) (244–508) (15.17–29.49) (−0.33 to 0.2) (−0.49 to 0.03) (−1.4 to −0.9)
Myanmar 0.521 3,597 24.27 3,940 16.60 −0.32 4,142 14.25 −0.14 −0.41 −1.8 <0.001
(1,948–5,638) (13.6–38.86) (2,483–6,288) (10.48–27.13) (−0.52 to 0.01) (2,794–6,664) (9.64–23.27) (−0.33 to 0.15) (−0.61 to −0.01) (−2 to −1.7)
Palestine 0.588 31 5.95 43 4.16 −0.30 67 4.66 0.12 −0.22 −0.9 <0.001
(20–42) (3.84–8) (32–50) (3.04–4.88) (−0.48 to −0.04) (44–83) (2.97–5.72) (−0.16 to 0.39) (−0.45 to 0.15) (−1.2 to −0.6)
Tajikistan 0.539 215 13.01 196 8.01 −0.38 263 7.65 −0.05 −0.41 −1.8 <0.001
(152–250) (9.13–15.05) (155–298) (6.52–11.57) (−0.52 to −0.02) (195–432) (5.82–11.86) (−0.26 to 0.25) (−0.57 to 0.01) (−2.1 to −1.5)
Timor-Leste 0.514 38 18.49 46 13.27 −0.28 69 15.52 0.17 −0.16 −0.6 <0.001
(21–55) (10.81–27.16) (25–73) (7.44–20.97) (−0.6 to 0.06) (40–105) (9.4–23.67) (−0.09 to 0.57) (−0.51 to 0.3) (−0.9 to −0.4)
Low SDI
Afghanistan 0.343 493 12.79 854 12.18 −0.05 1,070 11.39 −0.07 −0.11 −0.4 <0.001
(149–768) (4.02–19.73) (274–1,329) (4.63–18.53) (−0.29 to 0.31) (380–1,699) (4.58–17.47) (−0.26 to 0.17) (−0.35 to 0.29) (−0.5 to −0.3)
Nepal 0.422 1,348 22.23 1,372 13.11 −0.41 1,891 13.91 0.06 −0.37 −1.6 <0.001
(626–1,849) (10.42–30.33) (834–1,925) (8.03–18.13) (−0.59 to −0.05) (1,163–2,757) (8.66–20.11) (−0.17 to 0.34) (−0.59 to 0.08) (−1.7 to 1.4)
Pakistan 0.449 2,196 6.97 4,386 8.02 0.15 5,699 7.70 −0.04 0.11 0.4 <0.001
(1,759–2,774) (5.63–8.84) (3,259–5,736) (6.02–10.28) (−0.14 to 0.51) (4,025–8,109) (5.51–10.8) (−0.33 to 0.38) (−0.22 to 0.58) (0.3–0.4)
Yemen 0.412 214 6.92 380 6.17 −0.11 573 6.39 0.04 −0.08 −0.3 <0.001
(96–332) (3.27–10.42) (221–543) (3.79–8.6) (−0.35 to 0.29) (341–871) (3.98–9.4) (−0.19 to 0.31) (−0.37 to 0.49) (−0.4 to −0.1)
Figure 2: The relative change (%) in age-standardized incidence rate (ASIR), the age-standardized death rate (ASMR), the age-standardized DALYs rate (DALYs ASR), and age-standardized prevalence rate (ASPR) of cervical cancer in Asian countries from 1990 to 2019.
Figure 2:

The relative change (%) in age-standardized incidence rate (ASIR), the age-standardized death rate (ASMR), the age-standardized DALYs rate (DALYs ASR), and age-standardized prevalence rate (ASPR) of cervical cancer in Asian countries from 1990 to 2019.

Figure 3: The AAPC in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), the age-standardized death rate (ASDR), and age-standardized DALYs rate (DALYs ASR) of cervical cancer in Asian countries from 1990 to 2019.
Figure 3:

The AAPC in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), the age-standardized death rate (ASDR), and age-standardized DALYs rate (DALYs ASR) of cervical cancer in Asian countries from 1990 to 2019.

Prevalence rate of cervical cancer in Asia

In 2019 approximately 53% (1,525,981 of 2,887,521) of cervical cancer cases lived in Asian countries. In Asia, the number of women who lived with cervical cancer increased from 675,875 (95% CI: 559,840–877,160) in 1990–1,525,981 (95% CI: 1,195,496–1,760,364) in 2019, which is over a 2.26-fold increase; while globally, this number increased 1.89 times. During this period in Asia, the age-standardized prevalence rate (ASPR) of cervical cancer with a relatively 15% change and AAPC 0.5 (95% CI: 0.4–0.6), increased from 52.12 (95% CI: 43.52–67.87) per 100.000 in 1990 to 60 (95% CI: 47.11–69.24) per 100.000 in 2019, while in the same time, this rate globally increased relatively by 4% and AAPC 0.2 (95% CI: 0.0–0.3).

In 1990, the highest ASPR of cervical cancer was observed in Central Asia countries (88.82 (95% CI: 82.89–95.86)) but these countries experienced a slow decrease from 1990 to 2019; so ASPR of cervical cancer in these countries has the top situation in Asia countries in 2019, yet. In contrast, East Asia countries experienced a significant increase trend (0.82 (95% CI: −0.28 to 1.72)) with AAPC 2.1 (95% CI: 1.9–2.4) in ASPR from 1990 to 2019. During this time period, the highest significant AAPC was observed in Southeast Asia with AAPC −0.3 (95% CI: −0.2 to −0.4) (Figure 1)

In 2019, among high SDI Asian countries, Brunei Darussalam (207.61) has the highest ASPR of cervical cancer, and Kuwait (23.33) has the lowest rate. While Singapore experienced the highest decreasing trend (56% decrease) with AAPC –2.7 (95% CI: −3.1 to −2.4), Saudi Arabia reported an increasing trend (85% increase) with AAPC 2.1 (95% CI: 1.6–2.6) from 1990 to 2019.

Among high-middle SDI Asian countries, Kazakhstan (107.22) has the highest ASPR of cervical cancer, and Jordan (20.46) has the lowest rate. While Georgia experienced the highest decreasing trend (27% decrease) with AAPC −1.1 (95% CI: −1.7 to −0.6), Sri Lanka reported an increasing trend (21% increase) with AAPC 0.7 (95% CI: 0.2–1.1) from 1990 to 2019.

Among middle SDI Asian countries, Thailand (95.39) has the highest ASPR of cervical cancer, and Republic of Syrian Arab Republic (15.55) has the lowest rate. While Thailand experienced the highest decreasing trend (28% decrease) with AAPC −1.1 (95% CI: −0.4 to −1.8), China reported an increasing trend (102% increase) with AAPC 2.5 (95% CI: 2.2–2.8) from 1990 to 2019.

Among low-middle SDI Asian countries, Democratic People’s Republic of Korea (101.23) has the highest ASPR of cervical cancer, and Palestine (19.41) has the lowest rate. While Maldives experienced the highest decreasing trend (49% decrease) with AAPC −2.3 (95% CI: −2.6 to −2.0), Timor-Leste reported an increasing trend (4% increase) with no significant AAPC (p=0.29) from 1990 to 2019, and the increasing trend has started from 2010.

Among low SDI Asian countries, Nepal (60.38) has the highest ASPR of cervical cancer, and Yemen (25.61) has the lowest rate. While Nepal experienced the highest decreasing trend (23% decrease) with AAPC –0.9 (95% CI: −1.0 to −0.7), Pakistan reported an increasing trend (31% increase) with AAPC 0.9 (95% CI: 0.8–1.0) from 1990 to 2019.

Among Asian countries, 15 countries experienced a significant increase in the cervical cancer prevalence rate between 1990 and 2019, but the greatest increase was detected in China (102%), and the greatest decrease was detected in Singapore (56%).

In 2019, the highest ASPR of cervical cancer was reported in Brunei Darussalam (142.93), Kazakhstan (107.22), Democratic People’s Republic of Korea (101.23), Thailand (95.39), and Kyrgyzstan (94.4). The lowest ASPR of cervical cancer was reported in Syrian Arab Republic (15.55), Kuwait (19.12), Palestine (19.41), Iran (Islamic Republic of) (19.93), and Jordan (20.46). Detailed results are presented in Table 2 and Figures 2 and 3.

Table 2:

The prevalence of cervical cancer in Asian countries in 1990, 2010 and 2019 and the temporal trends between 1990 and 2019, by geographical region and SDI.

Location SDI 2019 1990 2010 % change 1990–2010 2019 % change 2010–2019 % change 1990–2019 AAPC
Number ASR per 1,000,000 Number ASR per 1,000,000 Number ASR per 1,000,000 AAPC p-Value
Global 1,538,196 66.20 2,409,890 13.49 0.02 2,887,521 69.10 0.03 0.04 0.2 0.005
(1,390,311–1,779,520) (60.05–76.54) (2,113,161–2,563,466) (59.15–71.69) (−0.09 to 0.09) (2,439,415–3,21,9975) (58.34–77.1) (−0.07 to 0.12) (−0.11–0.17) (0–0.3)
Asia 675,875 52.12 1,241,886 57.69 0.11 1,525,981 60.00 0.04 0.15 0.5 <0.001
(559,840–877,160) (43.52–67.87) (1,022,470–1,347,461) (47.54–62.54) (−0.12 to 0.3) (1,195,496–1,760,364) (47.11–69.24) (−0.1 to 0.19) (−0.15 to 0.43) (0.4–0.6)
Countries by geographical location
Central Asia 25,709 88.82 36,528 88.16 −0.01 42,047 84.58 −0.04 −0.05 −0.2 0.082
(23,992–27,748) (82.89–95.86) (34,051–38,908) (82.35–93.83) (−0.08 to 0.07) (36,083–48,542) (72.62–97.55) (−0.15 to 0.11) (−0.17 to 0.1) (−0.3 to 0)
East Asia 181,833 33.42 509,571 56.76 0.70 606,297 60.91 0.07 0.82 2.1 <0.001
(140,754–321,616) (26.01–58.84) (346,674–587,003) (38.79–65.34) (−0.17 to 1.28) (330,195–779,482) (33.49–78.23) (−0.22 to 0.39) (−0.28 to 1.72) (1.9–2.4)
High-income Asia Pacific 75,997 72.40 95,972 77.63 0.07 93,884 73.19 −0.06 0.01 0 0.64
(70,325–86,717) (66.68–82.56) (78,932–103,004) (62.33–83.25) (−0.19 to 0.18) (73,301–112,723) (55.87–88.41) (−0.22 to 0.13) (−0.28 to 0.24) (−0.1 to 0.2)
North Africa and Middle East 31,513 27.45 56,921 26.50 −0.03 76,621 27.29 0.03 −0.01 0 0.462
(22,556–36,287) (19.79–31.49) (43,672–65,768) (20.51–30.43) (−0.14 to 0.2) (57,948–93,782) (20.53–33.16) (−0.07 to 0.17) (−0.13 to 0.39) (−0.1 to 0.1)
South Asia 232,837 58.93 340,664 50.01 −0.15 471,942 55.27 0.11 −0.06 −0.2 0.192
(179,193–283,010) (45.7–71.33) (295,597–417,332) (43.43–61.86) (−0.28 to 0.08) (375,852–591,748) (44.05–69.23) (−0.09 to 0.38) (−0.27 to 0.25) (−0.5 to 0.1)
Southeast Asia 145,650 80.30 231,640 74.98 −0.07 271,045 72.75 −0.03 −0.09 −0.3 <0.001
(109,417–175,748) (60.85–97.25) (190,491–283,129) (61.98–91.85) (−0.19 to 0.09) (219,925–350,396) (59.03–94.14) (−0.17 to 0.15) (−0.25 to 0.16) (−0.4 to −0.2)
Countries by SDI 2019 high SDI
Brunei Darussalam 0.823 185 207.61 254 136.37 −0.34 333 142.93 0.05 −0.31 −1.3 <0.001
(127–244) (149.46–266.35) (206–319) (112.87–170.84) (−0.5 to −0.08) (245–447) (107.61–189.34) (−0.19 to 0.33) (−0.5 to −0.01) (−1.5 to −1.1)
Cyprus 0.841 151 36.47 296 42.48 0.16 336 37.37 −0.12 0.02 0.2 0.546
(120–224) (28.85–54.28) (238–360) (34.41–52.03) (−0.16 to 0.53) (242–424) (26.99–47.27) (−0.32 to 0.12) (−0.34 to 0.45) (−0.4 to 0.7)
Israel 0.803 835 34.57 1,698 41.80 0.21 1978 40.79 −0.02 0.18 0.6 <0.001
(714–994) (29.58–40.97) (1,358–1,935) (33.49–47.72) (−0.16 to 0.48) (1,367–2,672) (27.75–55.1) (−0.3 to 0.35) (−0.23 to 0.65) (0.4–0.8)
Japan 0.870 54,947 66.03 71,666 83.53 0.27 68,758 80.39 −0.04 0.22 0.7 <0.001
(51,367–61,788) (61.85–73.73) (55,358–77,053) (60.67–90.55) (−0.16 to 0.4) (48,135–88,027) (53.76–103.78) (−0.25 to 0.23) (−0.23 to 0.6) (0.5–0.9)
Kuwait 0.851 155 31.78 251 23.33 −0.27 421 19.12 −0.18 −0.40 −1.5 <0.001
(124–188) (25.55–37.73) (211–291) (20.12–26.49) (−0.4 to −0.09) (304–625) (14.07–27.97) (−0.38 to 0.15) (−0.57 to 0.13) (−2 to −1)
Qatar 0.830 35 37.43 118 41.80 0.12 223 36.60 −0.12 −0.02 −0.1 0.533
(25–50) (27.29–51.4) (88–157) (32.16–53.98) (−0.19 to 0.58) (154–320) (26.42–50.11) (−0.33 to 0.14) (−0.34 to 0.48) (−0.6 to 0.3)
Republic of Korea 0.878 19,120 88.01 22,363 67.59 −0.23 22,828 61.39 −0.09 −0.30 −1.2 <0.001
(14,970–22,125) (70.34–101.95) (19,026–28,208) (57.6–84.54) (−0.34 to −0.05) (17,518–30,105) (46.9–80.39) (−0.28 to 0.17) (−0.47 to −0.04) (−1.7 to −0.8)
Saudi Arabia 0.805 558 14.26 2,530 25.63 0.80 4,212 26.40 0.03 0.85 2.1 <0.001
(361–978) (9.46–24.21) (1,998–3,423) (20.68–34.16) (0.14–1.77) (2,848–6,222) (18.66–37.68) (−0.23 to 0.36) (0.08–2.15) (1.6–2.6)
Singapore 0.861 1,745 112.33 1,690 56.89 −0.49 1,966 49.74 −0.13 −0.56 −2.7 <0.001
(1,482–1,973) (94.79–125.84) (1,501–1,990) (50.58–66.86) (−0.57 to −0.37) (1,490–2,582) (37.81–65.74) (−0.32 to 0.13) (−0.66 to −0.4) (−3.1 to −2.4)
Taiwan (Province of China) 0.868 14,383 159.00 13,954 88.98 −0.44 14,521 80.49 −0.10 −0.49 −2.3 <0.001
(12,412–15,521) (137.62–171.86) (12,571–18,160) (80.3–115.62) (−0.51 to −0.2) (10,615–21,024) (57.9–116.35) (−0.33 to 0.21) (−0.64 to −0.24) (−2.7 to −1.9)
United Arab Emirates 0.880 147 54.16 460 54.25 0.00 1,113 43.52 −0.20 −0.20 −0.8 0.001
(98–231) (38.03–74.95) (335–781) (39.75–68.77) (−0.31 to 0.49) (725–1,759) (30.66–60.18) (−0.4 to 0.07) (−0.48 to 0.28) (−1.2 to 0.3)
High-middle SDI
Bahrain 0.751 42 30.17 119 28.80 −0.05 175 27.83 −0.03 −0.08 −0.3 0.187
(33–54) (24.32–38.51) (91–154) (22.66–36.59) (−0.26 to 0.26) (127–237) (20.56–37.32) (−0.24 to 0.24) (−0.33 to 0.31) (−0.7 to 0.1)
Georgia 0.702 4,055 129.29 2,463 99.39 −0.23 2,191 94.26 −0.07 −0.27 −1.1 <0.001
(3,026–4,678) (96.35–148.81) (2,062–2,870) (82.64–117.06) (−0.38 to −0.02) (1,661–2,723) (70.96–118.13) (−0.37 to 0.32) (−0.45 to −0.05) (−1.7 to −0.6)
Jordan 0.731 255 25.32 524 20.44 −0.19 928 20.46 0.00 −0.19 −0.8 <0.001
(185–333) (18.58–32.79) (359–643) (14.33–24.89) (−0.41 to 0.16) (624–1,262) (13.94–27.56) (−0.25 to 0.32) (−0.45 to 0.26) (−1 to −0.5)
Kazakhstan 0.723 7,953 99.76 10,512 115.56 0.16 11,292 107.22 −0.07 0.07 0.3 0.035
(7,100–9,191) (89.24–115.43) (9,342–11,701) (102.51–128.06) (−0.02 to 0.34) (9,271–13,938) (88.16–132.32) (−0.24 to 0.15) (−0.13 to 0.33) (0–0.6)
Lebanon 0.708 476 34.94 748 33.88 −0.03 1,055 36.09 0.07 0.03 0.1 0.026
(307–631) (22.83–46.26) (508–1,000) (22.99–45.22) (−0.31 to 0.38) (674–1,520) (23.12–51.79) (−0.2 to 0.39) (−0.29 to 0.6) (0–0.2)
Malaysia 0.737 5,882 91.93 9,353 74.68 −0.19 13,998 91.31 0.22 −0.01 −0.1 0.407
(3,954–6,979) (61.55–108.32) (8,007–11,609) (64.23–90.99) (−0.34 to 0.12) (9,889–18,814) (64.87–122.1) (−0.11 to 0.67) (−0.29 to 0.41) (−0.3 to 0.1)
Oman 0.783 144 32.87 328 40.81 0.24 388 29.09 −0.29 −0.11 −0.4 0.149
(95–206) (21.97–46.32) (240–396) (30.24–48.37) (−0.14 to 0.9) (275–518) (21.1–37.6) (−0.44 to −0.09) (−0.4 to 0.45) (−0.9 to 0.1)
Sri Lanka 0.690 2,631 35.74 4,983 42.59 0.19 5,831 43.08 0.01 0.21 0.7 0.005
(2,178–3,544) (29.49–48.24) (3,635–5,831) (31.18–49.58) (−0.12 to 0.48) (3,907–8,202) (28.97–60.99) (−0.28 to 0.42) (−0.19 to 0.83) (0.2–1.1)
Turkey 0.748 6,373 27.60 9,178 23.61 −0.14 10,797 22.57 −0.04 −0.18 −0.7 <0.001
(3,875–8,390) (17.06–36) (6,497–11,063) (16.83–28.52) (−0.37 to 0.38) (7,610–14,084) (15.9–29.44) (−0.28 to 0.3) (−0.44 to 0.32) (−1 to −0.5)
Middle SDI
Armenia 0.689 1,625 96.59 1,967 103.40 0.07 1,675 85.84 −0.17 −0.11 −0.4 0.308
(1,416–1,846) (84.78–109.66) (1,596–2,197) (82.42–115.64) (−0.17 to 0.26) (1,302–2,075) (66.44–106.07) (−0.35 to 0.05) (−0.32 to 0.15) (−1.2 to 0.4)
Azerbaijan 0.683 2,166 66.18 3,315 64.28 −0.03 3,708 59.86 −0.07 −0.10 −0.4 0.026
(1,791–2,595) (55.23–80.24) (2,702–4,164) (52.94–81.22) (−0.22 to 0.2) (2,669–5,113) (43.37–82.63) (−0.32 to 0.23) (−0.36 to 0.24) (−0.7 to 0)
China 0.686 156,179 29.65 479,918 55.31 0.87 575,163 59.85 0.08 1.02 2.5 <0.001
(115,946–288,882) (22.09–54.88) (317,453–558,591) (36.89–64.32) (−0.14 to 1.61) (294,895–749,387) (30.98–78.22) (−0.23 to 0.42) (−0.27 to 2.13) (2.2–2.8)
Indonesia 0.660 46,808 64.59 76,565 64.53 0.00 84,100 59.19 −0.08 −0.08 −0.3 <0.001
(28,444–68,261) (39.59–95.09) (49,569–107,784) (41.97–92.61) (−0.22 to 0.28) (55,398–130,367) (39.25–92.47) (−0.32 to 0.29) (−0.31 to 0.33) (−0.4 to −0.2)
Iran (Islamic Republic of) 0.670 4,213 23.09 6,529 17.93 −0.22 9,239 19.93 0.11 −0.14 −0.6 <0.001
(2,844–5,007) (15.78–27.25) (4,953–7,208) (13.45–19.82) (−0.343 to 0.01) (6,749–10,694) (14.52–23.1) (−0.01 to 0.28) (−0.27 to 0.26) (−0.8 to −0.4)
Iraq 0.671 966 18.63 2,474 20.62 0.11 3,831 22.81 0.11 0.22 0.7 <0.001
(674–1,420) (12.91–26.81) (1,726–3,568) (14.55–29.24) (−0.25 to 0.65) (2,590–5,566) (15.63–32.76) (−0.21 to 0.53) (−0.23 to 0.97) (0.3–1)
Philippines 0.623 17,519 77.33 28,251 68.36 −0.12 36,196 70.96 0.04 −0.08 −0.3 0.006
(12,089–20,927) (54.61–92.56) (21,851–33,016) (53.79–79.96) (−0.29 to 0.11) (23,972–49,551) (47.45–96.7) (−0.27 to 0.43) (−0.38 to 0.31) (−0.5 to −0.1)
Syrian Arab Republic 0.619 636 16.73 1,164 15.28 −0.09 1,156 15.55 0.02 −0.07 −0.4 0.38
(421–870) (11.32–22.71) (868–1,521) (11.6–19.85) (−0.37 to 0.41) (798–1,671) (10.78–22.38) (−0.29 to 0.44) (−0.38 to 0.54) (−1.2 to 0.4)
Thailand 0.687 33,811 131.73 46,345 105.54 −0.20 47,207 95.39 −0.10 −0.28 −1.1 0.002
(23,297–41,141) (93.09–159.81) (37,523–58,860) (85.56–134) (−0.39 to 0.14) (32,284–69,966) (64.29–139.92) (−0.39 to 0.34) (−0.53 to 0.13) (−1.8 to −0.4)
Turkmenistan 0.670 899 68.39 1,798 80.80 0.18 2,142 83.69 0.04 0.22 0.7 0.11
(794–1,031) (59.86–77.34) (1,398–2,039) (63.46–91.04) (−0.08 to 0.37) (1,498–2,909) (58.65–113.35) (−0.22 to 0.41) (−0.13 to 0.63) (−0.2 to 1.6)
Uzbekistan 0.631 5,367 73.18 11,532 86.07 0.18 15,048 88.90 0.03 0.21 0.7 0.005
(4,675–6,073) (63.55–82.81) (10,150–12,957) (75.87–96.42) (0.02–0.36) (11,575–18,728) (68.38–111.11) (−0.19 to 0.3) (−0.08 to 0.55) (0.2–1.2)
Viet Nam 0.617 18,590 74.33 40,115 88.14 0.19 53,218 91.70 0.04 0.23 0.7 <0.001
(13,201–24,721) (53.11–98.93) (28,696–51,640) (63.66–112.71) (−0.15 to 0.73) (36,679–71,084) (63.01–122.49) (−0.2 to 0.36) (−0.18 to 0.9) (0.6–0.8)
Low-middle SDI
Bangladesh 0.483 21,696 68.19 25,846 43.79 −0.36 35,965 45.74 0.04 −0.33 −1.3 <0.001
(9,544–29,191) (30.05–90.9) (14,342–38,968) (24.47–63.57) (−0.56 to 0.21) (19,474–57,928) (24.92–72.88) (−0.23 to 0.35) (−0.57 to 0.36) (−1.6 to −1)
Bhutan 0.455 126 69.57 153 55.95 −0.20 205 59.57 0.06 −0.14 −0.6 <0.001
(56–185) (31.15–101.32) (87–240) (32.9–86.25) (−0.49 to 0.62) (112–340) (33.6–97.81) (−0.21 to 0.41) (−0.51 to 0.78) (−0.8 to −0.3)
Cambodia 0.469 3,044 84.00 4,900 76.44 −0.09 6,721 83.35 0.09 −0.01 0 0.862
(1,604–4,351) (45.82–120.08) (3,264–6,800) (50.93–106.96) (−0.36 to 0.44) (4,640–9,868) (57.77–123.09) (−0.15 to 0.42) (−0.35 to 0.69) (0.1 to 0.1)
Democratic People’s Republic of Korea 0.558 11,271 103.99 15,700 103.90 0.00 16,613 101.23 −0.03 −0.03 −0.1 0.131
(7,021–19,269) (64.24–178.02) (9,735–23,315) (63.75–154.56) (−0.35 to 0.46) (10,033–25,434) (60.92–154.22) (−0.27 to 0.34) (−0.42 to 0.55) (−0.2 to 0)
India 0.566 196,994 61.41 288,737 52.72 −0.14 399,438 58.94 0.12 −0.04 −0.1 0.706
(153,543–244,805) (48.3–76.91) (249,705–367,506) (45.52–67.73) (−0.28 to 0.08) (307,721–521,461) (45.34–77.01) (−0.12 to 0.44) (−0.27 to 0.26) (−0.5 to 0.4)
Kyrgyzstan 0.596 1,928 107.33 2,643 101.16 −0.06 2,973 94.40 −0.07 −0.12 −0.4 0.02
(1,651–2,183) (92.46–121.19) (2,331–2,930) (89.66–111.84) (−0.19 to 0.1) (2,352–3,644) (74.72–115.49) (−0.24 to 0.13) (−0.3 to 0.1) (−0.8 to −0.1)
Lao People’s Democratic Republic 0.490 1,279 89.27 1,712 70.11 −0.21 2,180 69.19 −0.01 −0.22 −0.9 <0.001
(614–1,903) (44.42–133.65) (941–2,517) (38.93–104.53) (−0.47 to 0.27) (1,304–3,262) (41.34–104.16) (−0.25 to 0.34) (−0.51 to 0.45) (−1 to −0.8)
Maldives 0.562 56 92.95 66 50.18 −0.46 92 47.68 −0.05 −0.49 −2.3 <0.001
(22–83) (37.38–136.99) (53–84) (41.3–63.6) (−0.64 to 0.39) (69–126) (36.21–64.17) (−0.28 to 0.22) (−0.67 to 0.37) (−2.6 to 2)
Mongolia 0.606 735 109.57 1,371 99.75 −0.09 1728 93.13 −0.07 −0.15 −0.6 0.007
(546–1,071) (82.18–154.57) (1,040–1,975) (76.32–137.86) (−0.35 to 0.3) (1,177–2,611) (63.9–139.36) (−0.32 to 0.32) (−0.43 to 0.28) (−1 to −0.2)
Myanmar 0.521 15,218 95.50 18,237 72.09 −0.25 20,176 67.00 −0.07 −0.30 −1.2 <0.001
(7,703–23,369) (49.6–147.34) (11,272–28,095) (44.37–111.92) (−0.5 to 0.18) (12,984–31,713) (43.19–105.43) (−0.31 to 0.3) (−0.56 to 0.23) (−1.5 to −1)
Palestine 0.588 134 22.57 190 15.44 −0.32 334 19.41 0.26 −0.14 −0.5 0.002
(85–186) (14.56–31.11) (149–230) (11.98–18.49) (−0.51 to 0) (232–425) (13.47–24.19) (−0.08 to 0.61) (−0.41 to 0.32) (−0.8 to −0.2)
Tajikistan 0.539 981 56.41 927 32.06 −0.43 1,290 31.93 0.00 −0.43 −1.9 <0.001
(743–1,169) (42.55–66.52) (711–1,493) (24.81–49.95) (−0.57 to −0.09) (912–2,223) (22.95–53.59) (−0.25 to 0.35) (−0.6 to −0.01) (−2.3 to −1.5)
Timor-Leste 0.514 159 64.51 193 52.69 −0.18 312 67.40 0.28 0.04 0.2 0.29
(83–232) (35.49–94.34) (88–300) (24.25–82.29) (−0.63 to 0.31) (149–468) (34.66–100.8) (−0.05 to 0.84) (−0.5 to 0.71) (−0.2 to 0.6)
Low SDI
Afghanistan 0.343 1,667 41.42 3,531 41.59 0.00 4,645 41.15 −0.01 −0.01 0 0.772
(430–2,715) (10.77–67.23) (966–5,691) (12.65–66.25) (−0.28 to 0.41) (1,492–7,609) (14.14–66.52) (−0.24 to 0.28) (−0.31 to 0.5) (−0.1 to 0.1)
Nepal 0.422 5,272 78.09 6,111 53.46 −0.32 8,802 60.38 0.13 −0.23 −0.9 <0.001
(2,415–7,389) (35.6–108.95) (3,589–8,865) (31.75–75.98) (−0.55 to 0.2) (5,181–13,139) (36.06–89.19) (−0.14 to 0.49) (−0.52 to 0.41) (−1 to −0.7)
Pakistan 0.449 8,749 25.07 19,818 31.66 0.26 27,532 32.74 0.03 0.31 0.9 <0.001
(6,850–11,209) (19.75–31.91) (14,219–26,467) (22.92–41.68) (−0.09 to 0.72) (18,805–40,082) (22.68–47.35) (−0.31 to 0.52) (−0.11 to 0.93) (0.8–1)
Yemen 0.412 852 23.83 1738 23.77 0.00 2,737 25.61 0.08 0.07 0.3 0.055
(357–13,55) (10.57–37.18) (990–2,607) (13.6–34.97) (−0.31 to 0.56) (1,567–4306) (14.93–39.17) (−0.2 to 0.42) (−0.31 to 0.8) (0–0.5)

Mortality rate of cervical cancer in Asia

In 2019 more than 52% (146,502 of 280,479) of cervical cancer death happened in Asia countries. In Asia, the number of cervical cancer deaths increased from 87,096 (95% CI: 73,370–115,938) in 1,990–146,502 (95% CI: 118,910–170,830) in 2019, which is over a 1.7-fold increase; while globally, this number increased 1.52 times. During this period in Asia, the age-standardized death rate (ASDR) of cervical cancer with a relatively 26% change and AAPC −1.0 (95% CI: −1.2 to −0.8), decreased from 7.79 (95% CI: 6.57–10.37) per 100.000 in 1990 to 5.79 (95% CI: 4.7–6.75) per 100.000 in 2019, while in the same period, this rate globally decreased relatively by 23% and AAPC −0.9 (95% CI: −1.0 to −0.8).

Between 1990 and 2019 years, all geographic regions of Asia experienced a decreasing trend in ASDR of cervical cancer. The highest decrease in ASDR of cervical cancer was observed in South Asia and Southeast Asia countries (30%) and the lowest in East Asia countries (14% with AAPC –0.5 (95% CI: −0.8 to −0.2)). High-income Asia Pacific had the highest AAPC (−1.5 (95% CI: −1.7 to −1.4)) in this period. In 2019, the highest ASDR of cervical cancer was allocated to Central Asia countries with 7.58 (95% CI: 6.68–8.7) death per 100.000 (Figure 1).

In 2019, among high SDI Asian countries, Brunei Darussalam (10.46) has the highest ASDR of cervical cancer, and Kuwait (1.76) has the lowest rate. In this region, all countries experienced a decreasing trend in ASDR of cervical cancer from 1990 to 2019, and Singapore reported the highest decreasing trend (65% decrease) with AAPC −3.6 (95% CI: −3.8 to −3.4).

Among high-middle SDI Asian countries, Malaysia (9.00) has the highest ASDR of cervical cancer, and Jordan (2.04) has the lowest rate. In this region, all countries experienced a decreasing trend in ASDR of cervical cancer from 1990 to 2019 and Jordan reported the highest decreasing trend (44% decrease) with AAPC −2.0 (95% CI: −2.4 to −1.6).

Among middle SDI Asian countries, Viet Nam (8.80) has the highest ASDR of cervical cancer, and the Republic of Syrian Arab Republic (1.78) has the lowest rate. While all countries of this region experienced a decreasing trend in ASDR of cervical cancer from 1990 to 2019 between 11% (Turkmenistan) with no significant AAPC (p=0.544) to 54% (Thailand) with AAPC −2.7 (95% CI: −2.9 to −2.5), Uzbekistan reported an increasing trend (5% increase) with no significant AAPC (p=0.277) from 1990 to 2019, and decreasing trend from 2010 cannot compensate increasing trend in 1990–2010.

Among low-middle SDI Asian countries, Mongolia (12.20) has the highest ASDR of cervical cancer, and Palestine (2.87) has the lowest rate. In this region, all countries experienced a decreasing trend in ASDR of cervical cancer from 1990 to 2019 and Maldives reported the highest decreasing trend (68% decrease) with AAPC −4.0 (95% CI: −4.4 to −3.5).

Among low SDI Asian countries, Nepal (8.15) has the highest ASDR of cervical cancer, and Yemen (4.00) has the lowest rate. In this region, all countries experienced a decreasing trend in ASDR of cervical cancer from 1990 to 2019 and Nepal reported the highest decreasing trend (45% decrease) with AAPC –2.0 (95% CI: −2.2 to −1.9).

Among Asian countries, 48 countries experienced a significant decrease in the cervical cancer mortality rate between 1990 and 2019, the greatest decrease was detected in Maldives, Singapore, Taiwan (Province of China), Bangladesh, and the Republic of Korea. Only Uzbekistan experienced an increasing trend in cervical cancer death rates from 1990 to 2019.

In 2019, the highest ASDR of cervical cancer was reported in Mongolia (12.2), Brunei Darussalam (10.46), Cambodia (9.67), Timor-Leste (9.03), and Malaysia (9). The lowest ASDR of cervical cancer was reported in Kuwait (1.76), the Syrian Arab Republic (1.78), Jordan (2.04), Iran (Islamic Republic of) (2.06), and Saudi Arabia (2.35). Results with details were presented in Table 3 and Figures 2 and 3.

Table 3:

The mortality of cervical cancer in Asian countries in 1990, 2010 and 2019 and the temporal trends between 1990 and 2019, by geographical region and SDI.

Location SDI 2019 1990 2010 % change 1990–2010 2019 % change 2010–2019 % change 1990–2019 AAPC
Number ASR per 1,000,000 Number ASR per 1,000,000 Number ASR per 1,000,000 AAPC p-Value
Global 184,527 8.48 237,933 13.49 −0.19 280,479 6.51 −0.05 −0.23 −0.9 <0.001
(164,836–218,942) (7.59–10.07) (210,986–268,670) (6.09–7.74) (−0.28 to −0.12) (238,864–313,930) (5.55–7.29) (−0.13 to −0.04) (−0.35 to −0.12) (−1 to −0.8)
Asia 87,096 7.79 120,260 6.11 −0.22 146,502 5.79 −0.05 −0.26 −1.0 <0.001
(73,370–115,938) (6.57–10.37) (103,867–138,099) (5.3–7.05) (−0.36 to −0.08) (118,910–170,830) (4.7–6.75) (−0.17 to 0.08) (−0.44 to −0.07) (−1.2 to −0.8)
Countries by geographical location
Central Asia 2,720 9.81 3,256 8.90 −0.09 3,423 7.58 −0.15 −0.23 −0.8 <0.001
(2,480–2,887) (8.95–10.43) (3,094–3,458) (8.46–9.51) (−0.15 to −0.01) (3,000–3,927) (6.68–8.7) (−0.24 to −0.04) (−0.31 to −0.11) (−1 to −0.6)
East Asia 28,404 6.05 45,988 5.48 −0.09 55,960 5.18 −0.05 −0.14 −0.5 <0.001
(22,319–46,141) (4.77–9.76) (32,689–52,914) (3.94–6.27) (−0.5 to 0.2) (33,187–71,362) (3.09–6.59) (−0.29 to 0.2) (−0.62 to 0.24) (−0.8 to −0.2)
High-income Asia Pacific 4,642 4.20 5,235 3.00 −0.29 5,604 2.70 −0.10 −0.36 −1.5 <0.001
(4,347–5,322) (3.93–4.81) (4,376–5,622) (2.59–3.18) (−0.42 to −0.25) (4,577–6217) (2.22–2.96) (−0.15 to −0.04) (−0.5 to −0.3) (−1.7 to −1.4)
North Africa and Middle East 3,971 4.37 5,721 3.44 −0.21 7,005 3.15 −0.08 −0.28 −1.1 <0.001
(2,819–4,530) (3.1–4.99) (4,550–6,545) (2.74–3.92) (−0.29 to −0.01) (5,443–8,311) (2.47–3.69) (−0.16 to 0.02) (−0.37 to 0.03) (−1.2 to −1.1)
South Asia 33,337 10.49 41,075 7.16 −0.32 53,303 7.01 −0.02 −0.33 −1.4 <0.001
(26,223–39,953) (8.29–12.62) (35,244–54,262) (6.13–9.46) (−0.42 to −0.14) (42,871–69,946) (5.66–9.21) (−0.21 to 0.19) (−0.47 to −0.13) (−1.9 to −0.8)
Southeast Asia 16,714 11.05 22,503 8.47 −0.23 25,129 7.36 −0.13 −0.33 −1.4 <0.001
(12,565–21,467) (8.36–14.54) (18,480–29,998) (7.02–11.33) (−0.31 to −0.12) (20,525–34,980) (6.03–10.33) (−0.24 to 0.01) (−0.44 to −0.16) (−1.5 to −1.3)
Countries by SDI 2019 high SDI
Brunei Darussalam 0.823 11 17.51 14 11.08 −0.37 18 10.46 −0.06 −0.40 −1.8 <0.001
(8–13) (13.31–21.37) (12–17) (9.45–13.49) (−0.49 to −0.18) (15–24) (8.59–13.36) (−0.21 to 0.11) (−0.53 to −0.23) (−2 to −1.6)
Cyprus 0.841 17 4.27 23 3.09 −0.28 29 2.89 −0.06 −0.32 −1.3 <0.001
(14–24) (3.32–5.92) (17–26) (2.29–3.53) (−0.52 to −0.03) (19–34) (1.93–3.41) (−0.2 to 0.09) (−0.59 to −0.04) (−1.6 to −1.1)
Israel 0.803 76 3.01 126 2.71 −0.10 150 2.53 −0.07 −0.16 −0.6 <0.001
(69–93) (2.75–3.65) (102–136) (2.18–2.94) (−0.39 to 0.01) (118–170) (1.99–2.85) (−0.16 to 0.04) (−0.45 to −0.03) (−0.9 to −0.3)
Japan 0.87 3,394 3.66 3,991 3.01 −0.18 4,210 2.78 −0.08 −0.24 −1.0 <0.001
(3,111–3,735) (3.37–4.06) (3,261–4,300) (2.51–3.17) (−0.35 to −0.15) (3,348–4,688) (2.18–3.04) (−0.15 to −0.01) (−0.45 to −0.17) (−1.2 to −0.8)
Kuwait 0.851 9 3.19 15 2.40 −0.25 21 1.76 −0.26 −0.45 −1.9 <0.001
(7–11) (2.51–3.76) (12–16) (1.94–2.67) (−0.4 to −0.03) (16–29) (1.3–2.41) (−0.42 to −0) (−0.6 to −0.2) (−2.4 to −1.4)
Qatar 0.83 3 5.99 6 6.51 0.09 10 5.03 −0.23 −0.16 −0.5 0.047
(2–4) (4.51–8.33) (5–8) (5.02–8.19) (−0.27 to 0.47) (7–14) (3.83–6.62) (−0.38 to 0.01) (−0.38 to 0.17) (−1.1 to 0)
Republic of Korea 0.878 1,140 6.04 1,144 3.30 −0.45 1,270 2.72 −0.17 −0.55 −2.7 <0.001
(998–1,480) (5.45–8.27) (920–1,395) (2.66–4.04) (−0.58 to −0.37) (1,010–1,587) (2.17–3.4) (−0.26 to −0.07) (−0.66 to −0.44) (−3 to −2.5)
Saudi Arabia 0.805 75 2.85 159 2.81 −0.02 204 2.35 −0.16 −0.18 −0.7 <0.001
(52–124) (2.04–4.59) (131–199) (2.34–3.29) (−0.33 to −0.4) (149–279) (1.73–3.11) (−0.35 to −0.08) (−0.47 to 0.31) (−0.8 to −0.6)
Singapore 0.861 98 7.57 86 3.17 −0.58 105 2.62 −0.17 −0.65 −3.6 < 0.001
(86–106) (6.73–8.18) (78–97) (2.87–3.55) (−0.62 to −0.52) (92–123) (2.27–3.06) (−0.26 to −0.07) (−0.7 to −0.6) (−3.8 to −3.4)
Taiwan (Province of China) 0.868 1,012 12.93 910 5.86 −0.55 1,033 5.00 −0.15 −0.61 −3.2 <0.001
(913–1,066) (11.77–13.64) (827–1,057) (5.32–6.74) (−0.58 to −0.47) (799–1,393) (3.86–6.83) (−0.33 to 0.1) (−0.7 to −0.47) (−3.5 to −2.9)
United Arab Emirates 0.88 17 12.26 43 14.04 0.14 76 6.80 −0.52 −0.45 −2.0 0.006
(12–24) (7.64–17.88) (33–54) (8.27–17.34) (−0.24 to 0.64) (54–107) (4.3–9.12) (−0.62 to −0.36) (−0.62 to −0.15) (−3.4 to −0.6)
High-middle SDI
Bahrain 0.751 4 4.98 8 3.62 −0.27 11 2.96 −0.18 −0.41 −1.7 <0.001
(4–6) (4.06–6.6) (6–10) (3.01–4.62) (−0.42 to −0.06) (9–16) (2.3–3.99) (−0.34 to −0.01) (−0.56 to −0.17) (−2.2 to −1.3)
Georgia 0.702 367 10.50 248 8.16 −0.22 231 7.75 −0.07 −0.26 −1.1 0.001
(294–412) (8.34–11.83) (218–285) (7.12–9.33) (−0.34 to –0.06) (183–278) (6.15–9.43) (−0.28 to 0.19) (−0.42 to −0.08) (−1.7 to −0.5)
Jordan 0.731 26 3.66 39 2.23 −0.39 67 2.04 −0.09 −0.44 −2.0 <0.001
(20–34) (2.84–4.79) (30–47) (1.78–2.69) (−0.52 to −0.17) (48–89) (1.52–2.74) (−0.27 to 0.15) (−0.59 to −0.16) (−2.4 to −1.6)
Kazakhstan 0.723 893 11.49 924 10.53 −0.08 793 7.65 −0.27 −0.33 −1.3 <0.001
(804–977) (10.37–12.56) (850–1,002) (9.7–11.4) (−0.17 to 0.02) (667–964) (6.44–9.24) (−0.39 to −0.13) (−0.44 to −0.18) (−2 to −0.6)
Lebanon 0.708 47 3.94 59 2.70 −0.31 70 2.43 −0.10 −0.38 −1.7 <0.001
(35–59) (3–4.95) (44–79) (2.02–3.61) (−0.47 to 0) (51–97) (1.77–3.39) (−0.27 to 0.1) (−0.54 to −0.03) (−1.7 to −1.6)
Malaysia 0.737 662 13.16 832 8.45 −0.36 1,204 9.00 0.07 −0.32 −1.3 <0.001
(436–761) (8.53–15.15) (715–980) (6.94–9.75) (−0.45 to −0.15) (832–1,578) (6.25–11.73) (−0.18 to 0.38) (−0.48 to −0.08) (−1.6 to −0.9)
Oman 0.783 15 4.59 22 4.32 −0.06 23 3.10 −0.28 −0.32 −1.3 <0.001
(10–20) (3.16–6.34) (16–25) (3.22–5.04) (−0.34 to 0.37) (17–29) (2.37–3.8) (−0.41 to −0.12) (−0.52 to 0.09) (−1.6 to −1.1)
Sri Lanka 0.69 250 4.28 448 4.20 −0.02 499 3.60 −0.14 −0.16 −0.5 0.036
(211–351) (3.6–6.12) (326–502) (3.08–4.7) (−0.31 to 0.19) (336–688) (2.43–4.96) (−0.37 to 0.15) (−0.46 to 0.23) (−1 to 0)
Turkey 0.748 852 4.39 993 2.76 −0.37 1,171 2.53 −0.08 −0.42 −1.9 <0.001
(542–1,059) (2.79–5.41) (721–1,164) (2.01–3.24) (−0.49 to −0.06) (800–1,479) (1.72–3.19) (−0.28 to 0.17) (−0.57 to −0.08) (−2.2 to −1.5)
Middle SDI
Armenia 0.689 152 9.55 187 8.93 −0.06 158 7.09 −0.21 −0.26 −1.1 <0.001
(140–168) (8.77–10.55) (152–202) (7.33–9.61) (−0.26_0.03) (127–191) (5.72–8.59) (−0.34 to −0.03) (−0.42 to −0.08) (−1.6 to −0.6)
Azerbaijan 0.683 225 7.44 310 7.01 −0.06 334 6.04 −0.14 −0.19 −0.7 <0.001
(195–282) (6.43–9.42) (262–415) (5.95–9.68) (−0.22 to 0.15) (248–477) (4.56–8.72) (−0.33 to 0.09) (−0.39 to 0.07) (−1 to 0.4)
China 0.686 26,420 5.85 43,642 5.40 −0.08 53,441 5.13 −0.05 −0.12 −0.4 <0.001
(20,524–43,527) (4.59–9.57) (30,173–50,171) (3.77–6.23) (−0.51 to 0.24) (30,399–68,856) (2.92–6.6) (−0.3 to 0.22) (−0.64 to 0.29) (−0.6 to −0.3)
Indonesia 0.66 5,743 9.66 8,095 8.22 −0.15 8,703 7.08 −0.14 −0.27 −1.1 <0.001
(3,520–8697) (6.01–14.9) (5,327–12658) (5.47–13.17) (−0.3 to 0.05) (5,769–14,506) (4.77–12.05) (−0.34 to 0.13) (−0.44 to 0) (−1.1 to −1)
Iran (Islamic Republic of) 0.67 416 3.22 572 2.10 −0.35 761 2.06 −0.02 −0.36 −1.5 <0.001
(297–501) (2.33–4.05) (428–622) (1.57–2.29) (−0.46 to −0.2) (552–874) (1.49–2.37) (−0.1 to 0.1) (−0.5 to −0.14) (−1.6 to −1.4)
Iraq 0.671 121 2.88 223 2.52 −0.13 306 2.40 −0.05 −0.17 −0.6 <0.001
(89–168) (2.12–4.04) (162–303) (1.87–3.37) (−0.37 to 0.19) (219–415) (1.72–3.18) (−0.26 to 0.23) (−0.42 to 0.24) (−0.9 to −0.4)
Philippines 0.623 1,608 8.98 2,519 7.15 −0.20 3,120 6.83 −0.05 −0.24 −0.9 <0.001
(1,326–1,960) (7.59–11.29) (2,170–3,018) (6.23–9.04) (−0.34 to −0.03) (2,282–4,238) (5.03–9.25) (−0.28 to 0.26) (−0.45 to 0.04) (−1.2 to 0.6)
Syrian Arab Republic 0.619 63 2.30 89 1.88 −0.19 104 1.78 −0.05 −0.23 −0.9 <0.001
(45–85) (1.67–3.13) (70–112) (1.49–2.33) (−0.4 to 0.16) (75–144) (1.31–2.43) (−0.28 to 0.24) (−0.45 to 0.18) (−1.1 to −0.7)
Thailand 0.687 3,136 14.76 3,495 8.51 −0.42 3,657 6.73 −0.21 −0.54 −2.7 <0.001
(2,332–3,682) (11.1–17.29) (2,955–4,468) (7.17–10.76) (−0.53 to −0.26) (2,668–5,233) (4.9–9.6) (−0.44 to 0.1) −0.68 to −0.32) (−2.9 to −2.5)
Turkmenistan 0.67 94 8.06 150 7.72 −0.04 173 7.18 −0.07 −0.11 −0.3 0.544
(85–102) (7.36–8.78) (120–164) (6.3–8.42) (−0.21 to −0.06) (122–227) (5.14–9.37) (−0.29 to 0.21) (−0.34 to 0.17) (−1.2 to 0.7)
Uzbekistan 0.631 535 8.01 953 9.16 0.14 1,173 8.45 −0.08 0.05 0.2 0.277
(488–586) (7.29–8.8) (865–1,026) (8.45–9.82) (0.02–0.3) (932–1,433) (6.84–10.28) (−0.24 to 0.12) (−0.16 to 0.29) (−0.2 to 0.6)
Viet Nam 0.617 2,478 10.59 4,084 9.99 −0.06 4,718 8.80 −0.12 −0.17 −0.6 <0.001
(1,846–3,323) (7.92–14.24) (3,000–5,055) (7.31–12.27) (−0.32 to 0.34) (3,273–6,161) (6.11–11.45) (−0.29 to 0.09) (−0.41 to 0.21) (−0.7 to −0.6)
Low-middle SDI
Bangladesh 0.483 3,244 12.99 3,047 6.56 −0.49 3,864 5.67 −0.14 −0.56 −2.7 <0.001
(1,469–4,235) (5.87–16.83) (1,706–4,189) (3.67–8.89) (−0.63 to −0.18) (2,150–5,841) (3.14–8.52) (−0.33 to 0.09) (−0.71 to −0.21) (−2.9 to −2.5)
Bhutan 0.455 20 13.55 18 7.76 −0.43 21 7.24 −0.07 −0.47 −2.2 <0.001
(9–28) (6.25–18.92) (11–26) (4.72–11.2) (−0.6 to 0.01) (13–32) (4.35 to 11.01) (−0.25 to 0.14) (−0.65 to 0) (−2.3 to −2.1)
Cambodia 0.469 437 14.66 573 10.28 −0.30 709 9.67 −0.06 −0.34 −1.4 <0.001
(244–628) (8.29–21.33) (399–858) (7.26–15.73) (0.47 to 0.02) (508–1,096) (7.05–15.15) (−0.23 to 0.17) (−0.52 to 0.05) (−1.5 to −1.4)
Democratic People’s Republic of Korea 0.558 973 9.41 1,435 9.24 −0.02 1,486 8.28 −0.10 −0.12 −0.4 <0.001
(668–1,677) (6.55–16.44) (947–2,167) (6.05–13.91) (−0.3 to 0.32) (982–2,248) (5.42–12.52) (−0.27 to 0.13) (−0.41 to 0.27) (−0.5 to −0.4)
India 0.566 27,897 10.90 34,821 7.42 −0.32 45,447 7.38 0.00 −0.32 −1.4 <0.001
(22,140–35,328) (8.59–13.74) (29,557–48,001) (6.26–10.31) (−0.43 to −0.15) (35,004–62,352) (5.71–10.13) (−0.22 to 0.25) (−0.48 to −0.11) (−2 to −0.7)
Kyrgyzstan 0.596 225 12.66 233 10.25 −0.19 252 8.94 −0.13 −0.29 −1.3 <0.001
(188–244) (10.65–13.76) (215–250) (9.43–10.99) (−0.26 to −0.08) (203–298) (7.19–10.54) (−0.27 to 0.03) (−0.41 to −0.16) (−1.6 to −0.9)
Lao People’s Democratic Republic 0.49 211 16.93 207 10.33 −0.39 234 8.98 −0.13 −0.47 −2.2 <0.001
(114–320) (9.36–26.11) (117–311) (5.85–15.69) (−0.57 to −0.09) (145–359) (5.53–14.29) (−0.3 to 0.12) (−0.64 TO −0.12) (−2.3 to −2.1)
Maldives 0.562 6 13.12 5 4.80 −0.63 6 4.14 −0.14 −0.68 −4.0 <0.001
(2–9) (5.71–18.24) (4–6) (4.02–5.72) (−0.74 to −0.13) (5–8) (3.25–5.28) (−0.31 to 0.07) (−0.79 to −0.21) (−4.4 to −3.5)
Mongolia 0.606 110 18.70 144 14.55 −0.22 175 12.20 −0.16 −0.35 −1.5 <0.001
(86–142) (14.62–23.65) (113–186) (11.06–18.37) (−0.41 to 0.06) (126–243) (8.77–16.57) (−0.35 to 0.12) (−0.53 to −0.08) (−1.8 to −1.1)
Myanmar 0.521 2,090 15.07 2,134 9.60 −0.36 2,145 7.73 −0.19 −0.49 −2.3 <0.001
(1,212–3,322) (8.95–24.35) (1,401–3,541) (6.41–16.28) (−0.53 to −0.11) (1,499–3,612) (5.48–13.24) (−0.36 to 0.04) (−0.65 to −0.21) (−2.4 to 2.2)
Palestine 0.588 19 3.91 25 2.77 −0.29 34 2.87 0.04 −0.27 −1.1 <0.001
(12–24) (2.54–5.1) (17–29) (1.89–3.24) (−0.46 to −0.04) (21–42) (1.72–3.52) (−0.21 to −0.27) (−0.48 to 0.05) (−1.4 to −0.9)
Tajikistan 0.539 119 7.55 106 5.04 −0.33 136 4.68 −0.07 −0.38 −1.6 <0.001
(79–136) (4.95–8.62) (87–150) (4.15–6.86) (−0.48 to 0.08) (103–211) (3.6–6.87) (−0.27 to 0.18) (−0.54 to 0.06) (−1.9 to −1.3)
Timor-Leste 0.514 22 12.47 27 8.30 −0.33 38 9.03 0.09 −0.28 −1.1 <0.001
(13–33) (7.66–18.71) (17–44) (5.2–13.42) (−0.56 to −0.06) (25–59) (6.06–14.06) (−0.13 to 0.41) (−0.520.11) (−1.3 to −0.9)
Low SDI
Afghanistan 0.343 332 8.96 506 8.37 −0.07 609 7.59 −0.09 −0.15 −0.6 <0.001
(111–508) (3.18–13.47) (189–774) (3.51–12.46) (−0.3 to 0.26) (239–939) (3.4–11.25) (−0.26 to 0.12) (−0.38 to 0.21) (−0.6 to −0.5)
Nepal 0.422 827 14.83 774 8.06 −0.46 1,024 8.15 0.01 −0.45 −2.0 <0.001
(385–1,130) (6.91–19.94) (477–1,055) (5.02–10.9) (−0.61 to −0.17) (638–1,476) (5.05–11.65) (−0.19 to 0.25) (−0.62 to −0.08) (−2.2 to −1.9)
Pakistan 0.449 1,349 4.64 2,416 5.01 0.08 2,947 4.55 −0.09 −0.02 −0.1 0.04
(1,087–1,692) (3.69–5.77) (1,823–3,125) (3.81–6.35) (−0.18 to 0.42) (2,095–4,139) (3.23–6.28) (−0.32 to 0.24) (−0.28 to 0.41) (−0.1 to 0)
Yemen 0.412 132 4.77 210 3.98 −0.17 304 4.00 0.01 −0.16 −0.6 <0.001
(63–196) (2.36–7.06) (130–294) (2.51–5.53) (−0.37 to 0.17) (191–447) (2.52–5.69) (−0.19 to 0.26) (−0.4 to 0.31) (−0.7 to −0.5)

Burden of cervical cancer in Asia

In 2019 more than 52% (4,693,918 of 8,955,013) of cervical cancer burden was allocated to Asian countries. In Asia, the number of cervical cancer DALYs increased from 3,013,572 (95% CI: 2,521,200–3,998,699) in 1,990–4,693,918 (95% CI: 3,779,579–5,446,237) in 2019, which is over a 1.5-fold increase; while globally, this number increased 1.45 times. During this period in Asia, the age-standardized DALYs rate of cervical cancer with a relatively 26% change and AAPC -1.0 (95% CI: −1.2 to −0.9), increased from 248.79 (95% CI: 209.05–331.18) per 100.000 in 1990 to 183.34 (95% CI: 147.71–212.54) per 100.000 in 2019, while in the same period, while in the same period, this rate globally decreased relatively by 23% and AAPC −0.9 (95% CI: −1.0 to −0.8).

In 1990, the highest DALYs ASR of cervical cancer was observed in Southeast Asia countries (354.96 (95% CI: 266.86–447.24) per 100.000) but these countries experienced the highest decreasing trend (37% decrease with AAPC -1.6 (95% CI: −1.7 to −1.5)) from 1990 to 2019 and so in 2019 the highest DALYs ASR was allocated to Central Asia countries (249.41 (95% CI: 217.42–288.15) per 100.000). Generally, all Asian regions experienced a significant decreasing trend in DALYs ASR from 1990 to 2019 (Figure 1).

In 2019, among high SDI Asian countries, Brunei Darussalam (305.13) has the highest DALYs ASR of cervical cancer, and Kuwait (44.34) has the lowest rate. In this region, all countries experienced a decreasing trend in DALYs ASR of cervical cancer from 1990 to 2019 and Singapore (AAPC=−3.9 (95% CI: −4.1 to −3.7)), Taiwan (Province of China) (AAPC=−3.5 (95% CI: −3.9 to −3.2)), and the Republic of Korea (AAPC=−3.2 (95% CI: −2.9 to −3.5)), reported the highest decreasing trend with more than 60% relative decrease.

Among high-middle SDI Asian countries, Kazakhstan (262.01) and Georgia (261.64) have the highest DALYs ASR of cervical cancer, and the Syrian Arab Republic (46.56) has the lowest rate. In this region, all countries experienced a decreasing trend in DALYs ASR of cervical cancer from 1990 to 2019; Jordan reported the highest decreasing trend (51% decrease) and Turkey experienced the highest AAPC (−2.5 (95% CI: −2.7 to −.2)).

Among middle SDI Asian countries, Uzbekistan (276.85) has the highest DALYs ASR of cervical cancer, and Jordan (55.25) has the lowest rate. In this region, all countries experienced a decreasing trend in DALYs ASR of cervical cancer from 1990 to 2019 and Thailand reported the highest decreasing trend (56% decrease) with AAPC −2.8 (95% CI: −3.2 to −.4).

Among low-middle SDI Asian countries, Mongolia (363.49) has the highest DALYs ASR of cervical cancer, and Palestine (69.83) has the lowest rate. In this region, all countries experienced a decreasing trend in DALYs ASR of cervical cancer from 1990 to 2019 and Maldives reported the highest decreasing trend (73% decrease) with AAPC −4.5 (95% CI: −4.8 to −.2).

Among low SDI Asian countries, Nepal (259.06) has the highest DALYs ASR of cervical cancer, and Yemen (117.57) has the lowest rate. In this region, all countries experienced a decreasing trend in DALYs ASR of cervical cancer from 1990 to 2019 and Nepal reported the highest decreasing trend (49% decrease) with AAPC −2.3 (95% CI: −2.4 to −2.5).

Among Asian countries, 48 countries experienced a significant decrease in cervical cancer DALYs ASR between 1990 and 2019; the greatest decrease was detected in Maldives, Singapore, Taiwan (Province of China), the Republic of Korea, and Bangladesh. Only Uzbekistan experienced an increasing trend in cervical cancer death rates from 1990 to 2019.

In 2019, the highest DALYs ASR of cervical cancer was reported in Mongolia (363.49), Cambodia (305.98), Brunei Darussalam (305.13), Kyrgyzstan (291.78), and Lao People’s Democratic Republic (289.76). The lowest DALYs ASR of cervical cancer was reported in Kuwait (44.34), Syrian Arab Republic (46.56), Iran (Islamic Republic of) (54.11), Jordan (55.25), and Turkey (61.84). Detailed results are provided in Table 4 and Figures 2 and 3.

Table 4:

The DALY of cervical cancer in Asian countries in 1990, 2010 and 2019 and the temporal trends between 1990 and 2019, by geographical region and SDI.

Location SDI 2019 1990 2010 % change 1990–2010 2019 % change 2010–2019 % change 1990–2019 AAPC
Number ASR per 1,000,000 Number ASR per 1,000,000 Number ASR per 1,000,000 AAPC p-Value
Global 6,176,248 275.05 7,817,338 13.49 −0.20 8,955,013 210.64 −0.05 −0.23 −0.9 <0.001
(5,437,672–7,316,926) (242.75–326.15) (6,854,644–8,681,430) (194.58–246.11) (−0.29 to –0.12) (7,547,733–9,978,462) (177.67–234.85) (−0.13 to 0.04) (−0.35 to –0.12) (−1 to –0.8)
Asia 3,013,572 248.79 4,031,625 194.56 −0.22 4,693,918 183.34 −0.06 −0.26 −1.0 <0.001
(2,521,200–3,998,699) (209.05–331.18) (3,413,842–4,585,271) (165.55–221.71) (−0.37 .07) (3,779,579–5,446,237) (147.71–212.54) (−0.18 to 0.07) (−0.45 to –0.07) (−1.2 to –0.9)
Countries by geographical location
Central Asia 89,498 317.62 114,884 293.03 −0.08 119,723 249.41 −0.15 −0.21 −0.8 <0.001
(83,578–95,464) (299.06–339.68) (108,768–121,519) (277.49–311.84) (−0.13 to –0.02) (103,947–138,538) (217.42–288.15) (−0.24 to –.03) (−0.3 to –0.1) (−1 to –0.6)
East Asia 921,107 182.74 1,489,462 169.69 −0.07 1,696,322 159.12 −0.06 −0.13 −0.5 <0.001
(714,657–1,517,191) (142.14–297.89) (1,022,946–1,710,596) (117.5–194.35) (−0.52 to 0.25) (972,552–2,166,628) (91.62–202.95) (−0.3 to 0.2) (−0.64 to 0.28) (−0.7 to −0.3)
High-income Asia Pacific 136,984 126.77 137,071 96.46 −0.24 133,639 85.67 −0.11 −0.32 −1.4 <0.001
(127,564–156,318) (118.36–144.52) (118,175–145,003) (82.14–101.47) (−0.39 to –0.18) (109,967–146,607) (67.59–93.64) (−0.17 to –0.05) (−0.49 to –0.25) (−1.5 to –1.2)
North Africa and Middle East 132,999 130.16 184,894 97.81 −0.25 221,931 88.28 −0.10 −0.32 −1.3 <0.001
(94,237–152,105) (92.26–148.26) (143,423–215,228) (77.3–113.05) (−0.32 to –0.06) (169,203–268,187) (68.42–105.74) (−0.18 to 0.02) (−0.41 to –0.03) (−1.4 to –1.3)
South Asia 1,230,955 345.39 1,462,728 233.08 −0.33 1,833,690 226.59 −0.03 −0.34 −1.4 <0.001
(969,017–1,468,757) (271.36–413.3) (1,261,483–1,917,590) (200.56–307.11) (−0.42 to –0.14) (1,466,658–2,370,915) (181.92–292.64) (−0.22 to 0.18) (−0.48 to –0.14) (−1.9 to –1)
Southeast Asia 592,315 354.96 753,871 259.70 −0.27 808,250 223.36 −0.14 −0.37 −1.6 <0.001
(440,718–733,903) (266.86–447.24) (609,618–970,253) (211.39–339.4) (−0.35 to −0.16) (653,206–1,088,292) (181.44–302.65) (−0.26 to 0.01) (−0.48 to –0.2) (−1.7 to –1.5)
Countries by SDI 2019 high SDI
Brunei Darussalam 0.82 399 546.10 490 315.10 −0.42 634 305.13 −0.03 −0.44 −2.0 <0.001
(289–504) (411.3–674.07) (408–604) (267.97–390.37) (−0.55 to –0.24) (498–830) (245.47–395.91) (−0.21 to 0.16) (−0.57 to –0.25) (−2 to –1.9)
Cyprus 0.84 462 110.53 584 80.25 −0.27 690 72.28 −0.10 −0.35 −1.5 <0.001
(372–669) (88.92–158.84) (446–667) (61.66–92.09) (−0.49 to −0.05) (467–821) (49.31–85.95) (−0.24 to 0.07) (−0.59 to –0.1) (−1.7 to –1.3)
Israel 0.80 2,167 87.98 3,400 78.84 −0.10 3,872 72.51 −0.08 −0.18 −0.7 <0.001
(1,977–2,565) (80.08–104.66) (2,725–3,713) (63.15–86.17) (−0.4 to 0.02) (3,008–4,379) (56.03–82.16) (−0.18 to 0.04) (−0.46 to –0.03) (−1 to –0.4)
Japan 0.87 92,262 104.70 101,722 99.76 −0.05 97,454 90.99 −0.09 −0.13 −0.5 <0.001
(87,262–103,695) (99.43–117.74) (85,045–107,312) (77.91–104.68) (−0.31 to 0) (76,368–106,871) (67.46–99.86) (−0.16 to –0.02) (−0.41 to –0.05) (−0.7 to –0.3)
Kuwait 0.85 334 92.15 483 61.60 −0.33 709 44.34 −0.28 −0.52 −2.5 <0.001
(273–395) (73.96–109.07) (411–541) (50.92–69.04) (−0.45 to −0.16) (531–1,035) (33.14–62.29) (−0.44 to 0.01) (−0.65 to –0.31) (−3.1 to –1.9)
Qatar 0.83 99 158.10 222 138.94 −0.12 362 104.18 −0.25 −0.34 −1.5 <0.001
(72–140) (118.14–218.37) (169–289) (107.9–174.04) (−0.37 to 0.19) (258–514) (78.22–139.27) (−0.41 to –0.04) (−0.52 to –0.05) (−1.9 to –1)
Republic of Korea 0.88 41,124 201.47 32,338 94.17 −0.53 32,673 77.90 −0.17 −0.61 −3.2 <0.001
(34,272–48,092) (172.86–243.22) (27,074–40,740) (79.31–118.03) (−0.59 to 0.45) (26,790–41,287) (63.89–97.95) (−0.26 to –0.04) (−0.68 to –0.5) (−3.5 to –2.9)
Saudi Arabia 0.81 2,486 77.97 5,765 77.68 0.00 7,725 64.92 −0.16 −0.17 −0.7 <0.001
(1,681–4,337) (53.93–131.98) (4,683–7,653) (64.75–96.65) (−0.33 to 0.45) (5,494–10,956) (48.08–88.08) (−0.36 to 0.08) (−0.49 to 0.37) (−0.8 to –0.5)
Singapore 0.86 3,198 225.26 2,521 87.77 −0.61 2,879 71.95 −0.18 −0.68 −3.9 <0.001
(2,826–3,495) (198.11–244.91) (2,296–2,918) (80–100.92) (−0.65 to −0.54) (2,489–3,423) (62.24–85.34) (−0.28 to –0.06) (−0.72 to –0.62) (−4.1 to –3.7)
Taiwan (Province of China) 0.87 32,183 380.08 24,483 155.34 −0.59 25,833 133.34 −0.14 −0.65 −3.5 <0.001
(28,169–33,984) (336.13–401.34) (22,711–30,333) (144.15–192.5) (−0.62 to −0.46) (19,484–36,179) (100.83–187.46) (−0.35 to 0.13) (−0.74 to –0.49) (−3.9 to –3.2)
United Arab Emirates 0.88 563 298.16 1,443 297.83 0.00 2,870 168.62 −0.43 −0.43 −1.9 <0.001
(399–781) (199.5–420.54) (1,104–1,960) (190.04–370.98) (−0.31 to 0.47) (1,998–4,185) (117.32–230.98) (−0.56 to –0.27) (−0.62 to –0.12) (−2.4 to –1.4)
High-middle SDI
Bahrain 0.75 145 135.43 271 89.89 −0.34 376 74.42 −0.17 −0.45 −1.0 <0.001
(116–185) (110.11–174.31) (215–347) (72.83–114.41) (−0.47 to −0.14) (283–504) (56.8–99.68) (−0.33 to 0.03) (−0.6 to –0.23) (−1.3 to –0.6)
Georgia 0.70 11,967 358.06 7,194 115.55 −0.21 6,925 261.64 −0.07 −0.27 −1.1 0.001
(9,159–13,611) (272.58–408.23) (6,125–7,737) (98.58–124.36) (−0.34 to −0.04) (5,440–8,461) (203.26–320.31) (−0.28 to 0.18) (−0.43 to –0.08) (−1.7 to –0.4)
Jordan 0.73 909 106.21 1,315 62.24 −0.41 2,148 55.25 −0.11 −0.48 −2.3 <0.001
(689–1,166) (81.44–135.46) (980–1,593) (47.81–74.87) (−0.55 to −0.2) (1,514–2,875) (39.79–73.64) (−0.3 to 0.14) (−0.62 to –0.21) (−2.6 to –1.9)
Kazakhstan 0.72 27,978 355.99 31,809 352.65 −0.01 27,646 262.01 −0.26 −0.26 −1.0 <0.001
(25,583–30,994) (325.64–393.77) (29,383–34,613) (326.08–384.46) (−0.12 to 0.1) (22,960–33,600) (217.61–317.76) (−0.38 to –0.1) (−0.39 to –0.12) (−1.3 to –0.6)
Lebanon 0.71 1,560 120.71 1718 78.14 −0.35 2069 71.83 −0.08 −0.40 −1.8 <0.001
(1,101–2,014) (87.07–154.25) (1,226–2,281) (55.86–103.87) (−0.51 to −0.08) (1,398–2,872) (48.58–99.59) (−0.28 to 0.16) (−0.57 to –0.07) (−1.8 to –1.7)
Malaysia 0.74 21,352 376.97 25,629 226.40 −0.40 35,386 243.91 0.08 −0.35 −1.5 <0.001
(14,470–24,686) (251.89–432.9) (22,202–31,293) (195.66–272.47) (−0.49 to −0.19) (25,189–47,108) (174.02–323.1) (−0.19 to 0.43) (−0.52 to –0.11) (−1.7 to –1.3)
Oman 0.78 486 131.57 730 117.63 −0.11 764 78.01 −0.34 −0.41 −1.8 <0.001
(330–669) (89.5–180.26) (537–847) (86.89–136.33) (−0.38 to 0.3) (561–965) (58.73–96.62) (−0.46 to –0.17) (−0.59 to –0.04) (−1.9 to –1.6)
Sri Lanka 0.69 8,561 128.96 13,447 118.17 −0.08 14,070 101.00 −0.15 −0.22 −0.9 <0.001
(7,143–11,574) (108.39–178) (9,649–15,258) (85.55–133.72) (−0.34 to 0.12) (9,438–19,608) (67.8–140.67) (−0.39 to 0.18) (−0.49 to 0.16) (−1.4 to –0.4)
Turkey 0.75 26,831 126.70 26,437 70.78 −0.44 29,205 61.84 −0.13 −0.51 −2.5 <0.001
(16,781–33,964) (79.93–158.73) (19,256–31,310) (51.82–83.7) (−0.56 to −0.13) (20,279–37,012) (42.93–78.27) (−0.33 to 0.13) (−0.65 to –0.21) (−2.7 to –2.2)
Middle SDI
Armenia 0.69 5,193 316.29 5,818 287.94 −0.09 4,679 222.33 −0.23 −0.30 −1.3 <0.001
(4,713–5,759) (287.45–350.78) (4,710–6,290) (232.46–310.63) (−0.29 to 0.01) (3,789–5,732) (179.36–273.31) (−0.38 to –0.05) (−0.45 to –0.11) (−1.8 to –0.7)
Azerbaijan 0.68 7,811 249.19 10,904 225.16 −0.10 11,321 188.35 −0.16 −0.24 −1.0 <0.001
(6,678–9,432) (213.58–306.02) (9,140–13955) (189.71–297.86) (−0.25 to 0.09) (8,319–15805) (139.57–263.71) (−0.36 to 0.08) (−0.44 to 0.01) (−1.3 to –0.6)
China 0.69 855,359 176.40 1,417,473 167.38 −0.05 1,622,242 157.50 −0.06 −0.11 −0.4 <0.001
(654,484–1,432,990) (135.68–294.69) (945,140–1,632,602) (112.64–192.58) (−0.53 to 0.31) (892,585–2.090,864) (86.9–202.91) (−0.31 to 0.21) (−0.65 to 0.34) (−0.6 to –0.2)
Indonesia 0.66 209,575 316.01 283,571 259.11 −0.18 291,925 216.87 −0.16 −0.31 −1.3 <0.001
(125,659–310,811) (191.9–475.38) (183,742–428,729) (169.1–398.71) (−0.34 to 0.02) (190,114 to 465,941) (143.05–352.41) (−0.37 to 0.13) (−0.49 to –0.04) (−1.3 to –1.2)
Iran (Islamic Republic of) 0.67 13,987 90.42 17,604 56.23 −0.38 22,367 54.11 −0.04 −0.40 −1.8 <0.001
(9,830–16,221) (63.85–107.54) (13,205–19,016) (41.95–61.21) (−0.45 to −0.2) (16,199–25,705) (38.94–62.2) (−0.12 to 0.08) (−0.49 to –0.16) (−1.9 to –1.6)
Iraq 0.67 3,944 85.55 7,615 74.32 −0.13 10,307 70.20 −0.06 −0.18 −0.7 <0.001
(2,857–5,501) (61.93–118) (5,424–10,708) (53.81–101.92) (−0.39 to 0.24) (7,148–14,211) (49.79–95.2) (−0.29 to 0.26) (−0.46 to 0.28) (−0.9 to –0.6)
Philippines 0.62 59,776 292.84 91,383 237.07 −0.19 110,566 226.75 −0.04 −0.23 −0.8 <0.001
(46,791–71,063) (238.34–356.17) (75,177–105,778) (199.33–275.98) (−0.33 to −0.01) (78,847–147799) (164.63–303.9) (−0.28 to 0.27) (−0.44 to 0.07) (−1.1 to –0.6)
Syrian Arab Republic 0.62 2,218 68.49 2,929 48.35 −0.29 3,190 46.56 −0.04 −0.32 −1.4 <0.001
(1,540–2,962) (48.28–90.74) (2,266–3,741) (38.17–61.09) (−0.49_0.06) (2,237–4,499) (33.24–64.92) (−0.31 to 0.31) (−0.53 to 0.09) (−1.7 to –1)
Thailand 0.69 110,301 468.74 110,760 257.41 −0.45 107,652 205.29 −0.20 −0.56 −2.8 <0.001
(80,340–130,587) (345.47–551.71) (92,655–142,376) (216.14–330.12) (−0.56 to −0.26) (75,550–159,387) (143.64–302.08) (−0.45 to 0.13) (−0.7 to –0.32) (−3.2 to –2.4)
Turkmenistan 0.67 3,265 266.86 5,684 271.89 0.02 6,282 250.40 −0.08 −0.06 −0.1 0.838
(2,960–3,591) (241.84–291.44) (4,475–6,272) (218.18–299.14) (−0.19 to 0.14) (4,416–8,339) (176.46–332.23) (−0.3 to 0.22) (−0.32 to 0.25) (−1.1 to 0.9)
Uzbekistan 0.63 18,403 266.46 35,747 298.31 0.12 43,308 276.85 −0.07 0.04 0.2 0.387
(16,722–20,319) (242.32–292.56) (32,346–38,541) (271.44–320.89) (0.01–0.24) (34,038–53,196) (219.9–339.05) (−0.25 to 0.14) (−0.19 to 0.28) (−0.2 to 0.6)
Viet Nam 0.62 77,909 323.87 122,024 283.21 −0.13 139,883 248.94 −0.12 −0.23 −0.9 <0.001
(56,911–102,264) (237.7–426.44) (88,765–152,891) (204.17–353.87) (−0.37 to 0.23) (96,361–184,065) (173.03–325.09) (−0.3 to 0.11) (−0.48 to 0.13) (−1 to –0.8)
Low-middle SDI
Bangladesh 0.48 121,352 433.38 109,624 209.39 −0.52 132,532 180.42 −0.14 −0.58 −2.9 <0.001
(55,104–159,389) (194.25–567.09) (61,691–156,043) (117.72–287.86) (−0.65 to −0.17) (74,025–204,663) (100.78–277.14) (−0.35 to 0.1) (−0.73 to –0.21) (−3.1 to –2.7)
Bhutan 0.46 733 450.61 606 242.55 −0.46 702 222.61 −0.08 −0.51 −2.4 <0.001
(338–1,053) (208.27–640.18) (355–903) (143.8–355.94) (−0.64 to 0.02) (408–1128) (131.29–352.43) (−0.29 to 0.16) (−0.7 to –0.01) (−2.5 to –2.3)
Cambodia 0.47 16,073 486.73 20,009 330.86 −0.32 23,732 305.98 −0.08 −0.37 −1.6 <0.001
(8,772–22,809) (270.54–694.94) (13,615–28,798) (226.81–486.56) (−0.5 to 0.03) (16,721–35,727) (215.02–460.08) (−0.27 to 0.18) (−0.56 to 0.02) (−1.7 to –1.5)
Democratic People’s Republic of Korea 0.56 33,565 312.19 47,506 308.92 −0.01 48,247 279.56 −0.10 −0.10 −0.4 <0.001
(22,099–58,251) (207.22–539.82) (30,101–70,337) (196.31–458.22) (−0.33 to 0.38) (30,551–72,214) (175.29–415.39) (−0.29–0.17) (−0.43 to 0.36) (−0.5 to –0.3)
India 0.57 1,029,221 355.76 1,233,912 242.12 −0.32 1,554,489 239.49 −0.01 −0.33 −1.4 <0.001
(808,715–1,290,948) (281.53–447.7) (1,052,925–1,680,475) (206.72–331.83) (−0.43 to −0.14) (1,198,223–2,094,137) (184.74–325.15) (−0.23 to 0.24) (−0.48 to –0.11) −1.9 to –0.8)
Kyrgyzstan 0.60 7,272 411.64 8,353 342.18 −0.17 8,758 291.78 −0.15 −0.29 −1.3 <0.001
(6,306–7,947) (360.62–449.93) (7,627–8,978) (313.23–367.56) (−0.24 to −0.07) (6,992–10,460) (233.19–347.31) (−0.29 to 0.02) (−0.41 to –0.15) (−1.6 to –0.9)
Lao People’s Democratic Republic 0.49 7,699 572.86 7,607 341.08 −0.40 8,381 289.76 −0.15 −0.49 −2.3 <0.001
(3,872–11,522) (300.19–865.17) (4,293–11,392) (193.29–518.99) (−0.59 to −0.08) (5,152–12,454) (180.22–437.83) (−0.34 to 0.13) (−0.66 to –0.12) (−2.4 to –2.2)
Maldives 0.56 220 410.91 149 131.01 −0.68 185 110.48 −0.16 −0.73 −4.5 <0.001
(88–315) (169.95–589.38) (126–184) (110.32–161.05) (−0.78 to 0.21) (142–246) (85.88–144.15) (−0.33 to 0.05) (−0.83 to –0.3) (−4.8 to –4.2)
Mongolia 0.61 3,624 583.47 5,158 436.09 −0.25 6,072 363.49 −0.17 −0.38 −1.6 <0.001
(2,803–4,898) (452.93–774.4) (3,972–6,880) (339.64–567.17) (−0.45 to 0.04) (4,295–8722) (262.7–509.99) (−0.36 to 0.14) (−0.56 to –0.1) (−1.9 to –1.4)
Myanmar 0.52 77,756 521.01 75,763 316.60 −0.39 72,415 247.28 −0.22 −0.53 −2.5 <0.001
(43,579–120,936) (297.92–814.26) (48,576–118,459) (204.5–509.02) (−0.57 to 0.14) (48,923–116,911) (167.17–404.93) (−0.4 to 0.05) (−0.69 to –0.22) (−2.7 to –2.4)
Palestine 0.59 534 101.84 685 67.42 −0.34 978 69.83 0.04 −0.31 −1.4 <0.001
(345–731) (65.98–137.04) (524–808) (49.02–79.55) (−0.5 to −0.09) (652–1210) (44.73–86.02) (−0.22 to 0.28) (−0.52 to 0.01) (−1.6 to –1.1)
Tajikistan 0.54 3,986 243.88 3,632 148.26 −0.39 4,732 136.39 −0.08 −0.44 −2.0 <0.001
(2,832–4,578) (170.22–281.14) (2,914–5,426) (121.24–213.08) (−0.53 to −0.04) (3,509–7,634) (103.44–212.47) (−0.29 to 0.19) (−0.6 to –0.02) (−2.3 to –1.7)
Timor-Leste 0.51 845 397.55 877 249.65 −0.37 1,238 278.94 0.12 −0.30 −1.2 <0.001
(470–1228) (232.69–580.22) (468–1,353) (136.24–388.3) (-0.65_-0.06) (730–1,887) (170.96–426.31) (−0.13 to 0.51) (−0.59 to 0.11) (−1.5 to –0.9)
Low SDI
Afghanistan 0.34 11,599 294.12 19,053 268.44 −0.09 22,877 238.64 −0.11 −0.19 −0.7 <0.001
(3,400–18,085) (88.46–454.94) (6,073–30,071) (99.56–415.13) (−0.32 to 0.26) (8,021–36,388) (93.29–368.12) (−0.29 to 0.13) (−0.41 to 0.19) (−0.8 to −0.6)
Nepal 0.42 31,254 508.47 27,404 261.24 −0.49 35,181 259.06 −0.01 −0.49 −2.3 <0.001
(14,450–43,339) (236.17–695.19) (16,576–38,189) (158.69–358.02) (−0.64 to –0.17) (21,805–50,994) (161.28–373.19) (−0.22 to 0.25) (−0.66 to –0.12) (−2.4 to −2.2)
Pakistan 0.45 48,396 151.80 91,182 166.06 0.09 110,786 149.93 −0.10 −0.01 −0.1 0.410
(39,053–60,790) (122.5–191.67) (67,918–119,158) (125.49–214.63) (−0.18 to 0.47) (78,203–158,090) (107.17–210.77) (−0.35 to 0.26) (−0.3 to 0.44) (0 to –0.8)
Yemen 0.41 4,484 143.74 7,150 116.29 −0.19 10,484 117.57 0.01 −0.18 −0.7 <0.001
(2,019–6,879) (68.2–214.03) (4,161–10,226) (70.71–164.68) (−0.41 to 0.19) (6,242–15,904) (72.58–172.6) (−0.21 to 0.29) (−0.44 to 0.33) (−0.8 to –0.5)

Discussion

This study was conducted to report the incidence, mortality and burden of cervical cancer in Asia. The results of this study showed that although the number of cervical cancer cases has increased by approximately twofold between 1990 and 2019, the ASIR of cervical cancer has decreased by 31%. During the same period, the ASDR of cervical cancer decreased by 26% to 5.79 per 1,000 women. The slow progression of precancerous lesions to cancer, and the appropriate response of cancerous lesions to treatment highlight the importance of screening programs [19]. Asian countries took several measures to improve screening programs. Also, although the success of these programs is evident in some countries, in other countries such as Nepal, Myanmar and the Philippines, cervical cancer is still considered one of the important health challenges [6]. Studies show that the results of individual, social, cultural and structural barriers affect compliance with screening programs. Lack of awareness, as one of the most important obstacles, keeps many Asian women away from regular screening [20].

The present study showed that the highest incidence of cervical cancer can be seen in East Asia. The higher incidence of this cancer in these countries can be partially due to the presence of risk factors such as HPV typing, awareness, attitudes and beliefs, culture and structural factors in these countries [21, 22]. Although screening is available in most Asian countries, it is opportunistic and therefore screening coverage is poor. Tajikistan had no screening program until the end of 2009. In 2013, Kazakhstan started a pilot vaccination program against oncogenic HPV types, but due to a lack of support, it was not fully implemented [2].

In general, 21% of Asian women (28% Chinese, 8% Japanese, 15% Filipino, 25% Korean, 36% Vietnamese and 26% Asian Indian) have never had a pap smear [23]. Although cervical cancer can be detected in the early stages, about 80% of women in developed countries will seek treatment after the onset of symptoms. Statistics show that 69% of Asian women seek treatment at advanced stages in comparison to 46% of European and 50% of North American women, indicating that Asian countries need effective measures and comprehensive planning in the field of disease control. Referral in the advanced stages of the disease leads to a high mortality rate in women and this is while cervical cancer is a preventable and treatable cancer [24].

Although ASDR has taken a downward trend in all regions of Asia, in some regions such as East Asia, this decline has been slower, which can be attributed to the lack of effective health policies that lead to the insufficient diagnosis, detection at higher stages, and failure of treatment. Advanced stages of HPV infection at the time of cancer diagnosis, as well as poor access to optimal treatments, poor treatment technology and cultural barriers, lead to poor prognosis and higher mortality [25].

While the incidence and mortality are older methods that show the status of the disease, DALY is a new method that correlates the burden of disease to the degree of disease, disability and long-term survival rate [26]. Although the downward trend of DALYs associated with cervical cancer can be observed in most Asian countries during 1990–2019, still 52% of the burden of cervical cancer in 2019 was related to Asian countries. In the current study, the highest DALYs per 100,000 women were observed in central Asia.

The obstacles in most developing countries highlight the relationship between cervical cancer and the level of development of a country and its people. Cervical cancer is significantly correlated to the geographical region and the level of development. The detection and treatment of precancerous lesions, which is more vigorous in developed countries, explains many of the geographic differences. Currently, to improve the existing situation, in addition to improving screening coverage and management, we also need to improve quality control of screening programs and provide feedback to participants [27, 28]. In combination with human evaluation, artificial intelligence could serve as a helpful tool in the interpretation of cervical smears or images [29]. However, the occurrence of Covid-19 in the last few years, which led to the reduction of oncology centers around the world and the refusal of patients to receive diagnostic and treatment services on time, has obscured the epidemiological trend of cancers, including cervical cancer [30]. Also, the implementation of educational and awareness-raising interventions regarding cervical cancer, elimination of misconceptions related to testing results, and emphasis on the preventable nature of this cancer by early detection using screening methods can facilitate the successful treatment of this disease and reduce some related obstacles. However, improving people’s attitudes is also effective [31].

Conclusions

While statistics for incidence, mortality and incidence of cervical cancer in Asia are declining, cervical cancer is still considered a major health challenge in this region. So it seems in addition to improving screening coverage and management, we need to implementation of educational and awareness-raising interventions regarding cervical cancer, eliminate misconceptions related to testing results, and emphasise the preventable nature of this cancer by early detection using screening methods.

Limitations

This study used online data to check the desired results; so, the possibility of error in the recorded data is one of the main limitations of this study. Quantification of all sources, delays in accessing data, changes in coding practices over time, and gaps in reporting results in some countries, are the most important limitations of an online database.

Corresponding author: Hamid Salehiniya, Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran, E-mail:

  1. Research funding: No specific funding was obtained for this study.

  2. Informed consent: In this study, informed consent was not necessary because of the use of an online database.

  3. Availability of data and material: The data presented in this study are available on request from the corresponding author.

  4. Ethics approval: The study was approved by the ethics committee of the Birjand University of Medical Sciences (ethics committee approval code IR. BUMS. REC.1400.316). As we used routinely collected anonymized electronic data, patient consent was not required. All procedures were performed in accordance with the relevant guidelines and regulations.

  5. Author contributions: AM, HS, ZM and LA designed and conceived the study. AM collected the data. LA, AM, HS, and IA analyzed the data. AM, SA, ZM, LA, and ZN, drafted the manuscript. HS and IA provided administrative support. LA and AM provided oversight. All authors contributed to the article and approved the submitted version.

  6. Conflict of interest: All authors declare that they have no conflicts of interest.

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Received: 2022-12-13
Accepted: 2023-02-20
Published Online: 2023-03-09

© 2023 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Frontmatter
  2. Review Articles
  3. Breast cancer status, grading system, etiology, and challenges in Asia: an updated review
  4. The role of acetylation of histone H3 and H4 in oral squamous cell carcinoma
  5. Research Articles
  6. Temporal trends of cervical cancer between 1990 and 2019, in Asian countries by geographical region and socio-demographic index, and comparison with global data
  7. Human EVI2B acts as a Janus-faced oncogene/antioncogene by differently affecting as per cancer type neoplastic cells growth and immune infiltration
  8. Wnt/β-catenin signaling activation by TIMP1 confers cisplatin-resistant gastric cancer cells to malignant behaviors and epithelial–mesenchymal transition
  9. Hsa_circ_0079598 acts as a potential diagnostic and prognostic biomarker for gastric cancer
  10. The inhibitory function of GDF11/BMP11 in liver cancer by inducing apoptosis and ROS–JNK pathway
  11. Identification of cancer stem cells derived from U118MG and the involvement of LncRNA-DC and STAT3 in promoting their malignant transformation
https://doi.org/10.1515/oncologie-2022-1009
Keywords for this article
Asia; burden; cervical cancer; incidence; mortality; prevalence
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Review Articles
  3. Breast cancer status, grading system, etiology, and challenges in Asia: an updated review
  4. The role of acetylation of histone H3 and H4 in oral squamous cell carcinoma
  5. Research Articles
  6. Temporal trends of cervical cancer between 1990 and 2019, in Asian countries by geographical region and socio-demographic index, and comparison with global data
  7. Human EVI2B acts as a Janus-faced oncogene/antioncogene by differently affecting as per cancer type neoplastic cells growth and immune infiltration
  8. Wnt/β-catenin signaling activation by TIMP1 confers cisplatin-resistant gastric cancer cells to malignant behaviors and epithelial–mesenchymal transition
  9. Hsa_circ_0079598 acts as a potential diagnostic and prognostic biomarker for gastric cancer
  10. The inhibitory function of GDF11/BMP11 in liver cancer by inducing apoptosis and ROS–JNK pathway
  11. Identification of cancer stem cells derived from U118MG and the involvement of LncRNA-DC and STAT3 in promoting their malignant transformation
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