Gynaecological Cancer Mortality in Serbia, 1991-2010: A Joinpoint Regression Analysis

  • Ilic, Milena (Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac) ;
  • Ilic, Irena (Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac)
  • Published : 2015.02.04


The descriptive epidemiological study aimed to analyse the mortality trends from gynaecological cancer in Serbia. Average annual percentage of change (AAPC) and the corresponding 95% confidence intervals (CIs) were computed for trend using joinpoint regression analysis. Nearly 25,000 gynaecological cancer deaths occurred in Serbia during the 1991-2010 period, with the average annual age-standardised mortality rate being 17.2 per 100,000 women. Increase of mortality was observed for cancer of the vulva and vagina (AAPC=+1.3%, 95% CI=0.1 to 2.6), ovarian cancer (AAPC=+0.8%, 95% CI=0.4-1.3) and for cervical cancer (AAPC=+0.7%, 95% CI=0.3 to 1.1). Mortality rates for gynaecological cancer overall declined in women aged 30-39 years, but mortality was increased in middle-aged women (for cervical cancer) and in the elderly (for ovarian cancer). Improvements to and implementation of the national cervical cancer screening programme conducted in 2013 and expected to be finalised in the following years throughout Serbia should contribute to improvement.


Supported by : Ministry of Education and Science of Republic of Serbia


  1. Trimble CL, Hildesheim A, Brinton LA, Shah KV, Kurman RJ (1996). Heterogeneous etiology of squamous carcinoma of the vulva. Obstet Gynecol, 87, 59-64.
  2. Verloop J, Van Leeuwen FE, Helmerhorst TJ, van Boven HH, Rookus MA (2010). Cancer risk in DES daughters. Cancer Causes Control, 21, 999-1007.
  3. Statistical Office of the Republic of Serbia (2001-2011). Statistical yearbook of the republic of Serbia for 2000-2010. Statistical office of the republic of Serbia, Belgrade.
  4. Arbyn M, Antoine J, Valerianova Z, et al (2010). Trends in cervical cancer incidence and mortality in Bulgaria, Estonia, Latvia, Lithuania and Romania. Tumori, 96, 517-23.
  5. Arbyn M, Castellsague X, de Sanjose S, et al (2011). Worldwide burden of cervical cancer in 2008. Ann Oncol, 22, 2675-86.
  6. Arbyn M, Geys H (2002). Trend of cervical cancer mortality in Belgium (1954-1994): tentative solution for the certification problem of unspecified uterine cancer. Int J Cancer, 102, 649-54.
  7. Bae-Jump VL, Bauer M, Van Le L (2007). Cytological evaluation correlates poorly with histological diagnosis of vulvar neoplasias. J Low Genit Tract Dis, 11, 8-11.
  8. Bergstrom R, Sparen P, Adami HO (1999). Trends in cancer of the cervix uteri in Sweden following cytological screening. Br J Cancer, 81, 159-66.
  9. Bray F, Loos AH, McCarron P, et al (2005). Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev, 14, 677-86.
  10. Bray F, Loos AH, Oostindier M, Weiderpass E (2005). Geographic and temporal variations in cancer of the corpus uteri: incidence and mortality in pre- and postmenopausal women in Europe. Int J Cancer, 117, 123-31.
  11. Bray F, Loos AH, Tognazzo S, La Vecchia C (2005). Ovarian cancer in Europe: Cross-sectional trends in incidence and mortality in 28 countries, 1953-2000. Int J Cancer, 113, 977-90.
  12. Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards B (2009). Estimating average annual per cent change in trend analysis. Statist Med, 28, 3670-82.
  13. de Kok IM, van der Aa MA, van Ballegooijen M, et al; Working group output of the Netherlands cancer registry (2011). Trends in cervical cancer in the Netherlands until 2007: has the bottom been reached? Int J Cancer, 128, 2174-81.
  14. dos Santos Silva I, Swerdlow AJ (1995). Recent trends in incidence of and mortality from breast, ovarian and endometrial cancers in England and Wales and their relation to changing fertility and oral contraceptive use. Br J Cancer, 72, 485-92.
  15. D'Souza ND, Murthy NS, Aras RY (2013). Projection of burden of cancer mortality for India, 2011-2026. Asian Pac J Cancer Prev, 14, 4387-92.
  16. Gyenwali D, Pariyar J, Onta SR (2013). Factors associated with late diagnosis of cervical cancer in Nepal. Asian Pac J Cancer Prev, 14, 4373-7.
  17. Howlader N, Noone AM, Krapcho M, et al (2013). SEER Cancer Statistics Review, 1975-2010, National Cancer Institute. Bethesda, MD.
  18. Forouzanfar MH, Foreman KJ, Delossantos AM, et al (2011). Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet, 378, 1461-84.
  19. International Agency for Research on Cancer (IARC) (2008). World cancer report, 2008. Boyle P. and Levin BE. (eds), IARC press, Lyon.
  20. International Menopause Society (2014). Menopause perspectives around the world. Serbia and Montenegro: Montenegro and Serbian menopause and andropause society. Available at: Accessed.
  21. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  22. Jung KW, Shin HR, Kong HJ, et al (2010). Long-term trends in cancer mortality in Korea (1983-2007): a joinpoint regression analysis. Asian Pac J Cancer Prev, 11, 1451-7.
  23. Kim HJ, Fay M, Feuer EJ, Midthune DN (2000). Permutation tests for joinpoint regression with applications to cancer rates. Statist Med, 19, 335-51.<335::AID-SIM336>3.0.CO;2-Z
  24. Kim HJ, Fay MP, Yu B, Barrett MJ, Feuer EJ (2004). Comparability of segmented line regression models. Biometrics, 60, 1005-14.
  25. Kimman M, Norman R, Jan S, Kingston D, Woodward M (2012). The burden of cancer in member countries of the Association of Southeast Asian Nations (ASEAN). Asian Pac J Cancer Prev, 13, 411-20.
  26. Knezevic A, Aleksic G, Soldatovic I, Banko A, Jovanovic T (2012). Cervical human papillomavirus infection in Serbia: risk factors, prevalence and genotype distribution in women with normal cervical cytology. Arch Biol Sci, 64, 1277-83.
  27. La Vecchia C, Bosetti C, Lucchini F, et al (2010). Cancer mortality in Europe, 2000-2004 and an overview of trends since 1975. Ann Oncol, 21, 1323-30.
  28. Lea JS, Miller DS (2001). Optimum screening interventions for gynecologic malignancies. Tex Med, 97, 49-55.
  29. Lindemann K, Vatten LJ, Ellstrom-Engh M, Eskild A (2008). Body mass, diabetes and smoking and endometrial cancer risk: a follow-up study. Br J Cancer, 98, 1582-5.
  30. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD (2005). Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull WHO, 83, 171-7.
  31. Ministry of Health, Republic of Serbia (2007). National health survey, Serbia 2006. Ministry of Health, Republic of Serbia, Belgrade.
  32. Rasevic M (2008). Serbia: Transition from abortion to contraception or not? Socioloski pregled, XLII, 295-305 (in Serbian).
  33. Razak NA, Mn K, Zubairi YZ, Naing NN, Zaki NM (2013). Estimating the five-year survival of cervical cancer patients treated in Hospital Universiti Sains Malaysia. Asian Pac J Cancer Prev, 14, 825-8.
  34. Sankaranarayanan R, Ferlay J (2006). Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol, 20, 207-25.