Background and Epidemiology

  • Nicole P. M. EzendamEmail author
  • Lonneke V. van de Poll-Franse
  • Jan-Willem Coebergh


Gynecological malignancies – cancer of the cervix, ovaries, uterus, vagina, vulva, and the fallopian tubes – affect many women each year: one in eight tumors among women is gynecologic. This chapter focuses on the four most common gynecological cancers: uterine, ovary, cervical, and vulvar cancer. To present the epidemiology of these gynecological cancers, the incidence, mortality, and survival in Europe and the United States are described. Moreover, this chapter provides information on important risk factors of these cancers, comorbidities that might affect treatment and mortality, and elements of cancer survivorship. Increasing numbers of patients survive gynecological cancer and (long-term) consequences of the cancer and its treatment become more apparent. As a result quality of life becomes a growing topic of attention.


Epidemiology Cervical cancer Ovarian cancer Uterine cancer Vaginal cancer Gynecologic malignancies 


  1. 1.
    Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61(4):212–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Waldron W, et al., editors. SEER cancer statistics review, 1975–2008. Bethesda: National Cancer Institute; 2012.Google Scholar
  4. 4.
    Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;366(9484):491–505.PubMedCrossRefGoogle Scholar
  5. 5.
    Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.PubMedCrossRefGoogle Scholar
  6. 6.
    WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human papillomavirus and related cancers in world. Summary report 2010. WHO; 2010.Google Scholar
  7. 7.
    Tota JE, Chevarie-Davis M, Richardson LA, Devries M, Franco EL. Epidemiology and burden of HPV infection and related diseases: implications for prevention strategies. Prev Med. 2011;53 Suppl 1:S12–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Bodelon C, Madeleine MM, Voigt LF, Weiss NS. Is the incidence of invasive vulvar cancer increasing in the United States? Cancer Causes Control. 2009;20(9):1779–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Dittmer C, Katalinic A, Mundhenke C, Thill M, Fischer D. Epidemiology of vulvar and ­vaginal cancer in Germany. Arch Gynecol Obstet. 2011;284(1):169–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Hale GE, Hughes CL, Cline JM. Endometrial cancer: hormonal factors, the perimenopausal “window of risk,” and isoflavones. J Clin Endocrinol Metab. 2002;87(1):3–15.PubMedCrossRefGoogle Scholar
  12. 12.
    Woodruff JD, Pickar JH. Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone. The Menopause Study Group. Am J Obstet Gynecol. 1994;170(5 Pt 1):1213–23.PubMedGoogle Scholar
  13. 13.
    Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet. 1998;351(9114):1451–67.Google Scholar
  14. 14.
    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.PubMedCrossRefGoogle Scholar
  15. 15.
    Soliman PT, Wu D, Tortolero-Luna G, Schmeler KM, Slomovitz BM, Bray MS, et al. Association between adiponectin, insulin resistance, and endometrial cancer. Cancer. 2006;106(11):2376–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Weiderpass E, Persson I, Adami HO, Magnusson C, Lindgren A, Baron JA. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control. 2000;11(2):185–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Schouten LJ, Goldbohm RA, van den Brandt PA. Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst. 2004;96(21):1635–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Weiderpass E, Adami HO, Baron JA, Magnusson C, Lindgren A, Persson I. Use of oral contraceptives and endometrial cancer risk (Sweden). Cancer Causes Control. 1999;10(4):277–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA. 1987;257(6):796–800.Google Scholar
  20. 20.
    Risch HA. Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone. J Natl Cancer Inst. 1998;90(23):1774–86.PubMedCrossRefGoogle Scholar
  21. 21.
    Tsilidis KK, Allen NE, Key TJ, Dossus L, Lukanova A, Bakken K, et al. Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2011;105(9):1436–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Hinkula M, Pukkala E, Kyyronen P, Kauppila A. Incidence of ovarian cancer of grand multiparous women – a population-based study in Finland. Gynecol Oncol. 2006;103(1):207–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Titus-Ernstoff L, Perez K, Cramer DW, Harlow BL, Baron JA, Greenberg ER. Menstrual and reproductive factors in relation to ovarian cancer risk. Br J Cancer. 2001;84(5):714–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008;371(9609):303–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Cibula D, Widschwendter M, Majek O, Dusek L. Tubal ligation and the risk of ovarian cancer: review and meta-analysis. Hum Reprod Update. 2011;17(1):55–67.PubMedCrossRefGoogle Scholar
  26. 26.
    Wei JJ, William J, Bulun S. Endometriosis and ovarian cancer: a review of clinical, pathologic, and molecular aspects. Int J Gynecol Pathol. 2011;30(6):553–68.PubMedCrossRefGoogle Scholar
  27. 27.
    Orezzoli JP, Russell AH, Oliva E, Del Carmen MG, Eichhorn J, Fuller AF. Prognostic implication of endometriosis in clear cell carcinoma of the ovary. Gynecol Oncol. 2008;110(3):336–44.PubMedCrossRefGoogle Scholar
  28. 28.
    Ramus SJ, Gayther SA. The contribution of BRCA1 and BRCA2 to ovarian cancer. Mol Oncol. 2009;3(2):138–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Pal T, Permuth-Wey J, Betts JA, Krischer JP, Fiorica J, Arango H, et al. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer. 2005;104(12):2807–16.PubMedCrossRefGoogle Scholar
  30. 30.
    Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Li N, Franceschi S, Howell-Jones R, Snijders PJ, Clifford GM. Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: variation by geographical region, histological type and year of publication. Int J Cancer. 2011;128(4):927–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ. 1999;318(7188):904–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Willoughby BJ, Faulkner K, Stamp EC, Whitaker CJ. A descriptive study of the decline in cervical screening coverage rates in the North East and Yorkshire and the Humber regions of the UK from 1995 to 2005. J Public Health (Oxf). 2006;28(4):355–60.CrossRefGoogle Scholar
  34. 34.
    Ting J, Kruzikas DT, Smith JS. A global review of age-specific and overall prevalence of cervical lesions. Int J Gynecol Cancer. 2010;20(7):1244–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Singh G, Miller B, Hankey B, Edwards B. Area socioeconomic variations in U.S. cancer incidence, 1975–1999. Bethesda: National Cancer Institute; 2003.Google Scholar
  36. 36.
    Saraiya M, Ahmed F, Krishnan S, Richards TB, Unger ER, Lawson HW. Cervical cancer incidence in a prevaccine era in the United States, 1998–2002. Obstet Gynecol. 2007;109(2 Pt 1):360–70.PubMedCrossRefGoogle Scholar
  37. 37.
    Lynge E, Antilla A, Arbyn M, Segnan N, Ronco G. What’s next? Perspectives and future needs of cervical screening in Europe in the era of molecular testing and vaccination. Eur J Cancer. 2009;45(15):2714–21.PubMedCrossRefGoogle Scholar
  38. 38.
    ICoESoC Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4):885–91.CrossRefGoogle Scholar
  39. 39.
    Appleby P, Beral V, de Berrington Gonzalez A, Colin D, Franceschi S, Goodill A, et al. Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer. 2006;118(6):1481–95.PubMedCrossRefGoogle Scholar
  40. 40.
    Messing MJ, Gallup DG. Carcinoma of the vulva in young women. Obstet Gynecol. 1995;86(1):51–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Monk BJ, Burger RA, Lin F, Parham G, Vasilev SA, Wilczynski SP. Prognostic significance of human papillomavirus DNA in vulvar carcinoma. Obstet Gynecol. 1995;85(5 Pt 1):709–15.PubMedCrossRefGoogle Scholar
  42. 42.
    Ansink A. Vulvar squamous cell carcinoma. Semin Dermatol. 1996;15(1):51–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Madsen BS, Jensen HL, van den Brule AJ, Wohlfahrt J, Frisch M. Risk factors for invasive squamous cell carcinoma of the vulva and vagina–population-based case–control study in Denmark. Int J Cancer. 2008;122(12):2827–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Boll D, Verhoeven RH, van der Aa MA, Lybeert ML, Coebergh JW, Janssen-Heijnen ML. Adherence to national guidelines for treatment and outcome of endometrial cancer stage I in relation to co-morbidity in Southern Netherlands 1995–2008. Eur J Cancer. 2011;47(10):1504–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Eurocare. Accessed 20 Dec 2011.
  46. 46.
    SEER. Accessed 20 Dec 2011.
  47. 47.
    Netherlands Cancer Registry. Accessed 10 Jan 2012.
  48. 48.
    Dutch Cancer Society. Kanker in Nederland tot 2020. VDB Almedeon bv, Oiserwijk, 2011.Google Scholar
  49. 49.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Nicole P. M. Ezendam
    • 1
    • 2
    Email author
  • Lonneke V. van de Poll-Franse
    • 1
    • 2
  • Jan-Willem Coebergh
    • 1
    • 2
  1. 1.Department of Public HealthErasmus MCRotterdamThe Netherlands
  2. 2.South Netherlands Cancer Registry, Comprehensive Cancer Centre SouthEindhovenThe Netherlands

Personalised recommendations