Statistics on Gynecologic Cancer in Japan

Statistics on Gynecologic Cancer in Japan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Statistics on Gynecologic Cancer in Japan Hidekatsu Nakai, Noriomi Matsumura This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3023227/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Feb, 2024 Read the published version in International Journal of Clinical Oncology → Version 1 posted 4 You are reading this latest preprint version Abstract In Japan, high-quality cancer statistics data have been collected through cancer registries, but these data are rarely summarized and reported in research articles. Here, we compiled statistical data on malignant tumors originating from gynecologic organs (ovary, corpus uteri, cervix uteri) in Japan. The number of patients in 2019 was 13,380, 17880, and 10879, respectively, and the number of deaths in 2021 was 5081, 2741, and 2894, respectively. Compared with 40 years ago, the incidence of ovarian cancer has tripled, the incidence of uterine corpus cancer (mainly endometrial cancer) has increased 15-fold, the mortality rate of uterine corpus cancer has tripled, and the incidence of cervical intraepithelial cancer has increased 10-fold in data standardized by the world population. Compared with the United States, the incidence rate of ovarian cancer has overtaken and the mortality rate of uterine corpus cancer is the same, while both the incidence and mortality rates of cervical cancer are higher in Japan. Immediate action is needed in Japan to prevent gynecologic cancers. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Cancer is a major cause of death, and cancer statistics are very important for the government to develop cancer control policies. In Japan, high-quality cancer statistics data have long been collected by the Ministry of Health, Labour and Welfare and are available on the Cancer Information Service website (#1). Although these data are important not only for policy making but also for cancer research, Japanese cancer statistics data have rarely been used for research purposes. This may be due to the fact that cancer statistics data in Japan have not been widely published or even cited in papers on cancer research conducted in Japan. On the other hand, the United States has also accumulated high-quality epidemiologic data on cancer for a long time, and these data have been published and cited in many research papers, thus influencing medical research. In this study, we summarize cancer statistics data on gynecologic cancers in Japan, focusing on changes over time. We then compare U.S. epidemiologic data on cancer over time with Japanese data. This report will be useful in informing the world about the current status of gynecologic cancer in Japan and will provide basic knowledge for future gynecologic cancer research in Japan. Materials and methods Cases included in the Japanese data analysis The Japanese data were downloaded from the Cancer Information website in May 2023 (#2). In this study, we analyzed the data of C53 (Malignant neoplasm of cervix uteri), C54 (Malignant neoplasm of corpus uteri), C56 (Malignant neoplasm of ovary), and D06 (Carcinoma in situ of cervix uteri) in the international classification of diseases (ICD)-10. C54 included uterine sarcoma (C54.2 Malignant neoplasm of myometrium) in addition to endometrial cancer. D06 does not include cervical intraepithelial neoplasia (CIN) 2, but does include CIN3. Analysis of Cancer Incidence and Mortality Rates This study analyzed national cancer incidence rates from 1975 to 2019. Data from 1975 to 2015 were national cancer incidence rates estimated from regional cancer registry data selected based on Death Certificate Only (DCO) ratio, Death Certificate Notification (DCN) raio, and Incidence/Mortality (IM) ratio (#3, #4) (cancer_incidence(1975–2015).xls). In 1975, data were available for 5 regions, but the number of registered regions has gradually increased since then, and 43 regional cancer registries were used to estimate 2015 values, and the population of these registered regions in 2015 was equivalent to 97% of the total Japanese population in that year (#2). Data for 2016–2019 were obtained from national cancer registry data (cancer_incidenceNCR(2016–2019).xls). In addition, changes in cancer incidence rates over time were also analyzed using cancer registry data from Yamagata, Fukui, and Nagasaki prefectures, which are highly accurate and stable over time (#5, #6, #7) (cancer_incidence3pref(1985–2015).xls). Changes in the cancer mortality rate over time were analyzed using data on cancer deaths from 1981 to 2021. (cancer_mortality(1958–2021).xls). Survival analysis Five-year and 10-year relative survival rates were examined using data from six prefectures (Miyagi, Yamagata, Fukui, Osaka, Niigata, and Nagasaki) diagnosed in 1993–2006 and followed up in 2002–2006 by the period method (#8) (cancer_survival_period(2002–2006).xls). In addition, 5-year relative survival rates over time for cases diagnosed in 1993–2011 were examined for regions selected on the basis of DCO ratio, DCN ratio, IM ratio, and unknown resident inquiry ratio (6 prefectures in 1993–2002, 7 prefectures in 2003–2005, 21 prefectures in 2006–2008, and 22 prefectures in 2009–2011) (#9) (cancer_survival(1993–2011).xls). In the cancer registry, cancers are classified into three groups, "localized," "regional," and "distant," based on the degree of progression. Since 1988, in the International Federation of Gynecology and Obstetrics (FIGO) staging classification, "localized" for C57 (malignant neoplasm of the ovary) is stage IA ~ B, "regional" is stage IC ~ III, and "distant" is stage IV. Since 1988, "localized" for C54 (malignant neoplasm of corpus uteri) is stage I, "regional" is stages II-IVA, and "distant" is stage IVB. Since 1989, in the Union for International Cancer Control classification, "localized" for C53 (malignant neoplasm of the cervix uteri) is T1N0M0, "distant" is M1, and "regional" is the other cases. In other words, in FIGO2018, "regional" for C53 is stage II-IVA, but this category included stage I cases with T1N1M0 in the previous FIGO staging classifications. Data Analysis of Cancer Incidence and Mortality Over Time in the United States The International Agency for Research on Cancer (IARC), a specialized agency of the World Health Organization (WHO), provides data standardized by world population to eliminate the effect of age distribution and to compare data by country (#10). We obtained and analyzed US C53, C54, and C56 data standardized by world population. Creation of Figures Heat maps were generated using Excel for Mac 16.72 (Microsoft), and line graphs were generated using Prism 9.5.1 (GraphPad Software). Results In 2019, the number of cases of ovarian, uterine corpus, and cervical cancer was 13,380, 17880, and 10879, respectively, and the number of deaths was 5081, 2741, and 2894, respectively, in 2021 (Table 1). Ovarian, uterine corpus, and cervical cancers were the ninth, sixth, and twelfth most common cancers among Japanese women, respectively. However, when standardized to the world population and excluding the effect of aging, ovarian, uterine corpus, and cervical cancers were the seventh, fifth, and eighth most common cancers, respectively. Lifetime incidence estimates indicate that the probability of a Japanese woman developing a gynecologic cancer during her lifetime was 1 in 62 for ovarian cancer, 1 in 48 for corpus cancer, and 1 in 76 for cervical cancer, with 1 in 20 women developing one of these cancers. Among these cancers, the relative survival rate was lowest for ovarian cancer, and the 10-year relative survival rate was much lower than the 5-year relative survival rate for ovarian cancer, a trend that was stronger for "regional" and "distant" cancers (Table 1). We next examined the annual trends in cancer statistics. First, the incidence rate of ovarian cancer (C56) was approximately 3 times higher in 2019 than in 1975 in data standardized to the world population, with a particular peak at age 50 years (Fig. 1 A). Mortality rates increased with age and showed no change over the past 30 years (Fig. 1 B). The 5-year relative survival rate of "regional" cases, corresponding to FIGO stages IC-III, increased gradually (Fig. 1 C). The increase in the incidence of uterine corpus cancer (C54) was remarkable, with the incidence rate standardized by the world population increasing approximately 15-fold in 2019 compared with 1975. The incidence rate increased particularly in women aged around 50 years (Fig. 2 A). Cervical cancer mortality increased approximately threefold in 2021 compared with 1981, and this increase was observed in all age groups (Fig. 2 B). The 5-year relative survival rate of patients with uterine corpus cancer gradually increased in the "regional" group, corresponding to FIGO stage II-IVA (Fig. 2 C). The incidence of cervical cancer (C53) was high in the elderly before 1980, but decreased thereafter. After 2000, it increased in the under-50 age group and leveled off after 2010 (Fig. 3 A). There was little change in cervical cancer mortality rates when the data were standardized to the world population. By age group, mortality rates decreased in the older age group after 2000 compared with 1990, while those in the younger age group increased (Fig. 3 B). The 5-year relative survival rate tended to increase over time for "regional" and "distant" cases. The incidence of cervical intraepithelial cancer (D06) increased moderately until about 2005, then increased dramatically until 2011, and continued to increase thereafter. The incidence rate standardized to the world population was about 10 times higher in 2019 than in 1975, with a particularly marked increase in those aged < 40 years (Fig. 4 ). National cancer incidence rates from 1975 to 2015 are estimates based on regional cancer registry data, with different regions participating in the registry in different years (#2, #3, #4). Therefore, it is recommended to use the measured data from cancer registries in three regions (Yamagata, Fukui, and Nagasaki prefectures), where the accuracy is stable over time (#2, #5, #6, #7). Therefore, we examined cancer incidence rates from 1985 to 2015 in these regions. The data for ovarian cancer (Fig. 5 A), uterine corpus cancer (Fig. 5 B), cervical cancer (Fig. 5 C), and cervical intraepithelial cancer (Fig. 5 D) were similar to the national estimates and showed no significant differences. Finally, we examined gynecologic cancer incidence rates since 1975 and mortality rates since 1981 in Japan and the United States, standardized to the world population. Ovarian cancer incidence rates in Japan were about one-third of those in the United States in 1975, but while rates in the United States declined, rates in Japan rose steadily, reversed around 2015, and are now higher in Japan. Uterine corpus cancer was about 30 times more common in the U.S. than in Japan in 1975, but the gap has narrowed. Cervical cancer was more common in Japan until about 1990, then became almost equal until about 2000, after which the incidence became more common in Japan (Fig. 6 A). The death rate for ovarian cancer in Japan was about half that in the United States in 1981, but the gap has narrowed since then. Mortality rates for uterine corpus cancer were almost the same after 2012. Cervical cancer mortality rates have been higher in Japan since 2000 (Fig. 6 B). Discussion In Japan, both cancer incidence and deaths continue to increase, mainly due to the aging of the population. However, looking at age-adjusted rates, which exclude the effect of population aging, cancer incidence increased until about 2010 and then leveled off, while deaths peaked in the mid-1990s and have been declining since then (#5). Cancer survival rates are increasing for many sites (#9). This study shows that although survival rates for gynecologic cancers are increasing (Fig. 1 C, 2 C, 3 C), as with the data for all cancers, the age-adjusted incidence and mortality data differ from the data for all cancers. Cancer registry data in Japan have not been published in many papers, and the world is not well aware of their most recent data. Blaustein`s Pathology of the Female Genital Tract, published in 2019, states for ovarian cancer, " In general, the disease is more common in industrialized countries where parity is lower, but there are notable exceptions such as Japan which has a low parity and low rate of ovarian cancer" (#11). However, the incidence of ovarian cancer in Japan is steadily increasing (Fig. 1 A) and has already surpassed that of the United States (Fig. 6 A). The increase in the incidence of ovarian cancer may be related to changes in the Japanese lifestyle. First, parity and oral contraceptive use are known protective factors (#12), and the declining birth rate without oral contraceptive use may have increased the incidence of ovarian cancer in Japan. In addition, excessive consumption of red meat (#14) and ultra-processed foods (#15) has been reported to be associated with increased ovarian cancer. In Japan, the diet has become more Westernized, with increased consumption of dairy products and meat and decreased consumption of seafood and rice (#13). Such dietary changes may also have led to an increase in ovarian cancer. In Japan, the incidence of uterine corpus cancer is increasing markedly (Fig. 2 A), and the mortality rate is also rising steadily (Fig. 2 B). As with ovarian cancer, the increase in uterine corpus cancer in Japan may be related to lifestyle. In addition to obesity (#16), the incidence of uterine corpus cancer is strongly related to diet, with a recent study showing that higher dietary inflammatory and insulinemic potential (#17), i.e., excessive red and processed meat and sugar-sweetened beverages, increases the risk of uterine corpus cancer. This is consistent with the changing dietary habits of the Japanese population (#13). On the other hand, oral contraceptive use (#18) and physical activity (#19) prevent uterine corpus cancer. In a survey conducted in Japan in 2022, only 46% of Japanese women met the WHO recommended standard for physical activity (#20). Recently, data from cancer registries on cervical cancer and cervical intraepithelial cancer in Japan have been widely published (#21, #22), and our data are similar to those. In Japan, the incidence of cervical cancer had decreased, probably due to the introduction of cervical cancer screening (#21), but has since increased in young people (Fig. 3 A). And there has been a marked increase in cervical intraepithelial cancer (Fig. 4 ). This cannot be explained simply by early detection of precancerous cervical lesions (#22), but may be related to increased incidence due to increased sexual activity. In Japan, HPV vaccination rates have been low due to extensive media coverage of HPV vaccine side effects in the past and ongoing HPV vaccine lawsuits (#23, #24). There is concern that cervical cancer will explode in the near future (#22). In conclusion, the incidence rates of ovarian, uterine corpus, and cervical intraepithelial cancers are increasing in Japan, and the mortality rate of uterine corpus cancer is also increasing. Therefore, immediate measures must be taken to prevent gynecologic cancers. Declarations Conflict of interest Hidekatsu Nakai declare no conflict of interest regarding with this article. Noriomi Matsumura received lecture fee from Chugai Pharmaceutical, AstraZeneca, and Takeda Pharmaceutical. Noriomi Matsumura is also an outside director of Takara Bio. References Cancer Statistics. Cancer Information Service, National Cancer Center, Japan (Vital Statistics of Japan, Ministry of Health, Labour and Welfare). https://ganjoho.jp/public/index.html Accessed May 2023 Cancer Statistics in Japan; Table download. https://ganjoho.jp/reg_stat/statistics/data/dl/en.html Accessed May 2023 The Research Group for Population-based cancer registration in Japan (1994) Cancer incidence and incidence rates in Japan in 1988: estimates based on data from ten population-based Cancer Registries. Jpn J Clin Oncol 24:299-304 Hori M, Matsuda T, Shibata A, et al (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45:884-491 Katanoda K, Hori M, Saito E, et al (2021) Updated Trends in Cancer in Japan: Incidence in 1985-2015 and Mortality in 1958-2018-A Sign of Decrease in Cancer Incidence. J Epidemiol 31:426-450 Katanoda K, Ajiki W, Matsuda T, et al (2012) Trend analysis of cancer incidence in Japan using data from selected population-based cancer registries. Cancer Sci 103:360-368 Katanoda K, Hori M, Matsuda T, et al (2015) An updated report on the trends in cancer incidence and mortality in Japan, 1958-2013. Jpn J Clin Oncol 45:390-401 Ito Y, Miyashiro I, Ito H, et al (2014) Long-term survival and conditional survival of cancer patients in Japan using population-based cancer registry data. Cancer Sci 105:1480-1486 Matsuda T, Ajiki W, Marugame T, et al (2011) Population-based survival of cancer patients diagnosed between 1993 and 1999 in Japan: a chronological and international comparative study. Jpn J Clin Oncol 41:40-51 International Agency for Research on Cancer, World Health Organization. Global Cancer Observatory. https://gco.iarc.fr/ Accessed May 2023 Kurman RJ, Ellenson LH, Ronnett BM (2019) Blaustein's Pathology of the Female Genital Tract 7th edition, Springer, pp842-844 McGuire V, Hartge P, Liao LM (2016) Parity and Oral Contraceptive Use in Relation to Ovarian Cancer Risk in Older Women. Cancer Epidemiol Biomarkers Prev 25:1059-1063 Matsumura N (2017) Diet and Physical Activity after Ovarian Cancer Diagnosis. Acta Medica Kindai Univ 42:37-42 Grosso G, Vignera SL, Condorelli RA, et al (2022) Total, red and processed meat consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr 73:726-737 Chang K, Gunter MJ, Rauber F, et al (2023) Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. EClinicalMedicine 56:101840 Bhaskaran K, Douglas I, Forbes H, et al (2014) Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet 384:755-765. Romanos-Nanclares A, Tabung FK, Sinnott JA, et al (2023) Inflammatory and insulinemic dietary patterns and risk of endometrial cancer among US women. J Natl Cancer Inst 115:311-321 Centers for Disease Control (1987) 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 257:796-800 Voskuil DW, Monninkhof EM, Elias SG, et al (2007) Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 16:639-648 Sasakawa Sports Foundation (2022) The 2022 SSF National Sports-Life Survey. https://www.ssf.or.jp/en/files/sld2022_e.pdf Saitoh E, Saika K, Morisada T, et al (2022) Status of cervical cancer screening among adolescents and young adults (AYA) in Japan. Int J Clin Oncol 27:473-480 Sakakibara A, Nakayama T, Uchida H, et al (2023) Trends and future projections of cervical cancer-related outcomes in Japan: What happens if the HPV vaccine program is not implemented? Int J Cancer 152:1863-1874 Matsumura N, Shiro R, Tsunoda I (2023) Critical evaluation on roles of macrophagic myofasciitis and aluminum adjuvants in HPV vaccine-induced adverse events. Cancer Sci 114:1218-1228 Matsumura N, Tsunoda I (2022) Scientific evaluation of alleged findings in HPV vaccines: Molecular mimicry and mouse models of vaccine-induced disease. Cancer Sci 113:3313-3320 Tables Table 1 is available in the Supplementary Files section. Supplementary Files CancerStatisticsTable.pdf Table 1 Gynecologic cancer incidence, mortality, and relative survival among women in Japan. Morbidity and mortality rates are expressed as crude rate. Cite Share Download PDF Status: Published Journal Publication published 21 Feb, 2024 Read the published version in International Journal of Clinical Oncology → Version 1 posted Reviewers agreed at journal 09 Jun, 2023 Reviewers invited by journal 09 Jun, 2023 Editor assigned by journal 06 Jun, 2023 First submitted to journal 05 Jun, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3023227","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":208249226,"identity":"a2d94e46-c6be-4048-9937-6917e2269c94","order_by":0,"name":"Hidekatsu Nakai","email":"","orcid":"","institution":"Kindai University Faculty of Medicine Graduate School of Medical Sciences: Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hidekatsu","middleName":"","lastName":"Nakai","suffix":""},{"id":208249227,"identity":"b466a4e6-7f0d-4559-8e85-85ca6eb0c3d2","order_by":1,"name":"Noriomi Matsumura","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYJCCAwwMEnJA2oCxwYCBsYEZLMhGUIsxaVpAILEBrIWBAYTxA3P23ocHPuZYpK9tb97AOKPgjmx/OwPjhx8MfHm4tFj2HDc4OHObRO62M8cKGDcYPDOecZiBWbKHga0YlxaDG2kMh3lBWm7kGDA+MDic2HCYgUEa6JdEXC6EaUk3u/8GomU+0JbfxGhJMLvBYwB02OHEDYcZ2PDbcuYYA8gvhtvOpBUcnGFw2HjjYcY2yx4DPH453sb84eO2Onmz44c3Puz5c1h23vnDh2/8qDiGM8RQwAEIBYoag2MJRGlBBjWkaxkFo2AUjILhCgBh+13UxN+t7QAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-4512-7975","institution":"Kindai University Faculty of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Noriomi","middleName":"","lastName":"Matsumura","suffix":""}],"badges":[],"createdAt":"2023-06-05 08:01:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3023227/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3023227/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10147-024-02473-8","type":"published","date":"2024-02-21T15:01:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":38408515,"identity":"36675522-6801-4d1a-8675-2563c692c1a2","added_by":"auto","created_at":"2023-06-12 15:00:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":96263,"visible":true,"origin":"","legend":"\u003cp\u003eStatistical data on ovarian cancer (C56) in Japan over time.\u003c/p\u003e\n\u003cp\u003eA) Incidence. The vertical axis of the heatmap represents the year, the horizontal axis represents the age group classification by 5 years, and the colors represent the annual number of affected persons per 100,000. The left graph of the heatmap shows the annual number of affected persons per 100,000, normalized by the world population. The bottom graph of the heat map shows the annual number of affected persons per 100,000 persons by 5-year age group in 1975, 1986, 1997, 2008, and 2019. Data for those aged 85 and older are shown together.\u003c/p\u003e\n\u003cp\u003eB) Cancer deaths. The heatmap and graph are shown in the same way as in A.\u003c/p\u003e\n\u003cp\u003eC) 5-year relative survival rate. The graphs are classified by year of diagnosis and show changes over time.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/8d41f6c87ce45c5d3f0c4bdd.jpg"},{"id":38408513,"identity":"c2d1546b-9ac6-42a8-8617-03c0738032e3","added_by":"auto","created_at":"2023-06-12 15:00:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":96254,"visible":true,"origin":"","legend":"\u003cp\u003eStatistical data on uterine corpus cancer (C54) in Japan over time.\u003c/p\u003e\n\u003cp\u003eA) Cancer incidence. B) Cancer death. C) 5-year relative survival rate. The heat map and graphs are displayed in the same way as in Figure 1.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/569770cf2bd2336cb934d590.jpg"},{"id":38409785,"identity":"e2b34cc2-ccb7-4bd0-8be2-56c57e4496d0","added_by":"auto","created_at":"2023-06-12 15:08:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":96178,"visible":true,"origin":"","legend":"\u003cp\u003eStatistical data on cervical cancer (C53) in Japan over time.\u003c/p\u003e\n\u003cp\u003eA) Cancer incidence. B) Cancer death. C) 5-year relative survival rate. The heat map and graphs are displayed in the same way as in Figure 1.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/c819e6ca0624ab17a6587195.jpg"},{"id":38408512,"identity":"33885db4-9c71-4a39-983f-c55bfedf30ab","added_by":"auto","created_at":"2023-06-12 15:00:57","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":37170,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of cervical intraepithelial cancer (D06) in Japan over time.\u003c/p\u003e\n\u003cp\u003eThe heat map and graphs are displayed in the same way as in Figure 1A.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/c417aefc91de3dddade8de39.jpg"},{"id":38408514,"identity":"2e577b9f-156f-429e-bb53-4ca4be76d6c2","added_by":"auto","created_at":"2023-06-12 15:00:57","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":133999,"visible":true,"origin":"","legend":"\u003cp\u003eChanges over time in gynecologic cancer incidence rates in areas with long-term, stable, and accurate cancer registries.\u003c/p\u003e\n\u003cp\u003eA) Ovarian cancer (C56). B) Uterine corpus cancer (C54). C) Cervical cancer (C53). D) Cervical intraepithelial cancer (D06).\u003c/p\u003e\n\u003cp\u003eThe heat map and graphs are displayed in the same way as in Figure 1A. Data from 1985 to 2015 are shown.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/f44e8024904e535c6ae94ecd.jpg"},{"id":38409786,"identity":"4a08d3d0-bfd7-407e-ae58-c3e25ce7c277","added_by":"auto","created_at":"2023-06-12 15:08:58","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":108946,"visible":true,"origin":"","legend":"\u003cp\u003eChanges over time in gynecologic cancer statistics in Japan and the United States.\u003c/p\u003e\n\u003cp\u003eA) Cancer incidence. The vertical axis is the number of cancer cases per 100,000 people per year standardized by the world population.\u003c/p\u003e\n\u003cp\u003eB) Cancer death. The vertical axis is the number of cancer deaths per 100,000 people per year standardized by the world population.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/147309d37c3c5c269b3cf8de.jpg"},{"id":51648346,"identity":"85070e40-1b66-43b2-9b30-39ced7445b87","added_by":"auto","created_at":"2024-02-26 15:12:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":568303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/eee74e9f-1d11-4e6a-9d5e-9f8f7836d264.pdf"},{"id":38408517,"identity":"96aa5765-f6c9-4e0c-b93e-1cfab903ae0f","added_by":"auto","created_at":"2023-06-12 15:00:57","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24934,"visible":true,"origin":"","legend":"\u003cp\u003eTable 1\u003c/p\u003e\n\u003cp\u003eGynecologic cancer incidence, mortality, and relative survival among women in Japan.\u003c/p\u003e\n\u003cp\u003eMorbidity and mortality rates are expressed as crude rate.\u003c/p\u003e","description":"","filename":"CancerStatisticsTable.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3023227/v1/67260d74a9c7203e2d025a6b.pdf"}],"financialInterests":"","formattedTitle":"Statistics on Gynecologic Cancer in Japan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a major cause of death, and cancer statistics are very important for the government to develop cancer control policies. In Japan, high-quality cancer statistics data have long been collected by the Ministry of Health, Labour and Welfare and are available on the Cancer Information Service website (#1). Although these data are important not only for policy making but also for cancer research, Japanese cancer statistics data have rarely been used for research purposes. This may be due to the fact that cancer statistics data in Japan have not been widely published or even cited in papers on cancer research conducted in Japan. On the other hand, the United States has also accumulated high-quality epidemiologic data on cancer for a long time, and these data have been published and cited in many research papers, thus influencing medical research.\u003c/p\u003e \u003cp\u003eIn this study, we summarize cancer statistics data on gynecologic cancers in Japan, focusing on changes over time. We then compare U.S. epidemiologic data on cancer over time with Japanese data. This report will be useful in informing the world about the current status of gynecologic cancer in Japan and will provide basic knowledge for future gynecologic cancer research in Japan.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eCases included in the Japanese data analysis\u003c/p\u003e \u003cp\u003eThe Japanese data were downloaded from the Cancer Information website in May 2023 (#2). In this study, we analyzed the data of C53 (Malignant neoplasm of cervix uteri), C54 (Malignant neoplasm of corpus uteri), C56 (Malignant neoplasm of ovary), and D06 (Carcinoma in situ of cervix uteri) in the international classification of diseases (ICD)-10. C54 included uterine sarcoma (C54.2 Malignant neoplasm of myometrium) in addition to endometrial cancer. D06 does not include cervical intraepithelial neoplasia (CIN) 2, but does include CIN3.\u003c/p\u003e \u003cp\u003eAnalysis of Cancer Incidence and Mortality Rates\u003c/p\u003e \u003cp\u003eThis study analyzed national cancer incidence rates from 1975 to 2019. Data from 1975 to 2015 were national cancer incidence rates estimated from regional cancer registry data selected based on Death Certificate Only (DCO) ratio, Death Certificate Notification (DCN) raio, and Incidence/Mortality (IM) ratio (#3, #4) (cancer_incidence(1975\u0026ndash;2015).xls). In 1975, data were available for 5 regions, but the number of registered regions has gradually increased since then, and 43 regional cancer registries were used to estimate 2015 values, and the population of these registered regions in 2015 was equivalent to 97% of the total Japanese population in that year (#2). Data for 2016\u0026ndash;2019 were obtained from national cancer registry data (cancer_incidenceNCR(2016\u0026ndash;2019).xls).\u003c/p\u003e \u003cp\u003eIn addition, changes in cancer incidence rates over time were also analyzed using cancer registry data from Yamagata, Fukui, and Nagasaki prefectures, which are highly accurate and stable over time (#5, #6, #7) (cancer_incidence3pref(1985\u0026ndash;2015).xls).\u003c/p\u003e \u003cp\u003eChanges in the cancer mortality rate over time were analyzed using data on cancer deaths from 1981 to 2021. (cancer_mortality(1958\u0026ndash;2021).xls).\u003c/p\u003e \u003cp\u003eSurvival analysis\u003c/p\u003e \u003cp\u003eFive-year and 10-year relative survival rates were examined using data from six prefectures (Miyagi, Yamagata, Fukui, Osaka, Niigata, and Nagasaki) diagnosed in 1993\u0026ndash;2006 and followed up in 2002\u0026ndash;2006 by the period method (#8) (cancer_survival_period(2002\u0026ndash;2006).xls).\u003c/p\u003e \u003cp\u003eIn addition, 5-year relative survival rates over time for cases diagnosed in 1993\u0026ndash;2011 were examined for regions selected on the basis of DCO ratio, DCN ratio, IM ratio, and unknown resident inquiry ratio (6 prefectures in 1993\u0026ndash;2002, 7 prefectures in 2003\u0026ndash;2005, 21 prefectures in 2006\u0026ndash;2008, and 22 prefectures in 2009\u0026ndash;2011) (#9) (cancer_survival(1993\u0026ndash;2011).xls).\u003c/p\u003e \u003cp\u003eIn the cancer registry, cancers are classified into three groups, \"localized,\" \"regional,\" and \"distant,\" based on the degree of progression. Since 1988, in the International Federation of Gynecology and Obstetrics (FIGO) staging classification, \"localized\" for C57 (malignant neoplasm of the ovary) is stage IA\u0026thinsp;~\u0026thinsp;B, \"regional\" is stage IC\u0026thinsp;~\u0026thinsp;III, and \"distant\" is stage IV. Since 1988, \"localized\" for C54 (malignant neoplasm of corpus uteri) is stage I, \"regional\" is stages II-IVA, and \"distant\" is stage IVB. Since 1989, in the Union for International Cancer Control classification, \"localized\" for C53 (malignant neoplasm of the cervix uteri) is T1N0M0, \"distant\" is M1, and \"regional\" is the other cases. In other words, in FIGO2018, \"regional\" for C53 is stage II-IVA, but this category included stage I cases with T1N1M0 in the previous FIGO staging classifications.\u003c/p\u003e \u003cp\u003eData Analysis of Cancer Incidence and Mortality Over Time in the United States\u003c/p\u003e \u003cp\u003eThe International Agency for Research on Cancer (IARC), a specialized agency of the World Health Organization (WHO), provides data standardized by world population to eliminate the effect of age distribution and to compare data by country (#10). We obtained and analyzed US C53, C54, and C56 data standardized by world population.\u003c/p\u003e \u003cp\u003eCreation of Figures\u003c/p\u003e \u003cp\u003eHeat maps were generated using Excel for Mac 16.72 (Microsoft), and line graphs were generated using Prism 9.5.1 (GraphPad Software).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn 2019, the number of cases of ovarian, uterine corpus, and cervical cancer was 13,380, 17880, and 10879, respectively, and the number of deaths was 5081, 2741, and 2894, respectively, in 2021 (Table\u0026nbsp;1). Ovarian, uterine corpus, and cervical cancers were the ninth, sixth, and twelfth most common cancers among Japanese women, respectively. However, when standardized to the world population and excluding the effect of aging, ovarian, uterine corpus, and cervical cancers were the seventh, fifth, and eighth most common cancers, respectively. Lifetime incidence estimates indicate that the probability of a Japanese woman developing a gynecologic cancer during her lifetime was 1 in 62 for ovarian cancer, 1 in 48 for corpus cancer, and 1 in 76 for cervical cancer, with 1 in 20 women developing one of these cancers. Among these cancers, the relative survival rate was lowest for ovarian cancer, and the 10-year relative survival rate was much lower than the 5-year relative survival rate for ovarian cancer, a trend that was stronger for \"regional\" and \"distant\" cancers (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eWe next examined the annual trends in cancer statistics. First, the incidence rate of ovarian cancer (C56) was approximately 3 times higher in 2019 than in 1975 in data standardized to the world population, with a particular peak at age 50 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Mortality rates increased with age and showed no change over the past 30 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The 5-year relative survival rate of \"regional\" cases, corresponding to FIGO stages IC-III, increased gradually (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe increase in the incidence of uterine corpus cancer (C54) was remarkable, with the incidence rate standardized by the world population increasing approximately 15-fold in 2019 compared with 1975. The incidence rate increased particularly in women aged around 50 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Cervical cancer mortality increased approximately threefold in 2021 compared with 1981, and this increase was observed in all age groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The 5-year relative survival rate of patients with uterine corpus cancer gradually increased in the \"regional\" group, corresponding to FIGO stage II-IVA (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe incidence of cervical cancer (C53) was high in the elderly before 1980, but decreased thereafter. After 2000, it increased in the under-50 age group and leveled off after 2010 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). There was little change in cervical cancer mortality rates when the data were standardized to the world population. By age group, mortality rates decreased in the older age group after 2000 compared with 1990, while those in the younger age group increased (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). The 5-year relative survival rate tended to increase over time for \"regional\" and \"distant\" cases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe incidence of cervical intraepithelial cancer (D06) increased moderately until about 2005, then increased dramatically until 2011, and continued to increase thereafter. The incidence rate standardized to the world population was about 10 times higher in 2019 than in 1975, with a particularly marked increase in those aged\u0026thinsp;\u0026lt;\u0026thinsp;40 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNational cancer incidence rates from 1975 to 2015 are estimates based on regional cancer registry data, with different regions participating in the registry in different years (#2, #3, #4). Therefore, it is recommended to use the measured data from cancer registries in three regions (Yamagata, Fukui, and Nagasaki prefectures), where the accuracy is stable over time (#2, #5, #6, #7). Therefore, we examined cancer incidence rates from 1985 to 2015 in these regions. The data for ovarian cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA), uterine corpus cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB), cervical cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC), and cervical intraepithelial cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eD) were similar to the national estimates and showed no significant differences.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally, we examined gynecologic cancer incidence rates since 1975 and mortality rates since 1981 in Japan and the United States, standardized to the world population. Ovarian cancer incidence rates in Japan were about one-third of those in the United States in 1975, but while rates in the United States declined, rates in Japan rose steadily, reversed around 2015, and are now higher in Japan. Uterine corpus cancer was about 30 times more common in the U.S. than in Japan in 1975, but the gap has narrowed. Cervical cancer was more common in Japan until about 1990, then became almost equal until about 2000, after which the incidence became more common in Japan (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA). The death rate for ovarian cancer in Japan was about half that in the United States in 1981, but the gap has narrowed since then. Mortality rates for uterine corpus cancer were almost the same after 2012. Cervical cancer mortality rates have been higher in Japan since 2000 (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Japan, both cancer incidence and deaths continue to increase, mainly due to the aging of the population. However, looking at age-adjusted rates, which exclude the effect of population aging, cancer incidence increased until about 2010 and then leveled off, while deaths peaked in the mid-1990s and have been declining since then (#5). Cancer survival rates are increasing for many sites (#9). This study shows that although survival rates for gynecologic cancers are increasing (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC), as with the data for all cancers, the age-adjusted incidence and mortality data differ from the data for all cancers.\u003c/p\u003e \u003cp\u003eCancer registry data in Japan have not been published in many papers, and the world is not well aware of their most recent data. Blaustein`s Pathology of the Female Genital Tract, published in 2019, states for ovarian cancer, \" In general, the disease is more common in industrialized countries where parity is lower, but there are notable exceptions such as Japan which has a low parity and low rate of ovarian cancer\" (#11). However, the incidence of ovarian cancer in Japan is steadily increasing (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA) and has already surpassed that of the United States (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA). The increase in the incidence of ovarian cancer may be related to changes in the Japanese lifestyle. First, parity and oral contraceptive use are known protective factors (#12), and the declining birth rate without oral contraceptive use may have increased the incidence of ovarian cancer in Japan. In addition, excessive consumption of red meat (#14) and ultra-processed foods (#15) has been reported to be associated with increased ovarian cancer. In Japan, the diet has become more Westernized, with increased consumption of dairy products and meat and decreased consumption of seafood and rice (#13). Such dietary changes may also have led to an increase in ovarian cancer.\u003c/p\u003e \u003cp\u003eIn Japan, the incidence of uterine corpus cancer is increasing markedly (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA), and the mortality rate is also rising steadily (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). As with ovarian cancer, the increase in uterine corpus cancer in Japan may be related to lifestyle. In addition to obesity (#16), the incidence of uterine corpus cancer is strongly related to diet, with a recent study showing that higher dietary inflammatory and insulinemic potential (#17), i.e., excessive red and processed meat and sugar-sweetened beverages, increases the risk of uterine corpus cancer. This is consistent with the changing dietary habits of the Japanese population (#13). On the other hand, oral contraceptive use (#18) and physical activity (#19) prevent uterine corpus cancer. In a survey conducted in Japan in 2022, only 46% of Japanese women met the WHO recommended standard for physical activity (#20).\u003c/p\u003e \u003cp\u003eRecently, data from cancer registries on cervical cancer and cervical intraepithelial cancer in Japan have been widely published (#21, #22), and our data are similar to those. In Japan, the incidence of cervical cancer had decreased, probably due to the introduction of cervical cancer screening (#21), but has since increased in young people (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). And there has been a marked increase in cervical intraepithelial cancer (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This cannot be explained simply by early detection of precancerous cervical lesions (#22), but may be related to increased incidence due to increased sexual activity. In Japan, HPV vaccination rates have been low due to extensive media coverage of HPV vaccine side effects in the past and ongoing HPV vaccine lawsuits (#23, #24). There is concern that cervical cancer will explode in the near future (#22).\u003c/p\u003e \u003cp\u003eIn conclusion, the incidence rates of ovarian, uterine corpus, and cervical intraepithelial cancers are increasing in Japan, and the mortality rate of uterine corpus cancer is also increasing. Therefore, immediate measures must be taken to prevent gynecologic cancers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e Hidekatsu Nakai declare no conflict of interest regarding with this article. Noriomi Matsumura received lecture fee from Chugai Pharmaceutical, AstraZeneca, and Takeda Pharmaceutical. Noriomi Matsumura is also an outside director of Takara Bio.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCancer Statistics. Cancer Information Service, National Cancer Center, Japan (Vital Statistics of Japan, Ministry of Health, Labour and Welfare). https://ganjoho.jp/public/index.html Accessed May 2023\u003c/li\u003e\n\u003cli\u003eCancer Statistics in Japan; Table download. https://ganjoho.jp/reg_stat/statistics/data/dl/en.html Accessed May 2023\u003c/li\u003e\n\u003cli\u003eThe Research Group for Population-based cancer registration in Japan (1994) Cancer incidence and incidence rates in Japan in 1988: estimates based on data from ten population-based Cancer Registries. Jpn J Clin Oncol 24:299-304\u003c/li\u003e\n\u003cli\u003eHori M, Matsuda T, Shibata A, et al (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45:884-491\u003c/li\u003e\n\u003cli\u003eKatanoda K, Hori M, Saito E, et al (2021) Updated Trends in Cancer in Japan: Incidence in 1985-2015 and Mortality in 1958-2018-A Sign of Decrease in Cancer Incidence. J Epidemiol 31:426-450\u003c/li\u003e\n\u003cli\u003eKatanoda K, Ajiki W, Matsuda T, et al (2012) Trend analysis of cancer incidence in Japan using data from selected population-based cancer registries. Cancer Sci 103:360-368\u003c/li\u003e\n\u003cli\u003eKatanoda K, Hori M, Matsuda T, et al (2015) An updated report on the trends in cancer incidence and mortality in Japan, 1958-2013. Jpn J Clin Oncol 45:390-401\u003c/li\u003e\n\u003cli\u003eIto Y, Miyashiro I, Ito H, et al (2014) Long-term survival and conditional survival of cancer patients in Japan using population-based cancer registry data. Cancer Sci 105:1480-1486\u003c/li\u003e\n\u003cli\u003eMatsuda T, Ajiki W, Marugame T, et al (2011) Population-based survival of cancer patients diagnosed between 1993 and 1999 in Japan: a chronological and international comparative study. Jpn J Clin Oncol 41:40-51\u003c/li\u003e\n\u003cli\u003eInternational Agency for Research on Cancer, World Health Organization. Global Cancer Observatory. https://gco.iarc.fr/ Accessed May 2023\u003c/li\u003e\n\u003cli\u003eKurman RJ, Ellenson LH, Ronnett BM (2019) Blaustein\u0026apos;s Pathology of the Female Genital Tract 7th edition, Springer, pp842-844\u003c/li\u003e\n\u003cli\u003eMcGuire V, Hartge P, Liao LM (2016) Parity and Oral Contraceptive Use in Relation to Ovarian Cancer Risk in Older Women. Cancer Epidemiol Biomarkers Prev 25:1059-1063\u003c/li\u003e\n\u003cli\u003eMatsumura N (2017) Diet and Physical Activity after Ovarian Cancer Diagnosis. Acta Medica Kindai Univ 42:37-42\u003c/li\u003e\n\u003cli\u003eGrosso G, Vignera SL, Condorelli RA, et al (2022) Total, red and processed meat consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr 73:726-737\u003c/li\u003e\n\u003cli\u003eChang K, Gunter MJ, Rauber F, et al (2023) Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. EClinicalMedicine 56:101840\u003c/li\u003e\n\u003cli\u003eBhaskaran K, Douglas I, Forbes H, et al (2014) Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5\u0026middot;24 million UK adults. Lancet 384:755-765.\u003c/li\u003e\n\u003cli\u003eRomanos-Nanclares A, Tabung FK, Sinnott JA, et al (2023) Inflammatory and insulinemic dietary patterns and risk of endometrial cancer among US women. J Natl Cancer Inst 115:311-321\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control (1987) 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 257:796-800\u003c/li\u003e\n\u003cli\u003eVoskuil DW, Monninkhof EM, Elias SG, et al (2007) Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 16:639-648\u003c/li\u003e\n\u003cli\u003eSasakawa Sports Foundation (2022) The 2022 SSF National Sports-Life Survey. https://www.ssf.or.jp/en/files/sld2022_e.pdf\u003c/li\u003e\n\u003cli\u003eSaitoh E, Saika K, Morisada T, et al (2022) Status of cervical cancer screening among adolescents and young adults (AYA) in Japan. Int J Clin Oncol 27:473-480\u003c/li\u003e\n\u003cli\u003eSakakibara A, Nakayama T, Uchida H, et al (2023) Trends and future projections of cervical cancer-related outcomes in Japan: What happens if the HPV vaccine program is not implemented? Int J Cancer 152:1863-1874\u003c/li\u003e\n\u003cli\u003eMatsumura N, Shiro R, Tsunoda I (2023) Critical evaluation on roles of macrophagic myofasciitis and aluminum adjuvants in HPV vaccine-induced adverse events. Cancer Sci 114:1218-1228\u003c/li\u003e\n\u003cli\u003eMatsumura N, Tsunoda I (2022) Scientific evaluation of alleged findings in HPV vaccines: Molecular mimicry and mouse models of vaccine-induced disease. Cancer Sci 113:3313-3320\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijco","sideBox":"Learn more about [International Journal of Clinical Oncology](http://link.springer.com/journal/10147)","snPcode":"10147","submissionUrl":"https://www.editorialmanager.com/ijco/default2.aspx","title":"International Journal of Clinical Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3023227/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3023227/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn Japan, high-quality cancer statistics data have been collected through cancer registries, but these data are rarely summarized and reported in research articles. Here, we compiled statistical data on malignant tumors originating from gynecologic organs (ovary, corpus uteri, cervix uteri) in Japan. The number of patients in 2019 was 13,380, 17880, and 10879, respectively, and the number of deaths in 2021 was 5081, 2741, and 2894, respectively. Compared with 40 years ago, the incidence of ovarian cancer has tripled, the incidence of uterine corpus cancer (mainly endometrial cancer) has increased 15-fold, the mortality rate of uterine corpus cancer has tripled, and the incidence of cervical intraepithelial cancer has increased 10-fold in data standardized by the world population. Compared with the United States, the incidence rate of ovarian cancer has overtaken and the mortality rate of uterine corpus cancer is the same, while both the incidence and mortality rates of cervical cancer are higher in Japan. Immediate action is needed in Japan to prevent gynecologic cancers.\u003c/p\u003e","manuscriptTitle":"Statistics on Gynecologic Cancer in Japan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-12 15:00:53","doi":"10.21203/rs.3.rs-3023227/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-06-10T03:03:13+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-06-09T06:26:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-06-07T01:33:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Oncology","date":"2023-06-05T04:00:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijco","sideBox":"Learn more about [International Journal of Clinical Oncology](http://link.springer.com/journal/10147)","snPcode":"10147","submissionUrl":"https://www.editorialmanager.com/ijco/default2.aspx","title":"International Journal of Clinical Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"07ceae7a-2d6a-44f0-ba0f-9dd51c11e05a","owner":[],"postedDate":"June 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-02-26T15:05:29+00:00","versionOfRecord":{"articleIdentity":"rs-3023227","link":"https://doi.org/10.1007/s10147-024-02473-8","journal":{"identity":"international-journal-of-clinical-oncology","isVorOnly":false,"title":"International Journal of Clinical Oncology"},"publishedOn":"2024-02-21 15:01:18","publishedOnDateReadable":"February 21st, 2024"},"versionCreatedAt":"2023-06-12 15:00:53","video":"","vorDoi":"10.1007/s10147-024-02473-8","vorDoiUrl":"https://doi.org/10.1007/s10147-024-02473-8","workflowStages":[]},"version":"v1","identity":"rs-3023227","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3023227","identity":"rs-3023227","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}