Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020

Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020 | 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 Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020 Xiting Han, Zhihong Wang, Dongmei Huang, Kehong Deng, Qian Wang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1900985/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Chinese women account for 17.51% of the world's deaths because of malignant tumors of the reproductive system, which is a serious threat to women's life and health. We analyzed the changes in mortality and disease burden of cervical cancer, uterine cancer and ovarian cancer in China from 2006 to 2020 to provide a basis for formulating scientific prevention and control measures. Methods Annual death data for cervical cancer, uterine cancer and ovarian cancer were collected from the Chinese Cause of Death Surveillance. The crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were applied to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were used to assess disease burden. Results From 2006 to 2020, a total ASMR and standardized YLL rates of malignant tumors of the reproductive system showed a relatively stable trend, leading to an average LLE of 0.18 years. The YLL rate was the highest in the 55–59 age group. The mortality rate and disease burden of the three types of cancer have changed from uterine cancer higher than cervical cancer and ovarian cancer in 2006 to cervical cancer higher than ovarian cancer and uterine cancer in 2020. The ASMR and standardized YLL rate of uterine cancer showed a downward trend, and AAPC was − 5.21% (-9.31%~-0.91%) and − 6.07% (-9.45%~-2.58%), respectively. The mortality rates of cervical cancer and ovarian cancer remain high. Conclusion The mortality and disease burden of malignant tumors of the female reproductive system in China are still at a high level. It is necessary to improve screening and prevention strategies as soon as possible, improve the techniques of diagnosis and treatment, and take adequate measures to protect women's life and health. Female reproductive system Malignant tumor Mortality Disease burden Figures Figure 1 Figure 2 Figure 3 Figure 4 Plain English summaries Malignant tumors of the female reproductive system are the leading causes of women's mortality worldwide, mainly including cervical cancer, uterine cancer and ovarian cancer. Numerous studies have reported mortality changes in the three primary reproductive system cancers among different countries, with inconsistent temporal trends. In 2020, almost 17.51% of malignant tumors of the female reproductive system deaths occurred in China because of the large population base and severe aging. However, there are limited studies on the disease burden of malignant tumors of the female reproductive system in China. This study analyzed the mortality, YLL and LLE of cervical cancer, uterine cancer and ovarian cancer using the National Death Cause Surveillance Dataset from 2006 to 2020. The findings revealed that mortality and disease burden of malignant tumors of the reproductive system showed a relatively stable change and tended to be younger. The mortality and disease burden of uterine cancer decreased significantly, but that of cervical cancer and ovarian cancer remain high. Cervical cancer has a higher mortality and disease burden than uterine cancer and ovarian cancer, making it the most severe malignant tumor of the female reproductive system. Screening and HPV vaccination will reduce the mortality and disease burden of cervical cancer in China, but this effect will take many years to manifest. Screening and prevention strategies for high-risk groups of uterine cancer and ovarian cancer should be established as soon as possible. In summary, the management and monitoring of malignant tumors of the female reproductive system should be strengthened. Introduction Cervical cancer, uterine cancer and ovarian cancer are the most common malignant tumors of the female reproductive system. According to GLOBOCAN 2020, the three types of cancer have caused about 342,000, 97,000 and 207,000 deaths worldwide, respectively, seriously threatening women's life and health [ 1 ]. Numerous studies have reported mortality changes in the three primary reproductive system cancers among different countries, with inconsistent temporal trends. Because of the large population base and severe aging, the number of deaths in China accounts for 17.51% of the world on malignant tumors of the female reproductive system [ 2 ]. Studies have shown that the mortality rate of cervical cancer and ovarian cancer in China has increased to varying degrees, becoming a stark public health issue [ 3 , 4 ]. In recent years, incidents of gynecological diseases in females tend to be younger, with the changes in living environment, behavior and reproductive characteristics [ 5 ]. In addition, the openness of sexual attitudes (such as premature sex life and multiple sexual partners) increased the risk of human papillomavirus (HPV) infection in the adolescent population, which is an important reason for the younger trend of cervical cancer [ 6 ]. The expansion of screening and the improvement of diagnostic capabilities provided a technical support for detecting more potential malignant tumors of the female reproductive system [ 7 ]. In the context of the prevalence of risk factors, the mortality and disease burden caused by malignant tumors of the female reproductive system needs to be further analyzed. Since 2004, the Chinese center for disease control and prevention has conducted all cause surveillance of death in 31 provinces (excluding Hong Kong, Macau, and Taiwan) every year, covering 6%-24% of the national population, which represents the Chinese population [ 8 ]. This study aims to evaluate trends of cervical cancer, uterine cancer, and ovarian cancer mortality and disease burden from 2006 to 2020 across age groups and periods. It will help optimize existing screening guidelines, achieve accurate early screening and warning of high-risk groups, and improve women's health. Materials And Methods Data sources The death data of malignant tumors of the female reproductive system in China were obtained from the "China death cause surveillance dataset" from 2006 to 2020. An additional file shows this in more detail (see Additional file 1). The content includes the number of women in each age group in the monitoring area and the number of deaths. These tumors were coded according to the International Classification of Diseases, Tenth Revision, mainly including cervical cancer, uterine cancer and ovarian cancer, and the codes were C53, C54 and C56, respectively. The female population data of China's sixth census in 2010 was selected as the standard population. Statistical techniques The Joinpoint 4.9.1.0 software was used to calculate crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) to evaluate the trend of mortality of the three types of malignancies. CMR was used to compare the mortality of different diseases in the surveillance population in the same year, and ASMR was used to compare the mortality of conditions in different years. APC was calculated based on log-linear regression. The model formula is: log(ASMRy)=α + βy (y is the year, α is a constant, and β is the regression coefficient), then APC=(eβ-1)×100% [ 9 ]. AAPC is the weighted average of the APCs of multiple trend stages according to the number of years. Up to 3 connection points could be set in the monitoring data of 15 years, and the optimal model was selected based on permutation test. Loss of life expectancy (LLE), years of life lost (YLL), and YLL rates were used as indicators of disease burden and calculated through the life table and disease burden table [ 10 ]. The LLE calculation formula is: \(\varDelta {\text{e}}_{0}={\text{e}{\prime }}_{0}-{\text{e}}_{0}\) ( \({\text{e}{\prime }}_{0}\) is the life expectancy at birth of a woman without the disease, and e 0 is the life expectancy at birth with the disease). YLL was obtained by multiplying the number of deaths by age group by the corresponding standard life expectancy. YLL rate is the ratio of YLL to the number of monitored populations. The inspection level was set to α = 0.05. Results Mortality of malignant tumors of the female reproductive system From 2006 to 2020, the overall CMR of malignant tumors of the female reproductive system in the national surveillance areas was between 7.0/10 5 and 10.77/10 5 , and the ASMR changes showed a relatively stable trend (Table 1 ). From 2006 to 2013, the CMR of uterine cancer was higher than that of cervical cancer and ovarian cancer. While from 2014 to 2020, the CMR of cervical cancer was higher than that of ovarian cancer and uterine cancer. The ASMR of cervical cancer showed an upward trend from 2012 to 2016 (APC = 16.28%) and a downward trend from 2016 to 2020 (APC=-6.46%). Still, the overall change trend during the monitoring period was not statistically significant ( P > 0.05) (Fig. 1 ). The ASMR of uterine cancer showed a downward trend from 2006 to 2020 (AAPC=-5.21%, 95% CI : -9.31%~-0.91%). The ASMR of ovarian cancer showed an upward trend from 2013 to 2017 (APC = 7.21%), but the overall change from 2006 to 2020 was not statistically significant. Table 1 Changes in mortality of malignant tumors of the female reproductive system in China (1/10 5 ) Year Cervical cancer Uterine cancer Ovarian cancer Total CMR ASMR CMR ASMR CMR ASMR CMR ASMR 2006 2.37 2.72 3.21 3.68 1.42 1.64 7.00 8.04 2007 2.94 3.29 3.56 4.02 1.65 1.86 8.14 9.17 2008 2.66 2.86 3.83 4.16 1.72 1.87 8.21 8.88 2009 2.90 3.02 3.73 3.86 1.86 1.95 8.49 8.84 2010 2.89 2.95 3.84 3.95 1.91 1.94 8.64 8.83 2011 2.85 2.75 3.58 3.47 1.78 1.69 8.21 7.91 2012 2.95 2.78 3.56 3.34 1.92 1.80 8.43 7.92 2013 3.27 2.95 3.61 3.23 1.87 1.67 8.76 7.85 2014 4.91 4.37 2.28 2.01 1.98 1.76 9.17 8.13 2015 5.30 4.72 2.01 1.78 2.08 1.85 9.40 8.35 2016 5.65 4.91 1.83 1.56 2.41 2.08 9.89 8.55 2017 5.68 4.91 1.88 1.61 2.53 2.16 10.09 8.69 2018 5.58 4.75 2.14 1.78 2.58 2.17 10.30 8.69 2019 5.39 4.33 2.52 1.97 2.86 2.25 10.77 8.55 2020 5.14 3.96 2.33 1.74 2.87 2.17 10.35 7.87 AAPC 4.86 2.16 -2.21 -5.21 5.03 1.87 2.54 -0.37 95% CI 1.33,8.51 -1.67,6.13 -6.23,1.98 -9.31,-0.91 0.99,9.22 -1.7,5.57 2.07,3.00 -3.07,2.4 t 2.72 1.10 -1.05 -2.36 2.45 1.02 11.92 -0.27 P 0.007 0.273 0.296 0.018 0.014 0.309 < 0.001 0.789 AAPC: Average annual percentage change; ASMR: Age-standardized mortality rate; CMR: Crude mortality rate. Age-specific mortality of malignant tumors of the female reproductive system In terms of age, the mortality rate of Chinese women from malignant tumors of the reproductive system is low before 30 years old (Fig. 2 ). However, it increases rapidly with age after 30 years old, especially over 65. In 2020, the mortality of uterine cancer in women decreased in the age group over 30 years old, while the mortality of cervical cancer and ovarian cancer increased in the age group over 45. Disease burden of malignant tumors of the female reproductive system During the study period, the overall YLL rate of malignant tumors of the female reproductive system in China ranged from 90.87/10 5 to 123.39/10 5 , and there was no statistically significant change in the standardized YLL rate (AAPC=--1.09%, 95% CI : -2.48%~0.32%) (Table 2 ). The standardized YLL rate of uterine cancer showed a downward trend (AAPC=-6.07%, 95% CI : -9.45%~-2.58%), while the standardized YLL rate for cervical cancer and ovarian cancer did not change significantly. In 2006, the YLL rate of uterine cancer was higher than that of cervical and ovarian cancer, and the YLL rate of cervical cancer was higher than that of ovarian and uterine cancer in 2020. Table 2 YLL rate of malignant tumors of the female reproductive system in China (1/10 5 ) Year Cervical cancer Uterine cancer Ovarian cancer Total YLL rate standardized YLL rate YLL rate standardized YLL rate YLL rate standardized YLL rate YLL rate standardized YLL rate 2006 32.13 36.19 40.43 45.55 18.31 20.95 90.87 102.69 2007 39.46 43.88 46.16 51.65 20.31 22.80 105.93 118.33 2008 33.84 36.04 47.00 50.58 21.97 23.59 102.81 110.21 2009 37.55 38.12 47.61 48.02 22.32 22.76 107.48 108.90 2010 37.88 37.58 46.31 45.95 23.20 22.92 107.39 106.45 2011 38.98 37.63 44.01 42.19 21.88 20.88 104.87 100.70 2012 40.30 38.47 42.90 40.72 23.44 22.31 106.64 101.49 2013 42.82 39.32 43.66 39.70 22.33 20.19 108.81 99.21 2014 62.89 57.51 26.27 23.67 24.8 22.64 113.96 103.82 2015 66.06 60.45 23.39 21.31 24.42 22.32 113.87 104.08 2016 70.90 65.02 20.53 18.44 28.8 26.15 120.23 109.62 2017 69.94 63.60 21.75 19.57 29.63 26.61 121.32 109.78 2018 67.59 61.75 23.13 20.65 29.86 26.91 120.58 109.31 2019 64.08 54.76 26.71 22.04 32.60 27.27 123.39 104.06 2020 60.02 50.04 24.38 19.48 32.58 26.50 116.98 96.02 AAPC 4.20 1.99 -3.60 -6.07 4.20 1.03 1.51 -1.09 95% CI 0.27,8.29 -2.02,6.16 -7.67,-0.66 -9.45,-2.58 3.36,5.05 -1.05,3.15 1.01,2.01 -2.48,0.32 t 2.10 0.96 -1.66 -3.36 10.97 0.96 6.59 -1.52 P 0.036 0.335 0.097 < 0.001 < 0.001 0.335 < 0.001 0.128 AAPC: Average annual percentage change; YLL: Years of life lost. Age-specific disease burden of malignant tumors of the female reproductive system The overall YLL rate of malignant tumors of the female reproductive system in China increased rapidly at 30–54, reached the highest at 55–59, and then decreased (Fig. 3 ). In 2020, the YLL rate of uterine cancer in women of all age groups had decreased significantly compared with that in 2006, while the YLL rates of cervical cancer and ovarian cancer have increased significantly at 45–79. From 2006 to 2020, the average LLE at birth because of cervical cancer, uterine cancer, ovarian cancer, and total deaths among Chinese women was 0.08, 0.06, 0.04, and 0.18 years, respectively (Fig. 4 ). Discussion In 2020, about 247,000 women in China suffered from malignant tumors of the reproductive system, and 113,186 died, posing a severe threat to women's life and health [ 2 ]. This study analyzed the mortality, YLL and LLE of cervical cancer, uterine cancer and ovarian cancer using the National Death Cause Surveillance Dataset from 2006 to 2020. The total CMR of malignant tumors of the reproductive system was between 7.0/10 5 and 10.77/10 5 , and the YLL rate was between 90.87/10 5 and 123.39/10 5 , with no statistically significant trends. The means of LLE at birth was 0.18 years. Cervical cancer had the highest mortality and disease burden among malignant tumors of the female reproductive system in 2020, instead of uterine cancer in 2006. The different trends of mortality and disease burden among the three types of cancer may be the combined effects of screening, improved diagnosis and treatment techniques, increased exposure to risk factors, and changes in reproductive characteristics [ 11 ]. Cervical cancer About 59,000 women died of cervical cancer in China in 2020, accounting for 17.28% of the global total. This study found that cervical cancer ASMR showed an upward trend from 2013 to 2017 and a downward trend from 2017 to 2020, consistent with the observed trends worldwide [7]. The YLL rate of cervical cancer increased significantly in women aged 45-79, suggesting that middle-aged and older adults are the key population in reducing the disease burden. Cervical cancer is a preventable tumor, and studies have determined the effectiveness of the HPV vaccine and the importance of early vaccination [12]. The United States has adopted effective screening, prevention and control, and the incidence and mortality of cervical cancer in women have decreased significantly [13]. The World Health Organization (WHO) launched the "Global strategy to accelerate the elimination of cervical cancer" in November 2020 [14]. Vaccination, screening and treatment are the key measures. The first Chinese domestic HPV vaccine "Cecolin" was pre-qualified by WHO in 2021. Increasing production, reducing prices, and promoting the inclusion of vaccines in national immunization programs are effective ways to promote HPV vaccination [15]. Since 2019, China has included cervical cancer screening in essential public health services to improve coverage. Liquid-based thin-layer cytology and HPV testing are the primary measures for cervical cancer screening, which are highly accurate. According to the "China national program for women's development (2021-2030)" formulated by the Chinese government, more than 70% of women will complete cervical cancer screening by 2030, providing policy support for the international strategic goal of "90-70-90" [16]. Uterine cancer The overall incidence of uterine cancer is on the rise worldwide, especially in developed countries [17]. This study shows that before 2013, uterine cancer was also the leading cause of death in malignant tumors of the female reproductive system in China. Mortality and disease burden of uterine cancer decreased significantly in women of all age groups between 2006 and 2020. Advances in surgery, radiotherapy and chemotherapy have improved the prognosis of patients with uterine cancer, with a higher survival rate than other gynecological cancers [18]. Uterine cancer mainly occurs in postmenopausal women, and long menstrual periods and low parity increase the risk, which is related to changes in estrogen and progesterone [19]. The presence of obesity and diabetes, which increases circulating levels of estrogen, are two important risk factors for uterine cancer [20]. Endometrial cancer is the primary pathological type of uterine cancer and is the most common gynecological malignancy in high-income countries, while uterine sarcoma is rare [21]. Currently, there is no effective population screening method for uterine cancer. The first symptom is uterine bleeding, which could be combined with aging and genetic susceptibility as the basis for screening key populations [22]. Health management and monitoring of high-risk groups of uterine cancer should be implemented to ensure timely diagnosis and treatment. Ovarian cancer Ovarian cancer has the highest case fatality rate among gynecological malignancies, with an estimated 55,000 new cases and 38,000 deaths in China in 2020 [2]. Although the ASMR of ovarian cancer in Chinese women increased from 2013 to 2017, there was no obvious change during the study period. The prevalence of risk factors, such as obesity, smoking, and menopausal hormone therapy, has increased the prevalence of ovarian cancer. In contrast, childbirth and breastfeeding are highly protective against the development of ovarian cancer [23]. Oral contraceptives have the effect of inhibiting ovulation, controlling luteinizing hormone, and reducing follicle-stimulating hormone. In the early 1960s, oral contraceptives became widely available in Europe, and the incidence of ovarian cancer in women decreased significantly [24]. Ovarian cancer mainly occurs in women after age 35, with the highest prevalence at 55-59, and the incidence tends to be younger. The effect of ovarian cancer treatment and prognosis is still poor, and the mortality and YLL rate in women over 45 increased from 2006 to 2020. Therefore, an accurate screening model of ovarian cancer risk groups should be established as soon as possible and carry a tertiary prevention strategy. Kobayashi Y et al. evaluated various prognostic models of ovarian cancer based on clinical indicators and molecular markers to provide a scientific basis for guiding patients' treatment decisions, which need to be validated in the Chinese female population [25]. However, some limitations in this study should be considered. We have not analyze the disease burden of vulvar cancer and uterine sarcoma due to unavailable data in the National Death Surveillance Database. Due to the lack of morbidity information, Disability Adjusted Life Year (DALY) and Years Lived with Disability (YLD) as the other two indicators of disease burden were not calculated because the surveillance content was mainly death data. Additionally, the latest available surveillance data is currently 2020. Conclusions From 2006 to 2020, the mortality rate and disease burden of uterine cancer in Chinese females decreased, and that of cervical cancer and ovarian cancer was still high. Aging, obesity, diabetes, hormone replacement therapy, and an unhealthy lifestyle are risk factors for the three types of cancer. Malignant tumors of the female reproductive system are closely related to the national fertility rate and are the fundamental guarantee for the normal development of the population. Medical resources should be distributed fairly, and it should improve tertiary prevention to protect women's health. Abbreviations ASMR: Age-standardized mortality rate; APC: Annual percentage change; AAPC: Average annual percentage change; CMR: Crude mortality rate; CI : Confidence interval; DALY: Disability adjusted life year; HPV: Human papillomavirus; ICD: International Classification of Diseases; LLE: Loss of life expectancy; WHO: World Health Organization; YLD: Years lived with disability; YLL: Years of life lost. Declarations Ethics approval and consent to participate This study is a secondary analysis of data available in the public domain and do not require an ethical clearance. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are available in the China Death Surveillance Database (https://ncncd.chinacdc.cn/xzzq_1). Competing interests We have no conflicts of interest to declare. Funding Funding for this research was provided by the medical science and technology research project of Henan province (LHGJ20210374). Authors' contributions JCZ originated and designed the study. XTH contributed to the analysis of the data and coordinated the writing of the article. ZHW, DMH, KHD, QW and CCL provided technical guidance, contributed to the interpretation of findings and revision of the manuscript. All the authors read and approved the final manuscript. Acknowledgements The authors acknowledge the Chinese center for disease control and prevention for the access granted to use these datasets. References Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F: Cancer statistics for the year 2020: An overview. Int J Cancer 2021. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F: Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021, 71(3):209–249. He R, Zhu B, Liu J, Zhang N, Zhang WH, Mao Y: Women's cancers in China: a spatio-temporal epidemiology analysis. BMC Womens Health 2021, 21(1):116. Jiang X, Tang H, Chen T: Epidemiology of gynecologic cancers in China. J Gynecol Oncol 2018, 29(1):e7. Wei M, Zhou W, Bi Y, Wang H, Liu Y, Zhang ZJ: Rising mortality rate of cervical cancer in younger women in urban China. J Gen Intern Med 2019, 34(2):281–284. Zhao F, Qiao Y: Cervical cancer prevention in China: a key to cancer control. Lancet 2019, 393(10175):969–970. Lin S, Gao K, Gu S, You L, Qian S, Tang M, Wang J, Chen K, Jin M: Worldwide trends in cervical cancer incidence and mortality, with predictions for the next 15 years. Cancer 2021, 127(21):4030–4039. Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, Yin P, Liu Y, Li Y, Liu J, et al: An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 2016, 94(1):46–57. Kim HJ, Luo J, Kim J, Chen HS, Feuer EJ: Clustering of trend data using joinpoint regression models. Stat Med 2014, 33(23):4087–4103. Wang Y, Chiang CJ, Lee WC: Age-standardized expected years of life lost: quantification of cancer severity. BMC Public Health 2019, 19(1):486. Wang Z, Guo E, Yang B, Xiao R, Lu F, You L, Chen G: Trends and age-period-cohort effects on mortality of the three major gynecologic cancers in China from 1990 to 2019: Cervical, ovarian and uterine cancer. Gynecol Oncol 2021, 163(2):358–363. Kjaer SK, Dehlendorff C, Belmonte F, Baandrup L: Real-world effectiveness of human papillomavirus vaccination against cervical cancer. J Natl Cancer Inst 2021, 113(10):1329–1335. Mix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC: Assessing impact of HPV vaccination on cervical cancer incidence among women aged 15–29 years in the United States, 1999–2017: an ecologic study. Cancer Epidemiol Biomarkers Prev 2021, 30(1):30–37. Simms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, Castle PE, Bray F, Canfell K: Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncol 2019, 20(3):394–407. Xia C, Xu X, Zhao X, Hu S, Qiao Y, Zhang Y, Hutubessy R, Basu P, Broutet N, Jit M, Zhao F: Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study. BMC Med 2021, 19(1):62. Ochalek J, Abbas K, Claxton K, Jit M, Lomas J: Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries. BMJ Glob Health 2020, 5(10):e003006. Henley SJ, Miller JW, Dowling NF, Benard VB, Richardson LC: Uterine cancer incidence and mortality - United States, 1999–2016. MMWR Morb Mortal Wkly Rep 2018, 67(48):1333–1338. Xi Y, Wang W, Chen W, Han K, Qiao L, Chen W: Incidence and mortality of corpus uteri cancer in China, 2008–2012. Chin J Cancer Res 2019, 31(3):435–442. Gao Y, Zhao M, Dai X, Tong M, Wei J, Chen Q: The prevalence of endometrial cancer in pre- and postmenopausal Chinese women. Menopause 2016, 23(8):884–887. Van Arsdale A, Miller DT, Kuo DY, Isani S, Sanchez L, Nevadunsky NS: Association of obesity with survival in patients with endometrial cancer. Gynecol Oncol 2019, 154(1):156–162. Koskas M, Amant F, Mirza MR, Creutzberg CL: Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet 2021, 155 Suppl 1:45–60. Gentry-Maharaj A, Karpinskyj C: Current and future approaches to screening for endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2020, 65:79–97. Menon U, Karpinskyj C, Gentry-Maharaj A: Ovarian cancer prevention and screening. Obstet Gynecol 2018, 131(5):909–927. Li K, Hüsing A, Fortner RT, Tjønneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, et al: An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015, 112(7):1257–1265. Kobayashi Y, Banno K, Aoki D: Current status and future directions of ovarian cancer prognostic models. J Gynecol Oncol 2021, 32(2):e34. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.xlsx The data that support the findings of this study. Cancer: three types of malignant tumors of the female reproductive system, Year: monitoring year of 2006-2020, Age group: 19 age groups were divided, Count: the number of deaths, Population: the number of people monitored, Standard population: the age distribution of females in the sixth census of China in 2010. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 27 Oct, 2022 Reviews received at journal 08 Sep, 2022 Reviewers agreed at journal 25 Aug, 2022 Reviewers invited by journal 20 Aug, 2022 Editor assigned by journal 20 Aug, 2022 Editor invited by journal 29 Jul, 2022 Submission checks completed at journal 29 Jul, 2022 First submitted to journal 27 Jul, 2022 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-1900985","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":124959886,"identity":"8bf31a9e-e80f-424c-a0f2-8c45db8be6f0","order_by":0,"name":"Xiting Han","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiting","middleName":"","lastName":"Han","suffix":""},{"id":124959889,"identity":"4ba3ff1d-312b-4024-9e2a-e8bc3af63c83","order_by":1,"name":"Zhihong Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhihong","middleName":"","lastName":"Wang","suffix":""},{"id":124959892,"identity":"0fe7ea25-4064-492a-9183-fbe15ea7a763","order_by":2,"name":"Dongmei Huang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dongmei","middleName":"","lastName":"Huang","suffix":""},{"id":124959893,"identity":"daab68a4-e5e2-4deb-9fbb-bf5868b8a3bf","order_by":3,"name":"Kehong Deng","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kehong","middleName":"","lastName":"Deng","suffix":""},{"id":124959894,"identity":"d596661e-9bdd-4e16-86cf-445ce6e2f168","order_by":4,"name":"Qian Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Wang","suffix":""},{"id":124959896,"identity":"c5cac3f2-c540-41c4-8a2f-ad303df75bce","order_by":5,"name":"Cancan Li","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cancan","middleName":"","lastName":"Li","suffix":""},{"id":124959899,"identity":"ea9d22a3-7406-4aa6-b3c8-03ed8588c714","order_by":6,"name":"Jicun Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACxmYwdYCBjZmx4cAHAxs74rXwsTMfPDijIC2ZWMsOMMjxsyUf5vlwiLGBkFrmduZn0gV/7iS2MfMYHLYxOMDMwH746Ab8DmMzk57B8wyiJcfgDh8DT1raDfxaeNikeSQOw7Q8Y2aQ4DEjQosBVIuFwWHGBuK0JIC0sCUcZiBOC5uxNc+Bw8ZtzMwHDvYYpCWzEfKLYf/hh7d5/hyWnd9/sPnDjz82dvzsh4/h19KALsKGTzkIyBNSMApGwSgYBaOAAQAMYkdvmHR/CAAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jicun","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2022-07-27 09:44:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1900985/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1900985/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24747233,"identity":"e64fd7cb-13f7-4944-802d-e8660451cbd3","added_by":"auto","created_at":"2022-08-03 20:06:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111439,"visible":true,"origin":"","legend":"\u003cp\u003eTrend of mortality of malignant tumors of the female reproductive system in China, 2006-2020\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/0e9a677aaf5c720db2cbfc8a.jpg"},{"id":24747234,"identity":"490633da-006d-475e-b6b8-4654db1e1b49","added_by":"auto","created_at":"2022-08-03 20:06:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":11879279,"visible":true,"origin":"","legend":"\u003cp\u003eThe mortality changes of malignant tumors of the female reproductive system by age. a: Cervical cancer, b: Uterine cancer, c: Ovarian cancer, d: Total\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/5876b554f3d7e5cf3d730a08.jpg"},{"id":24747236,"identity":"f91f3965-cbbb-40a2-a02e-fd8c4180403f","added_by":"auto","created_at":"2022-08-03 20:06:14","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":12666360,"visible":true,"origin":"","legend":"\u003cp\u003eYears of life lost rate changes of malignant tumors of the female reproductive system by age. a: Cervical cancer, b: Uterine cancer, c: Ovarian cancer, d: Total\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/3723d7f8e27d3552b3143776.jpg"},{"id":24747232,"identity":"21d3bcd0-94dd-4fc8-b8b0-dd9a92fc3de9","added_by":"auto","created_at":"2022-08-03 20:06:13","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1456264,"visible":true,"origin":"","legend":"\u003cp\u003eLoss of life expectancy among Chinese women due to malignant tumors of the female reproductive system\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/805f175dd4b1c198a6ff2f10.jpg"},{"id":24747237,"identity":"510451f5-15e9-41c4-ac7b-e059a3037745","added_by":"auto","created_at":"2022-08-03 20:06:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":451646,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/76435c31-0ea1-4aba-b60f-b0a43269ad89.pdf"},{"id":24747235,"identity":"c93a1627-7415-417d-9e00-0ff658034382","added_by":"auto","created_at":"2022-08-03 20:06:13","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41573,"visible":true,"origin":"","legend":"\u003cp\u003eThe data that support the findings of this study. Cancer: three types of malignant tumors of the female reproductive system, Year: monitoring year of 2006-2020, Age group: 19 age groups were divided, Count: the number of deaths, Population: the number of people monitored, Standard population: the age distribution of females in the sixth census of China in 2010.\u003c/p\u003e","description":"","filename":"Additionalfile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1900985/v1/bb0055cf7c9b9158eb6b04d2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020","fulltext":[{"header":"Plain English summaries","content":"\u003cp\u003eMalignant tumors of the female reproductive system are the leading causes of women\u0026apos;s mortality worldwide, mainly including cervical cancer, uterine cancer and ovarian cancer. Numerous studies have reported mortality changes in the three primary reproductive system cancers among different countries, with inconsistent temporal trends. In 2020, almost 17.51% of malignant tumors of the female reproductive system deaths occurred in China because of the large population base and severe aging. However, there are limited studies on the disease burden of malignant tumors of the female reproductive system in China.\u003c/p\u003e\n\u003cp\u003eThis study analyzed the mortality, YLL and LLE of cervical cancer, uterine cancer and ovarian cancer using the National Death Cause Surveillance Dataset from 2006 to 2020. The findings revealed that mortality and disease burden of malignant tumors of the reproductive system showed a relatively stable change and tended to be younger. The mortality and disease burden of uterine cancer decreased significantly, but that of cervical cancer and ovarian cancer remain high. Cervical cancer has a higher mortality and disease burden than uterine cancer and ovarian cancer, making it the most severe malignant tumor of the female reproductive system.\u003c/p\u003e\n\u003cp\u003eScreening and HPV vaccination will reduce the mortality and disease burden of cervical cancer in China, but this effect will take many years to manifest. Screening and prevention strategies for high-risk groups of uterine cancer and ovarian cancer should be established as soon as possible. In summary, the management and monitoring of malignant tumors of the female reproductive system should be strengthened.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eCervical cancer, uterine cancer and ovarian cancer are the most common malignant tumors of the female reproductive system. According to GLOBOCAN 2020, the three types of cancer have caused about 342,000, 97,000 and 207,000 deaths worldwide, respectively, seriously threatening women's life and health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Numerous studies have reported mortality changes in the three primary reproductive system cancers among different countries, with inconsistent temporal trends. Because of the large population base and severe aging, the number of deaths in China accounts for 17.51% of the world on malignant tumors of the female reproductive system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have shown that the mortality rate of cervical cancer and ovarian cancer in China has increased to varying degrees, becoming a stark public health issue [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recent years, incidents of gynecological diseases in females tend to be younger, with the changes in living environment, behavior and reproductive characteristics [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition, the openness of sexual attitudes (such as premature sex life and multiple sexual partners) increased the risk of human papillomavirus (HPV) infection in the adolescent population, which is an important reason for the younger trend of cervical cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The expansion of screening and the improvement of diagnostic capabilities provided a technical support for detecting more potential malignant tumors of the female reproductive system [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In the context of the prevalence of risk factors, the mortality and disease burden caused by malignant tumors of the female reproductive system needs to be further analyzed.\u003c/p\u003e \u003cp\u003eSince 2004, the Chinese center for disease control and prevention has conducted all cause surveillance of death in 31 provinces (excluding Hong Kong, Macau, and Taiwan) every year, covering 6%-24% of the national population, which represents the Chinese population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study aims to evaluate trends of cervical cancer, uterine cancer, and ovarian cancer mortality and disease burden from 2006 to 2020 across age groups and periods. It will help optimize existing screening guidelines, achieve accurate early screening and warning of high-risk groups, and improve women's health.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003cp\u003e\u003cstrong\u003eData sources\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe death data of malignant tumors of the female reproductive system in China were obtained from the \u0026quot;China death cause surveillance dataset\u0026quot; from 2006 to 2020. An additional file shows this in more detail (see Additional file 1). The content includes the number of women in each age group in the monitoring area and the number of deaths. These tumors were coded according to the International Classification of Diseases, Tenth Revision, mainly including cervical cancer, uterine cancer and ovarian cancer, and the codes were C53, C54 and C56, respectively. The female population data of China\u0026apos;s sixth census in 2010 was selected as the standard population.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Joinpoint 4.9.1.0 software was used to calculate crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) to evaluate the trend of mortality of the three types of malignancies. CMR was used to compare the mortality of different diseases in the surveillance population in the same year, and ASMR was used to compare the mortality of conditions in different years. APC was calculated based on log-linear regression. The model formula is: log(ASMRy)=\u0026alpha;\u0026thinsp;+\u0026thinsp;\u0026beta;y (y is the year, \u0026alpha; is a constant, and \u0026beta; is the regression coefficient), then APC=(e\u0026beta;-1)\u0026times;100% [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. AAPC is the weighted average of the APCs of multiple trend stages according to the number of years. Up to 3 connection points could be set in the monitoring data of 15 years, and the optimal model was selected based on permutation test.\u003c/p\u003e\n\u003cp\u003eLoss of life expectancy (LLE), years of life lost (YLL), and YLL rates were used as indicators of disease burden and calculated through the life table and disease burden table [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. The LLE calculation formula is: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\varDelta {\\text{e}}_{0}={\\text{e}{\\prime }}_{0}-{\\text{e}}_{0}\\)\u003c/span\u003e\u003c/span\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\text{e}{\\prime }}_{0}\\)\u003c/span\u003e\u003c/span\u003e is the life expectancy at birth of a woman without the disease, and e\u003csup\u003e0\u003c/sup\u003e is the life expectancy at birth with the disease). YLL was obtained by multiplying the number of deaths by age group by the corresponding standard life expectancy. YLL rate is the ratio of YLL to the number of monitored populations. The inspection level was set to \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec6\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality of malignant tumors of the female reproductive system\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFrom 2006 to 2020, the overall CMR of malignant tumors of the female reproductive system in the national surveillance areas was between 7.0/10\u003csup\u003e5\u003c/sup\u003e and 10.77/10\u003csup\u003e5\u003c/sup\u003e, and the ASMR changes showed a relatively stable trend (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). From 2006 to 2013, the CMR of uterine cancer was higher than that of cervical cancer and ovarian cancer. While from 2014 to 2020, the CMR of cervical cancer was higher than that of ovarian cancer and uterine cancer. The ASMR of cervical cancer showed an upward trend from 2012 to 2016 (APC\u0026thinsp;=\u0026thinsp;16.28%) and a downward trend from 2016 to 2020 (APC=-6.46%). Still, the overall change trend during the monitoring period was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The ASMR of uterine cancer showed a downward trend from 2006 to 2020 (AAPC=-5.21%, 95%\u003cem\u003eCI\u003c/em\u003e: -9.31%~-0.91%). The ASMR of ovarian cancer showed an upward trend from 2013 to 2017 (APC\u0026thinsp;=\u0026thinsp;7.21%), but the overall change from 2006 to 2020 was not statistically significant.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChanges in mortality of malignant tumors of the female reproductive system in China (1/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCervical cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUterine cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eOvarian cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eASMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eASMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eASMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eASMR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAAPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.33,8.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.67,6.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.23,1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-9.31,-0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99,9.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.7,5.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.07,3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.07,2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eAAPC: Average annual percentage change; ASMR: Age-standardized mortality rate; CMR: Crude mortality rate.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge-specific mortality of malignant tumors of the female reproductive system\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIn terms of age, the mortality rate of Chinese women from malignant tumors of the reproductive system is low before 30 years old (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). However, it increases rapidly with age after 30 years old, especially over 65. In 2020, the mortality of uterine cancer in women decreased in the age group over 30 years old, while the mortality of cervical cancer and ovarian cancer increased in the age group over 45.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisease burden of malignant tumors of the female reproductive system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, the overall YLL rate of malignant tumors of the female reproductive system in China ranged from 90.87/10\u003csup\u003e5\u003c/sup\u003e to 123.39/10\u003csup\u003e5\u003c/sup\u003e, and there was no statistically significant change in the standardized YLL rate (AAPC=--1.09%, 95%\u003cem\u003eCI\u003c/em\u003e: -2.48%~0.32%) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The standardized YLL rate of uterine cancer showed a downward trend (AAPC=-6.07%, 95%\u003cem\u003eCI\u003c/em\u003e: -9.45%~-2.58%), while the standardized YLL rate for cervical cancer and ovarian cancer did not change significantly. In 2006, the YLL rate of uterine cancer was higher than that of cervical and ovarian cancer, and the YLL rate of cervical cancer was higher than that of ovarian and uterine cancer in 2020.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eYLL rate of malignant tumors of the female reproductive system in China (1/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCervical cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUterine cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eOvarian cancer\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estandardized YLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estandardized YLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estandardized YLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003estandardized YLL rate\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e108.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e108.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e116.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAAPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27,8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.02,6.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-7.67,-0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-9.45,-2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.36,5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.05,3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.01,2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.48,0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eAAPC: Average annual percentage change; YLL: Years of life lost.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge-specific disease burden of malignant tumors of the female reproductive system\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe overall YLL rate of malignant tumors of the female reproductive system in China increased rapidly at 30\u0026ndash;54, reached the highest at 55\u0026ndash;59, and then decreased (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). In 2020, the YLL rate of uterine cancer in women of all age groups had decreased significantly compared with that in 2006, while the YLL rates of cervical cancer and ovarian cancer have increased significantly at 45\u0026ndash;79. From 2006 to 2020, the average LLE at birth because of cervical cancer, uterine cancer, ovarian cancer, and total deaths among Chinese women was 0.08, 0.06, 0.04, and 0.18 years, respectively (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn 2020, about 247,000 women in China suffered from malignant tumors of the reproductive system, and 113,186 died, posing a severe threat to women's life and health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This study analyzed the mortality, YLL and LLE of cervical cancer, uterine cancer and ovarian cancer using the National Death Cause Surveillance Dataset from 2006 to 2020. The total CMR of malignant tumors of the reproductive system was between 7.0/10\u003csup\u003e5\u003c/sup\u003e and 10.77/10\u003csup\u003e5\u003c/sup\u003e, and the YLL rate was between 90.87/10\u003csup\u003e5\u003c/sup\u003e and 123.39/10\u003csup\u003e5\u003c/sup\u003e, with no statistically significant trends. The means of LLE at birth was 0.18 years. Cervical cancer had the highest mortality and disease burden among malignant tumors of the female reproductive system in 2020, instead of uterine cancer in 2006. The different trends of mortality and disease burden among the three types of cancer may be the combined effects of screening, improved diagnosis and treatment techniques, increased exposure to risk factors, and changes in reproductive characteristics [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCervical cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbout 59,000 women died of cervical cancer in China in 2020, accounting for 17.28% of the global total. This study found that cervical cancer ASMR showed an upward trend from 2013 to 2017 and a downward trend from 2017 to 2020, consistent with the observed trends worldwide [7]. The YLL rate of cervical cancer increased significantly in women aged 45-79, suggesting that middle-aged and older adults are the key population in reducing the disease burden. Cervical cancer is a preventable tumor, and studies have determined the effectiveness of the HPV vaccine and the importance of early vaccination [12]. The United States has adopted effective screening, prevention and control, and the incidence and mortality of cervical cancer in women have decreased significantly [13]. The World Health Organization (WHO) launched the \u0026quot;Global strategy to accelerate the elimination of cervical cancer\u0026quot; in November 2020 [14]. Vaccination, screening and treatment are the key measures. The first Chinese domestic HPV vaccine \u0026quot;Cecolin\u0026quot; was pre-qualified by WHO in 2021. Increasing production, reducing prices, and promoting the inclusion of vaccines in national immunization programs are effective ways to promote HPV vaccination [15]. Since 2019, China has included cervical cancer screening in essential public health services to improve coverage. Liquid-based thin-layer cytology and HPV testing are the primary measures for cervical cancer screening, which are highly accurate. According to the \u0026quot;China national program for women\u0026apos;s development (2021-2030)\u0026quot; formulated by the Chinese government, more than 70% of women will complete cervical cancer screening by 2030, providing policy support for the international strategic goal of \u0026quot;90-70-90\u0026quot; [16].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUterine cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall incidence of uterine cancer is on the rise worldwide, especially in developed countries [17]. This study shows that before 2013, uterine cancer was also the leading cause of death in malignant tumors of the female reproductive system in China. Mortality and disease burden of uterine cancer decreased significantly in women of all age groups between 2006 and 2020. Advances in surgery, radiotherapy and chemotherapy have improved the prognosis of patients with uterine cancer, with a higher survival rate than other gynecological cancers [18]. Uterine cancer mainly occurs in postmenopausal women, and long menstrual periods and low parity increase the risk, which is related to changes in estrogen and progesterone [19]. The presence of obesity and diabetes, which increases circulating levels of estrogen, are two important risk factors for uterine cancer [20]. Endometrial cancer is the primary pathological type of uterine cancer and is the most common gynecological malignancy in high-income countries, while uterine sarcoma is rare [21]. Currently, there is no effective population screening method for uterine cancer. The first symptom is uterine bleeding, which could be combined with aging and genetic susceptibility as the basis for screening key populations [22]. Health management and monitoring of high-risk groups of uterine cancer should be implemented to ensure timely diagnosis and treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOvarian cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOvarian cancer has the highest case fatality rate among gynecological malignancies, with an estimated 55,000 new cases and 38,000 deaths in China in 2020 [2]. Although the ASMR of ovarian cancer in Chinese women increased from 2013 to 2017, there was no obvious change during the study period. The prevalence of risk factors, such as obesity, smoking, and menopausal hormone therapy, has increased the prevalence of ovarian cancer. In contrast, childbirth and breastfeeding are highly protective against the development of ovarian cancer [23]. Oral contraceptives have the effect of inhibiting ovulation, controlling luteinizing hormone, and reducing follicle-stimulating hormone. In the early 1960s, oral contraceptives became widely available in Europe, and the incidence of ovarian cancer in women decreased significantly [24]. Ovarian cancer mainly occurs in women after age 35, with the highest prevalence at 55-59, and the incidence tends to be younger. The effect of ovarian cancer treatment and prognosis is still poor, and the mortality and YLL rate in women over 45 increased from 2006 to 2020. Therefore, an accurate screening model of ovarian cancer risk groups should be established as soon as possible and carry a tertiary prevention strategy. Kobayashi Y et al. evaluated various prognostic models of ovarian cancer based on clinical indicators and molecular markers to provide a scientific basis for guiding patients\u0026apos; treatment decisions, which need to be validated in the Chinese female population [25].\u003c/p\u003e\n\u003cp\u003eHowever, some limitations in this study should be considered. We have not analyze the disease burden of vulvar cancer and uterine sarcoma due to unavailable data in the National Death Surveillance Database. Due to the lack of morbidity information, Disability Adjusted Life Year (DALY) and Years Lived with Disability (YLD) as the other two indicators of disease burden were not calculated because the surveillance content was mainly death data. Additionally, the latest available surveillance data is currently 2020.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFrom 2006 to 2020, the mortality rate and disease burden of uterine cancer in Chinese females decreased, and that of cervical cancer and ovarian cancer was still high. Aging, obesity, diabetes, hormone replacement therapy, and an unhealthy lifestyle are risk factors for the three types of cancer. Malignant tumors of the female reproductive system are closely related to the national fertility rate and are the fundamental guarantee for the normal development of the population. Medical resources should be distributed fairly, and it should improve tertiary prevention to protect women's health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASMR: Age-standardized mortality rate; APC: Annual percentage change; AAPC: Average annual percentage change; CMR: Crude mortality rate; \u003cem\u003eCI\u003c/em\u003e: Confidence interval; DALY: Disability adjusted life year; HPV: Human papillomavirus; ICD: International Classification of Diseases; LLE: Loss of life expectancy; WHO: World Health Organization; YLD: Years lived with disability; YLL: Years of life lost.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a secondary analysis of data available in the public domain and do not require an ethical clearance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available in the China Death Surveillance Database (https://ncncd.chinacdc.cn/xzzq_1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this research was provided by the medical science and technology research project of Henan province (LHGJ20210374).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJCZ originated and designed the study. XTH contributed to the analysis of the data and coordinated the writing of the article. ZHW, DMH, KHD, QW and CCL provided technical guidance, contributed to the interpretation of findings and revision of the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the Chinese center for disease control and prevention for the access granted to use these datasets.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerlay J, Colombet M, Soerjomataram I, Parkin DM, Pi\u0026ntilde;eros M, Znaor A, Bray F: Cancer statistics for the year 2020: An overview. Int J Cancer 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F: Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021, 71(3):209\u0026ndash;249.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe R, Zhu B, Liu J, Zhang N, Zhang WH, Mao Y: Women's cancers in China: a spatio-temporal epidemiology analysis. BMC Womens Health 2021, 21(1):116.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang X, Tang H, Chen T: Epidemiology of gynecologic cancers in China. J Gynecol Oncol 2018, 29(1):e7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei M, Zhou W, Bi Y, Wang H, Liu Y, Zhang ZJ: Rising mortality rate of cervical cancer in younger women in urban China. J Gen Intern Med 2019, 34(2):281\u0026ndash;284.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao F, Qiao Y: Cervical cancer prevention in China: a key to cancer control. Lancet 2019, 393(10175):969\u0026ndash;970.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin S, Gao K, Gu S, You L, Qian S, Tang M, Wang J, Chen K, Jin M: Worldwide trends in cervical cancer incidence and mortality, with predictions for the next 15 years. Cancer 2021, 127(21):4030\u0026ndash;4039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, Yin P, Liu Y, Li Y, Liu J, et al: An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 2016, 94(1):46\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HJ, Luo J, Kim J, Chen HS, Feuer EJ: Clustering of trend data using joinpoint regression models. Stat Med 2014, 33(23):4087\u0026ndash;4103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Chiang CJ, Lee WC: Age-standardized expected years of life lost: quantification of cancer severity. BMC Public Health 2019, 19(1):486.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Z, Guo E, Yang B, Xiao R, Lu F, You L, Chen G: Trends and age-period-cohort effects on mortality of the three major gynecologic cancers in China from 1990 to 2019: Cervical, ovarian and uterine cancer. Gynecol Oncol 2021, 163(2):358\u0026ndash;363.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKjaer SK, Dehlendorff C, Belmonte F, Baandrup L: Real-world effectiveness of human papillomavirus vaccination against cervical cancer. J Natl Cancer Inst 2021, 113(10):1329\u0026ndash;1335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC: Assessing impact of HPV vaccination on cervical cancer incidence among women aged 15\u0026ndash;29 years in the United States, 1999\u0026ndash;2017: an ecologic study. Cancer Epidemiol Biomarkers Prev 2021, 30(1):30\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimms KT, Steinberg J, Caruana M, Smith MA, Lew JB, Soerjomataram I, Castle PE, Bray F, Canfell K: Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncol 2019, 20(3):394\u0026ndash;407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia C, Xu X, Zhao X, Hu S, Qiao Y, Zhang Y, Hutubessy R, Basu P, Broutet N, Jit M, Zhao F: Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study. BMC Med 2021, 19(1):62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchalek J, Abbas K, Claxton K, Jit M, Lomas J: Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries. BMJ Glob Health 2020, 5(10):e003006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenley SJ, Miller JW, Dowling NF, Benard VB, Richardson LC: Uterine cancer incidence and mortality - United States, 1999\u0026ndash;2016. MMWR Morb Mortal Wkly Rep 2018, 67(48):1333\u0026ndash;1338.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXi Y, Wang W, Chen W, Han K, Qiao L, Chen W: Incidence and mortality of corpus uteri cancer in China, 2008\u0026ndash;2012. Chin J Cancer Res 2019, 31(3):435\u0026ndash;442.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao Y, Zhao M, Dai X, Tong M, Wei J, Chen Q: The prevalence of endometrial cancer in pre- and postmenopausal Chinese women. Menopause 2016, 23(8):884\u0026ndash;887.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Arsdale A, Miller DT, Kuo DY, Isani S, Sanchez L, Nevadunsky NS: Association of obesity with survival in patients with endometrial cancer. Gynecol Oncol 2019, 154(1):156\u0026ndash;162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoskas M, Amant F, Mirza MR, Creutzberg CL: Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet 2021, 155 Suppl 1:45\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGentry-Maharaj A, Karpinskyj C: Current and future approaches to screening for endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2020, 65:79\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenon U, Karpinskyj C, Gentry-Maharaj A: Ovarian cancer prevention and screening. Obstet Gynecol 2018, 131(5):909\u0026ndash;927.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi K, H\u0026uuml;sing A, Fortner RT, Tj\u0026oslash;nneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, et al: An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015, 112(7):1257\u0026ndash;1265.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobayashi Y, Banno K, Aoki D: Current status and future directions of ovarian cancer prognostic models. J Gynecol Oncol 2021, 32(2):e34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Female reproductive system, Malignant tumor, Mortality, Disease burden","lastPublishedDoi":"10.21203/rs.3.rs-1900985/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1900985/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChinese women account for 17.51% of the world's deaths because of malignant tumors of the reproductive system, which is a serious threat to women's life and health. We analyzed the changes in mortality and disease burden of cervical cancer, uterine cancer and ovarian cancer in China from 2006 to 2020 to provide a basis for formulating scientific prevention and control measures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAnnual death data for cervical cancer, uterine cancer and ovarian cancer were collected from the Chinese Cause of Death Surveillance. The crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were applied to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were used to assess disease burden.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom 2006 to 2020, a total ASMR and standardized YLL rates of malignant tumors of the reproductive system showed a relatively stable trend, leading to an average LLE of 0.18 years. The YLL rate was the highest in the 55\u0026ndash;59 age group. The mortality rate and disease burden of the three types of cancer have changed from uterine cancer higher than cervical cancer and ovarian cancer in 2006 to cervical cancer higher than ovarian cancer and uterine cancer in 2020. The ASMR and standardized YLL rate of uterine cancer showed a downward trend, and AAPC was \u0026minus;\u0026thinsp;5.21% (-9.31%~-0.91%) and \u0026minus;\u0026thinsp;6.07% (-9.45%~-2.58%), respectively. The mortality rates of cervical cancer and ovarian cancer remain high.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe mortality and disease burden of malignant tumors of the female reproductive system in China are still at a high level. It is necessary to improve screening and prevention strategies as soon as possible, improve the techniques of diagnosis and treatment, and take adequate measures to protect women's life and health.\u003c/p\u003e","manuscriptTitle":"Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-03 20:06:11","doi":"10.21203/rs.3.rs-1900985/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-10-27T12:16:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-09-08T16:26:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"cba994e0-44f6-4e41-a159-2a601ce1eab5","date":"2022-08-25T05:53:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-08-20T22:14:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-08-20T22:11:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-07-29T12:44:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-07-29T12:41:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2022-07-27T09:30:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c0a58bea-df79-42eb-b7aa-d2617d812210","owner":[],"postedDate":"August 3rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-11-30T17:44:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-03 20:06:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1900985","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1900985","identity":"rs-1900985","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}