1 Unit of Cancer Epidemiology / Belgian Cancer Centre. Department of ... Network of Excellence (Cancer Control using population-based Cancer Registries and.
TRENDS OF CERVICAL CANCER MORTALITY IN EUROPE M. Arbyn, A.O. Raifu, J. Antoine (VERSION 1)
Section Epidemiology Juliette Wytsmanstreet, 14 1050 Brussels | Belgium www.iph.fgov.be
Epidemiology | 07 2009 | Brussels, Belgium No deposit: D/2009/2505/41
TRENDS OF CERVICAL CANCER MORTALITY IN EUROPE
M. Arbyn1 A.O. Raifu1 J. Antoine1 1
Unit of Cancer Epidemiology / Belgian Cancer Centre Department of Epidemiology Scientific Institute of Public Health, Brussels, Belgium
The project is financially supported by 1. DG SANCO of the European Commission, through the EUNICE and EUROCHIP-3 Networks 2. DG Research of the European Commission, through the CCPRB and EUROCOURSE Networks 3. Belgian National Cancer Plan
Science at the service of Public health, Food chain safety and Environment.
Acknowledgments Funding was received from: (1) the DG SANCO of the European Commission (GrandDuchy of Luxembourg), trough EUNICE (European Network for Information in Cancer Epidemiology), via IARC (Lyon, France) and, through the EUROCHIP-3 Network (Istituto Nazionale dei Tumori, Milan, Italy) and through the European Network for Information on Cancer (IARC, Lyon, France); (2) 6th and 7th Framework Programme of DG Research of the European Commission through the CCPRB Network of Excellence (Cancer Control using population-based Cancer Registries and Biobanking (University of Lund, Sweden) and the EUROCOURSE Network (Optimisation of the Use of Registries for Scientific Excellence in research (Comprehensive Cancer Centre South, Eindhoven, the Netherlands); (3) Belgian National Cancer Plan, through the National Health Insurance Institute (Brussels, Belgium).
© Scientific Institute of Public Health, Brussels 2008 This report may not be reproduced, published or distributed without the consent of the ISP | WIV.
1. TABLE OF CONTENTS 1.
TABLE OF CONTENTS..............................................................................................................6
2.
EXECUTIVE SUMMARY...........................................................................................................7 2.1. 2.2. 2.3. 2.4.
BACKGROUND ..........................................................................................................................7 MATERIAL AND METHODS ........................................................................................................7 RESULTS...................................................................................................................................7 DISCUSSION..............................................................................................................................7
3.
INTRODUCTION.........................................................................................................................9
4.
MATERIAL AND METHODS..................................................................................................11 4.1. SOURCE OF DATA ...................................................................................................................11 4.1.1. Mortality data ...................................................................................................................11 4.1.2. Population data ................................................................................................................11 4.1.3. Geographical identification of states................................................................................11 4.1.4. Missing data .....................................................................................................................12 4.1.5. Codification of deaths from uterine cancer ......................................................................13 4.1.6. Age groups........................................................................................................................20 4.2. REALLOCATION OF DEATHS CAUSED BY CANCERS OF THE UTERUS .........................................20 4.2.1. Cancer of the uterus .........................................................................................................20 4.2.2. Reallocation of causes of death ........................................................................................20 4.2.3. Imputation.........................................................................................................................25 4.3. TREND ANALYSES ..................................................................................................................26 4.3.1. Mortality from uterus cancer among women younger than 45 years...............................26 4.3.2. Corrected number of deaths from cervix uteri cancer, mortality rates ............................26 4.3.3. Join Point regression........................................................................................................27 4.3.4. Standardised cohort mortality ratio .................................................................................27 4.4. STATISTICAL SOFTWARE ........................................................................................................28
5.
RESULTS ....................................................................................................................................29 5.1. 5.2. 5.3. 5.4. 5.5. 5.6. 5.7. 5.8.
MORTALITY FROM UTERUS CANCER AMONG WOMEN BETWEEN 20-44 YEARS ........................30 STANDARDISED COHORT MORTALITY RATIO FOR UTERUS CANCER AMONG WOMEN AGED 20-44 YEARS..........................................................................................................................32 CRUDE RATES OF MORTALITY FROM CERVIX CANCER (CERTIFIED AND CORRECTED FOR NOS) AND UTERUS CANCER ..................................................................................................34 AGE-STANDARDISED RATE OF MORTALITY FROM CERVIX CANCER (CERTIFIED AND CORRECTED FOR NOS) AND UTERUS CANCER ........................................................................36 CORRECTED AGE-SPECIFIC MORTALITY FROM CERVICAL CANCER BY PERIOD ........................38 CORRECTED AGE-SPECIFIC RATES OF MORTALITY FROM CERVICAL CANCER BY BIRTH COHORT .................................................................................................................................40 STANDARDISED COHORT MORTALITY RATIO (CERVICAL CANCER, CORRECTED, ALL AGES)....42 JOINPOINT REGRESSION OF STANDARDISED CORRECTED CERVICAL CANCER MORTALITY .......44
6.
DISCUSSION ..............................................................................................................................45
7.
ABBREVIATIONS .....................................................................................................................48
8.
FILES USED ...............................................................................................................................49
9.
REFERENCES............................................................................................................................50
2. EXECUTIVE SUMMARY 2.1. Background Cervical cancer mortality can be avoided to a large extent by screening and treatment of screen-detected cervical lesions. However, in 2004, approximately 27,000, in the European continent, and 16,000 women, in the the European Union, died from this cancer. Straightforeward analysis of trends in the cervical cancer mortality is hampered by inaccuracies in death cause certification. Adjustments are needed to correct for deaths from uterus cancer not otherwise specified. In the current report, we analysed cervical cancer mortality trends in all countries of the the European Continent but we focussed mainly on the 27 current Member States of the European Union.
2.2. Material and methods Data on number of deaths from uterine cancers and overall female population from all European countries were extracted from the WHO mortality data base. Three different reallocation rules were applied to correct cervical cancer mortality for inaccuracies in certification of death cause of not otherwise specified uterine cancer. Since the large majority of uterine cancers before the age of 45 years is from cervical origin, we analysed mortality from cancer of the uterus in the age group 20-44 years. This method does not require any reallocation. Joinpoint regression was used to study annual variation of corrected cervical cancer mortality in all European countries.
2.3. Results Corrected age-standardised cervical cancer mortality rates decreased significantly over the last decades in the 15 old Member States of the European Union. Member States in Eastern Europe and also the Baltic states showed mortality rates that decreased at lower intensity (Czech Republic, Poland), remained constant at a high rate (Estonia, Slovakia) or even increased (Bulgaria, Latvia, Lithuania, Romania). The standardised cohort mortality ratio indicated that mortality did not decrease further among women born after 1940.
2.4. Discussion Remarkable contrasts were observed in cervical cancer mortality, in particular, between the old and new EU Member States, which might probably be explained by differences in coverage and quality of cytology-based screening in the past. Cohorts 7
born after 1940 are a higher risk of cervical cancer because of increased exposure to the sexually transmitted high-risk human papillomavirus types, the main etiological risk factor. There is an elevated burden of cervical cancer in Central and Eastern Europe. Moreover, mortality rates tend to rise or remain stable in the most affected countries such as Romania, Bulgaria and the three Baltic states, whereas in most other European countries trends are decreasing. The east-west contrast might increase in the future, unless adequate preventive measures are adopted. Public health authorities should set up well-organised cervical cancer prevention programmes without delay as recommended by the European Council according to the European Guidelines for Quality Assurance in Cervical Cancer Screening. Carefully organised HPV vaccination might further corroborate the impact of screening.
8
3. INTRODUCTION According to recent estimates for the year 2004, approximately 34,300 women in the European Union developed cervical cancer and about 16,300 died from the disease (4). For whole European continent, estimates (which are less precise) are of the order of 52,000 cases and 27,000 deaths (5). The main etiologic factor for cervical cancer is persistent infection with sexually transmittable high-risk human papillomaviruses (6). By well organised screening and treatment of screen-detected high-grade cervical intraepithelial neoplasia (CIN) invasive cancer can be avoided (7). Therefore, trends in incidence of cervical cancer largely reflect coverage and quality of screening, as well as changes in exposure to risk factors which are mainly related to sexual habits of successive cohorts (8,9). Mortality trends are determined by the incidence and by the case fatality rate. Survival (the complement of case fatality) is influenced by stage and age of diagnosis, access to specialised care and effectiveness of available cancer management procedures (5,811). Screening plays a role in detecting invasive cancer at an early curable stage (12). The study of incidence trends would be more pertinent to assess the impact of cervical cancer screening. However, incidence data reported by cancer registries are less comprehensive than mortality statistics, which are compiled from nearly all European countries since several decades by the World Health Organisation. Furthermore, cancer incidence statistics from early periods in certain registries are inflated by inclusion of pre-invasive lesions, and cancer registries often do not separate microinvasive (easily curable) from fully invasive cancer cases (resulting in substantial mortality) (13). Trend analyses of cervical cancer mortality often are hampered by inaccuracies in certification of cause of death, since, in many countries, a substantial fraction of uterine cancer deaths are coded as cancer from the uterus not otherwise specified (NOS) where it is not determined whether the cancer originated form the cervix or the corpus uteri (14,15). Moreover, in the 8th International Codification of Diseases, cancer of the corpus uteri or of the uterus NOS were grouped in one 3-digit code. In a previous special issue dedicated to cervical cancer screening in Europe, Levi et al, analysed the trend of mortality from cervical cancer in Europe (16). No attempt was made to correct for inaccuracies in the certification of death by uterine cancers. As a proxy for cervical cancer mortality, cancer of all uterus cancers combined was studied among women younger than 45 years, since in this age group the large majority of uterine cancers originate from the cervix (17). However, this age group may not enable assessment of the full population impact of screening, as the majority of deaths from cervix cancer occur after the age of 45 years. In the current study an algorithm was developed to reallocate deaths from the uterus NOS or combined groups, building further on previously published methods (14,15). Finally, the trends of the corrected rates are tentatively explained as a result of secondary prevention taking into account changes in exposure to risk factors and impact of oncologic treatment on survival. This report has been prepared in the framework of the European Network for Information on Cancer Epidemiology (EUNICE), which was coordinated by the 9
International Agency for Research on Cancer (Lyon, France) and which was supported by the European Commission via DG SANCO (Luxembourg, Grand Duchy of Luxembourg). Therefore, the report focusses essentially on the 27 current Member States of the EU, although avaialble data from all countries from the European continent were processed; The trend analyses will be continued throughout other networks (EUROCHIP-3 [www.tumori.net/eurochip]), national and international collaborations (for instance cancer registries of Baltic States, Bulgaria, Croatia, and Romania; Belgian Cancer Plan) and is therefore necessarily incomplete. These collaborations should result in separate publications.
10
4. MATERIAL AND METHODS 4.1. Source of data 4.1.1. Mortality data Mortality data were downloaded from the WHO (World Health Organisation) Mortality Database available on the web at http://www.who.int/whosis/mort. This database contains aggregated data on the number of deaths arranged by country, sex, age group and cause of death. The WHO Mortality Database contains separate zipped files corresponding to the ICD (International Classification of Diseases) versions: icd7.zip, icd8.zip, icd9.zip and icd10.zip. The last downloading was done on 23 October 2007. The earliest data were from 1950, the most recent from 2006. The availability of mortality data per country and period is detailed in Table 1. We selected data from countries belonging to the European continent (with country codes between 4000 and 4400, 3080 for Cyprus and 3400 for Turkey) concerning mortality from cancer of the different parts of the uterus: cervix uteri cancer, corpus uteri cancer, cancer of the uterus not otherwise specified (NOS) and other uterine cancers. For Romania, the number of deaths for the period 1959-68 was aggregated over 10year age groups, whereas since 1969, 5-year age groups were used. We used the two earliest years (1969-70) for which 5-year age details were available and computed the average proportion within each pair of subsequent age groups and applied this proportion on the corresponding 10-year age groups for the period 1959-68.
4.1.2. Population data Population data files were downloaded alongside with the mortality data from the WHO website and data from females in the European states were selected and merged with the mortality files. The availability of population data per state and period is detailed in Table 1.
4.1.3. Geographical identification of states Several historical changes occurred in the geographical delineation of countries and states. Czechoslovakia was split in the Czech Republic and Slovakia in 1993. Several states were split from the Yugoslavian Republic at different time points (Slovenia and Croatia in 1991, the Former Yugoslavian Republic of Macedonia in 1993 and Bosnia & Herzegovina in 1995) leaving Serbia & Montenegroa. From 1973 to 1989, data from East and West Germany were combined and from 1990 onwards data for the whole of Germany were available. For the United Kingdom (UK), data are available for different subparts (England & Wales, Northern-Ireland and Scotland) and for the whole of the UK as well. a
In 2006, Montenegro, was split from Serbia & Montenegro, but no data is as yet available for this new state.
11
Henceforth, we will use the term areas to describe countries or states.
4.1.4. Missing data Small gaps in the data Seven areas including Armenia, Belarus, Estonia, Georgia, Lithuania, Moldova, and Ukraine lacked the population data for the year 1984. The population data of the year 1970 for Spain and of 2000 for the UK was also missing. Recent population data was lacking for Moldova (2006) and Slovenia (2005) but were available for mortality (see Table 1). We estimated the missing population in these areas through interpolation. The interpolation method is the process of estimating the missing observation within a data set. Data from one missing year x were estimated from the average computed over the years x-2, x-1, x+1 and x+2. When data is missing in two years (x1 and x2) consecutively, the missing data for year x1 was estimated by computing the average over the years x1-2, x1-1, x2+1 and x2+2. Data for the second missing year were estimated from the average computed over x1-1, x1, x2+1 and x2+2.
Excluded areas because of missing data No data were available for population and mortality for the areas: Andorra and Liechtenstein. For Cyprus (1964-74), Monaco (1986-87), San Marino (1995-2000), only population data are present for a restricted period. For Turkey, no population figures are available and mortality data are present for only three years (1983, 1984 and 1987). All these six areas were excluded from the current trend analysis. Table 1. Availability of data for population and deaths: period (range of years) and lacking years for each area of the European continent. Area
Population Range of available years Albania 1987-2004 Andora Armenia 1981-1983, 1985-2003 Austria 1955-2004 Belarus 1981-1983, 1985-2003 Belgium 1954-1997 Bosnia & Herzegovina 1985-1991 Bulgaria 1964-2004 Croatia 1985-2005 Cyprus 1964-1974 Czechoslovakia 1953-1991 Czech Republic 1986-2005 Denmark 1951-2001 Estonia 1981-1983, 1985-2004 Finland 1952-2005 France 1950-2004 Georgia 1981-1983, 1985-2001 Germany 1990-2004 East Germany 1973-1990 West Berlin 1955-1970 West Germany 1952-1990
Missing 1984 1984 1984 1984 -
Deaths Range of available years 1987-1989, 1992-2004 1981-1982, 1985-2003 1955-2004 1981-1982, 1985-2003 1954-1997 1985-1991 1964-2004 1985-2005 1953-1991 1986-2005 1951-2001 1981-1982, 1985-2004 1952-2005 1950-2004 1981-1982, 1985-2001 1990-2004 1973-1990 1955-1960, 1962-1970 1952-1990
Missing 1990-1991 1983-1984 1983-1984 1983-1984 1983-1984 1961 -
12
Area
Population Range of available years Missing Greece 1961-2004 Hungary 1955-2005 Iceland 1952-2005 Ireland 1950-2005 Italy 1951-2002 Latvia 1981-2004 Liechtenstein Lithuania 1981-1983, 1985-2004 1984 Luxembourg 1967-2004 Macedonia 1991-2003 Malta 1965-2004 Moldova 1981-1983, 1985-2005 1984, 2006 Monaco 1986-1987 Netherlands 1950-2004 Norway 1951-2004 Poland 1959-2005 Portugal 1955-2003 Romania 1959-2004 Russian Federation 1980-2005 San Marino 1995-2000 Serbia & Montenegro 1997-2002 Slovakia 1992-2005 Slovenia 1985-2004 2005 Spain 1951-1969, 1971-2004 1970 Sweden 1952-2004 Switzerland 1951-2004 Turkey 1983-1987 Ukraine 1981-1983, 1985-2005 1984 United Kingdom 1950-1999, 2001-2004 2000 England & Wales 1950-2004 Northern Ireland 1950-2004 Scotland 1950-2004 Yugoslavia 1960-1990 -
Deaths Range of available years 1961-2004 1955-2005 1952-2005 1950-2005 1951-2002 1981-2004 1981-1982, 1985-2004 1967-2004 1991-2003 1965, 1967-2004 1981-1982, 1985-2006 1950-2004 1951-2004 1959-1996, 1999-2005 1955-2003 1959-1978, 1980-2004 1980-2004 1997-2002 1992-2005 1985-2005 1951-2004 1952-2004 1951-2004 1983-1984, 1987 1981-1982, 1985-2005 1950-1999, 2001-2004 1950-2004 1950-2004 1950-2004 1960-1990
Missing 1983-1984 1966 1983-1984 1997-1998 1979 1985-1986 1983-1984 2000 -
4.1.5. Codification of deaths from uterine cancer The codes used to identify cancer of the different parts of the uterus in the subsequent editions of the International Classification of Diseases, Injuries, and Causes of Death (ICD) are shown in Table 2. Table 2. ICD codes used to identify cancer of the different parts of the uterus Cancer of the ICD edition Cervix Corpus Uterus NOS Uterus other parts Abbreviation CVX CRP NOS OTH 7 171 172 174 173 8 180 182.0 182.9 181 9 180 182 179 181 10 C53 C54 C55 C57/C58* *C57: malignant neoplasm of other and unspecified female genital organs C58: malignant neoplasm of placenta
13
In all ICD editions, separate codes were foreseen to identify cervical cancer (171 in the 7th, 180 in the 8th and 9th, and C53 in the 10th edition). Corpus uteri cancer and uterus NOS cancer were codified separately in all editions (172 [ICD-7], 182 [ICD-9] and C54 [ICD-10] for corpus cancer; 174 [ICD-7], 179 [ICD-9] and C55 [ICD-10] for uterus NOS cancer. However, in the 8th edition, 182 was used for both corpus and uterus NOS cancer. They could only be distinguished with the 4th digit (182.0 for corpus cancer and 182.9 for uterus NOS cancer), but distinction was in many countries not possible by lack of this 4th digit. Other rare cancers of the uterus such as placenta tumours (chorioblastoma) were coded with 173 in the 7th edition and with 181 in the 8th and 9th ICD edition. Table 3. Additional WHO codes used to identify uterus cancers. ICD edition Abbreviation 7 8 9 10
Cervix CVX A052 A055 B120 1037
Uterus other parts OTH B121 -
Cancer of the Corpus or uterus NOS CRPNOS B122 -
Corpus or uterus NOS or other CRPNOSOTH A053 A056 1038
In the WHO Mortality Database, still other non-ICD codes were used (see Table 3). A052, A055, B120 and 1037 were used to identify cancer of the cervix uteri, respectively in the 7th, 8th, 9th and 10th ICD period; A053 (ICD7), A056 (ICD8), and 1038 (ICD10) were used for the group of corpus uteri, uterus NOS and other uterus cancers. In the 9th ICD period, B122 was the code for the combined group of cancers of corpus uteri and uterus NOS, whereas B121 was the code for other uterine cancers including placenta cancer. The periods, in which the respective ICD-codes were used, are shown for each area in Table 4. Table 4. ICD codes used for classification of death causes in the WHO Mortality Database, by ICDedition and area. Area Albania Andora Armenia Austria Belarus Belgium Bosnia & Herzegovina Bulgaria Croatia Cyprus Czechoslovakia Czech Republic Denmark Estonia
7 1955-1968 1952-1967 -
ICD Edition 8 9 1987-2004 1981-2003 1969-1979 1980-2001 1981-2001 1968-1978 1979-1997 1985-1991
1964-1967 1953-1967
1968-1979 1968-1978
1951-1968 -
1969-1993 -
1980-2004 1985-1994 1979-1991 1986-1993 1981-1996
10 2002-2004 2002-2003 1995-2005 1994-2005 1994-2001 1997-2004
14
Area Finland France Georgia Germany East Germany West Berlin West Germany Greece Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxembourg Macedonia Malta Moldova Monaco Netherlands Norway Poland Portugal Romania Russian Federation San Marino Serbia & Montenegro Slovakia Slovenia Spain Sweden Switzerland Turkey Ukraine United Kingdom England & Wales Northern Ireland Scotland Yugoslavia
1955-1967 1952-1967 1961-1967 1955-1968 1952-1970 1950-1967 1951-1967 1967-1970 1965-1967 1950-1968 1951-1968 1959-1968 1955-1970 1959-1968 -
ICD Edition 8 9 1969-1986 1987-1995 1968-1978 1979-1999 1981-1997 1990-1997 1973-1978 1980-1990 1968-1970 1968-1978 1979-1990 1968-1978 1979-2004 1969-1978 1979-1995 1971-1980 1981-1995 1968-1978 1979-2005 1968-1978 1979-2002 1981-1995 1981-1997 1971-1978 1979-1997 1991-2003 1968-1978 1979-1994 1981-1995 1969-1978 1979-1995 1969-1985 1986-1995 1969-1979 1980-1996 1971-1979 1980-2001 1969-1978 1980-1998 1980-1998 -
10 1996-2005 2000-2004 1998-2001 1998-2004 1996-2003 1996-2005 1996-2004 1998-2004 1998-2004 1995-2004 1996-2006 1996-2004 1996-2004 1999-2005 2002-2003 1999-2004 1999-2005 1997-2002
1951-1967 1952-1968 1951-1968 1950-1967 1950-1967 1950-1967 1950-1967 1960-1967
1968-1979 1969-1986 1969-1994 1968-1978 1968-1978 1968-1978 1968-1978 1968-1978
1994-2005 1997-2005 1999-2004 1997-2004 1995-2004 2005 2001-2004 2001-2004 2001-2004 2000-2004 -
7 1952-1968 1950-1967 -
1992-1993 1985-1996 1980-1998 1987-1996 1981-2004 1979-1999 1979-2000 1979-2000 1979-1999 1979-1990
We used the following own abbreviated labels to recodify causes of deaths throughout all the periods: CVX (cervix uteri cancer), CRP (corpus uteri cancer), NOS (cancer uterus NOS), OTH (cancer of other parts of the uterus), CRPNOS (cancer of corpus uteri or uterus NOS), CRPNOSOTH (cancer of corpus uteri, uterus NOS or other parts of the uterus). The abbreviation UT is used for all cancers of the uterus together. The availability of mortality data for cancer from the different parts of the uterus is further detailed in Table 5, by area and period.
15
Table 5. Availability of data on mortality from cervix uteri cancer (CVX), corpus uteri cancer (CRP), uterus cancer not otherwise specificied (NOS), other uterine cancer (OTH), combination of CRP and NOS (CRPNOS) or combination of CRP, NOS and OTH (CRPNOSOTH) per area and period. CVX Areas
CRP
NOS
OTH
CRPNOS
CRPNOSOTH
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
1987-1989, 1992-2003 1981-1982, 1985-2003 1955-2004
1990-1991
1990-1991
-
-
1983-1984
-
-
-
1969-2004
1955-1968
1969-2004
1955-1968
1969-2002
1955-1968
1955-1979
1980-2004
1983-1984
-
-
-
-
-
-
-
-
1954, 19771978, 1985, 1987-1991
1955-1997
1954
1954-1967
1954-1978
1979-1997
1985-1991 1964-2004
-
-
1985-1991 1968-2004
1964-1967
1964-1979
1980-2004
1985-2004
-
1964-1965, 1968-1979, 1983 -
1985-1991 1966-2004
Croatia
1964-1965, 1968-1979, 1983 -
1955-1976, 1979-1984, 1986, 19921997 1985-1991 1966-1967, 1980-1982, 1984-2004 1985-2004
1954, 19771978, 1985, 1987-1991
Bosnia & Herzegovina Bulgaria
1955-1976, 1979-1984, 1986, 19921997 1985-1991 1966-1967, 1980-1982, 1984-2004 1985-2004
1981-1982, 1985-2003 1968-1997
1983-1984
Belgium
1981-1982, 1985-2003 1954-1997
1955-1968, 2003-2004 -
1987-1989, 1992-2003 1981-1982, 1985-2003 1969-2004
1990-1991
-
1987-1989, 1992-2003 -
1990-1991
-
1987-1989, 1992-2003 -
1990-1991
1983-1984
1987-1989, 1992-2003 -
-
-
-
1953-1991
-
1953-1954, 1958-1978 -
1953-1978
1979-1991
-
1955-1967, 1979-1991 1986-2004
1953-1967
1986-2004
1953-1954, 1958-1978 -
1968-1991
Czech Republic
1955-1967, 1979-1991 1986-2004
1995, 19972004 1953-1954
1985-2004
Czechoslovakia
1985-1994, 1996 1955-1991
-
-
-
1951-2001
-
1951-1954, 1982-1987 1981-1993
1951-1993
1994-2001
1983-1984
1955-1981, 1988-2001 1994-2004
1951-1968
1981-1982, 1985-2004 1952-2004
1951-1954, 1982-1987 1981-1993
1969-2001
Estonia
1955-1981, 1988-2001 1994-2004
-
-
1952-1954, 1984, 1988
1952-1954, 1984, 1988
1955-1995, 2000
1952-1968
1952-1986
1987-2004
1950, 19522003 1981-1982, 1985-1992, 1994-2001
1951
1950-1954
1955-1983, 1985-1987, 1989-2004 1955-2003
1981-1982, 1985-2004 1969-2004
1983-1984
1955-1983, 1985-1987, 1989-2004 1955-2003
1950-1954
1955-2003
1995, 19972003 1951-1954, 1994-2001 1981-1993, 1995-2004 1952-1954, 1996-1999, 2001-2004 1950-1954
1986-2004
Denmark
1986-1994, 1996, 2004 1955-1993
1968-2003
1950-1967
1998-2001
1981-1997
1998-2001
1981-1997
-
-
1981-1982, 1985-1992, 1994-2001
1983-1984, 1993
1950, 19521978 -
1951, 19792003 -
Albania Armenia Austria Belarus
Finland France Georgia
-
1983-1984, 1993
1994-1996
16
-
CVX Areas
CRP
NOS
OTH
CRPNOS
CRPNOSOTH
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Germany+++
1973-2004
-
1973-2004
-
1973-2004
-
-
1973-1978
1979-2004
1990-2004
-
1990-2004
-
1990-2004
-
1973-1967, 2003 2003
1973-2004
Germany
1990-2004
-
-
-
1979
1983-1990
1973-1982
1983-1990
1973-1982
1952-1968 1955-1967
1969-1990 1968-1970
1952-1968 1955-1967
1973-1975, 1977-1979 1952-1967 1955-1967
1979-1990
1969-1990 1968-1970
1976, 19801990 1968-1990 1968-1970
1973-1978
1961
1973-1975, 1977-1979 1952-1967 1955-1967
-
1966-2004 1970-2003
1961-1965 1955-1969
1966-2004 1970-2003
1961-1965 1955-1969
1966-2004 1970-1995, 1997, 2001
1961-1965 1955-1969, 1996, 19982000 1952-1970, 1996-2004 1950-1954
1968-2004 1970-2003
1961-1967 1955-1969
1952-1979 1955-1960, 1962-1970 1961-1978 1955-1978
1980-1990 1961
Greece Hungary
East Germany 1973-1978, 1980-1990 West Germany 1952-1990 West Berlin 1955-1960, 1962-1970 1961-2004 1955-2003
1973-2002, 2004 1990-2002, 2004 1976, 19801990 1968-1990 1968-1970
1971-2004
1952-1970
1952-1980
1981-2004
1968-2005
1950-1967
1950-1978
1979-2005
1968-2002 1981-2004 1981-1982, 1985-2004 1979-2004
1951-1967 1983-1984
1951-1978 -
1979-2002 -
1967-1978
1967-1978
1979-2004
1991-2003 1978-2004
1965-1977
1981-1982, 1985-2004
1983-1984
1965, 19671978 -
1966, 19792004 -
1969-2004
1950-1968
1950-1978
1979-2004
1969-2004
1951-1968
1951-1985
1986-2004
Iceland
1952-2004
-
1971-2004
1952-1970
1971-2004
1952-1970
1971-1995
Ireland
1950-2005
-
1974
1955-2005
1951-2002 1981-2004 1981-1982, 1985-2004 1967-2004
1983-1984
1951-1954 1981-1995 1981-1992
1955-1973, 1975-2005 1955-2002 1996-2004 1993-2004
1974
Italy Latvia Lithuania
1955-1973, 1975-2005 1955-2002 1996-2004 1993-2004
1951-1954 1981-1995 1981-1992
-
1979-2004
1967-1978
1979-2004
1967-1978
1956-2002 1993-1998, 2004 1979-1997
1991-2003 1965, 19672004 1981-1982, 1985-2004
1966
1991-2003 1978-2004
1965-1977
1991-2003 1978-2004
1965-1977
1991-2003 1978-1994
1983-1984
1996-2004
1981-1995
1996-2004
1981-1995
1991-1996, 1998, 2002
Luxembourg Macedonia Malta Moldova
Netherlands
1950-2004
-
1955-1969, 1972-2004
1950-1954, 1970-1971
1955-1969, 1972-2004
1950-1954, 1970-1971
1955-1997, 2000, 2002
Norway
1951-2004
-
1955-1978, 1982-2004
1951-1954, 1979-1981
1955-1978, 1982-2004
1951-1954, 1979-1981
1955-1995, 2003-2004
17
1951-1955 1981-1992, 1999-2003 1967-1978, 1998-2004 1965-1977, 1995-2004 1981-1990, 1997, 1999, 2000-2001, 2003-2004 1950-1954, 1998-1999, 2001, 20032004 1951-1954, 1996-2002
1979-2004 1979-2003
CVX Areas
CRP
NOS
OTH
CRPNOS
CRPNOSOTH
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Poland
1959-1996, 1999-2004
1997-1998
1961-1968, 1999-2004
1959-1960, 1969-1998
1961-1968, 1999-2004
1959-1960, 1969-1998
1961-1970, 1980-1989, 2001-2002
1969-1970, 1980-1996, 1999-2004
1959-1968, 1971-1979, 1997-1998
1959-1979
1980-2004
Portugal Romania
1955-2003 1959-1978, 1980-2004
1979
1984-2003 1970, 19992004
1955-1983 1959-1969, 1971-1998
1984-2003 1970, 19992004
1955-1983 1959-1969, 1971-1998
1980-2003 1969-1978, 1980-2004
1955-1979 1959-1968
1955-1979 1959-1978
1980-2003 1979-2004
Russian Federation Serbia & Montenegro Slovakia
1980-2004 1997-2002 1992-2002
-
1999-2004 1997-2002 1992-2002
1980-1998 -
1999-2004 1997-2002 1992-2002
1980-1998 -
1980-2004 1997-2002 1992-2002
-
-
-
Slovenia
1985-2004
-
1985-2004
-
1985-2004
-
-
-
-
1951-2004
-
1955-1967, 1975-2004
1951-1954, 1968-1974
1955-1967, 1975-2004
1951-1954, 1968-1974
1997-1998, 2000-2004 1951-1954, 2000, 2002
1985-2004
Spain
1968-2004
1951-1967
1951-1979
1980-2004
Sweden
1952-2002
-
1955-1969, 1987-2002
1952-1954, 1970-1986
1955-1969, 1987-2002
1952-1954, 1970-1986
1980-2003 1969-1978, 1980-2001, 2003 1992-1994, 1997-1998, 2001-2002 1985-1996, 1999 1955-1999, 2001, 20032004 1955-1996, 2000-2001
1959-1960, 1971-1979, 1990-2000, 2003-2004 1955-1979 1959-1968, 1979, 2002, 2004 1995-1996, 1999-2000
1969-2002
1952-1968
1952-1986
1987-2002
Switzerland
1951-2004
-
1955-2004
1951-1954
1955-1994
1955-1994
1969-2004
1951-1968
1955-1994
Ukraine
1981-1982, 1985-2004 1950-1999, 2001-2004
1983-1984
-
-
-
1951-1954, 1995-2004 -
-
1952-1954, 1997-1999, 2002 1951-1954, 1995-2004 -
1983-1984
-
2000
1955, 19581962, 1967, 1979-1999, 2001-2004
1955, 19581962, 1967, 1979-1999, 2001-2004
1950-1954, 1956-1957, 1963-1966, 2000
1950-1967, 2000
1950-1978
1979-2004
1950-2004 1950-2004
-
1955-2004 1955-2000
1950-1967 1950-1967
1950-1978 1950-1978
1979-2004 1979-2004
1950-2004
-
1950-1954 1950-1954, 2001-2004 1950-1954, 2000-2001, 2003-2004
1968-2004 1968-2004
Scotland
1955-2004 1955-1967, 1979-2004 1955-2004
1950-1954, 1956-1957, 1963-1966, 1968, 19691978, 2000 1950-1954 1950-1954, 1968-1978 1950-1954
1955, 19581962, 19671999, 20012004
England & Wales Northern Ireland
1950-1954, 1956-1957, 1963-1966, 1968, 19691978, 2000 1950-1954 1950-1954, 1968-1978 1950-1954
1981-1982, 1985-2004 1968-1999, 2001-2004
1951-1954, 1995-2004 -
1968-2004
1950-1967
1950-1978
1979-2004
United Kingdom
1955-2004 1955-1967, 1979-2004 1955-2004
1955-1999, 2002
18
CVX Areas Yugoslavia +++
CRP
NOS
OTH
CRPNOS
CRPNOSOTH
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
Available
Missing
1961-1990
1960
1960-1967, 1970, 19791990
1968-1969, 1971-1978
1960-1967, 1970, 19791990
1968-1969, 1971-1978
1960-1990
-
1968-1990
1960-1967
1961-1978
1960, 19791990
Unified Germany
19
4.1.6. Age groups Eighteen age groups were considered: 17 groups with equal width of 5 years (0-4, 5-9, …, 80-84) and an 18th open group of women aged 85 or older. The world reference population was used to adjust for differences in age composition between areas and periods (18).
4.2. Reallocation of deaths caused by cancers of the uterus 4.2.1. Cancer of the uterus To compute the number of deaths from uterus cancer (UT), the sum was made of: 1. 2. 3. 4.
UT = CVX + CRP + NOS + OTH, or UT = CVX + CRPNOS + OTH, or UT = CVX + CRPNOSOTH, or. UT = CVX + CRPNOS
The fourth option was used, when no data was available for OTH (separately or included as a group). No effort was done to adjust for this lack, since OTH cancers were very rare (
