BACKGROUND: Female cancers cover common breast cancers, relatively common endometrial, ovarian, and cervical cancers and rare vulvar cancer. Survival in these cancers is known to be relatively good compared to all cancers but long-term studies for these cancers are rare, and to fill the gap, here, we generate survival data through 50 years. MATERIALS AND METHODS: We applied generalized additive models to data from the NORDCAN database and analyzed 1- and 5-year relative survival for these cancers in Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over half a century (1971-2020). Conditional 5/1-year survival for patients who survived the 1st year after diagnosis and annual survival changes was also estimated. RESULTS: In 2016-20, 5-year survival was best for breast cancer reaching 92.3% (in SE), followed by endometrial cancer at 86.1% (SE) and cervical cancer at 75.6% (NO). Improvement in 5-year survival over the 50 years was the largest for ovarian cancer (20% units), finally reaching 52.9% (SE). For vulvar cancer, the final survival was between 70 and 73%. The best 5-year survival rate in 2016-20 was recorded for SE in breast, endometrial, and ovarian cancers; NO showed the highest rate for cervical and DK for vulvar cancers. DK had the lowest survival for breast and ovarian cancers, and FI, for the other cancers. CONCLUSIONS: The overall survival development appeared to consist of continuous improvements, most likely because of novel treatment and imaging techniques as well as overall organization of patient care. The large survival improvement for ovarian cancer was probably achieved by a surgical focus on tumors spread in the peritoneal cavity. For cervical and vulvar cancers, the high early mortality requires attention and could be helped by raising increasing public awareness of early symptoms in these cancers and developing pathways for fast initiation of treatment.

Biomedical Center Faculty of Medicine Charles University Pilsen Pilsen 30605 Czech Republic

Cancer Gene Therapy Group Translational Immunology Research Program University of Helsinki Helsinki Finland

Comprehensive Cancer Center Helsinki University Hospital Helsinki Finland

Department of Urology Helsinki University Hospital Helsinki Finland

Division of Cancer Epidemiology German Cancer Research Center Im Neuenheimer Feld 580 D 69120 Heidelberg Germany

Division of Pediatric Neurooncology German Cancer Research Center Heidelberg Germany

Hopp Children's Cancer Center Heidelberg Germany

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Brown K. F., Rumgay H., Dunlop C., et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. British Journal of Cancer . 2018;118(8):1130–1141. doi: 10.1038/s41416-018-0029-6. PubMed DOI PMC

Wilson L. F., Antonsson A., Green A. C., et al. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. International Journal of Cancer . 2018;142(4):691–701. doi: 10.1002/ijc.31088. PubMed DOI

Granstrom C., Sundquist J., Hemminki K. Population attributable fractions for ovarian cancer in Swedish women by morphological type. British Journal of Cancer . 2008;98(1):199–205. doi: 10.1038/sj.bjc.6604135. PubMed DOI PMC

Granstrom C., Sundquist J., Hemminki K. Population attributable risks for breast cancer in Swedish women by morphological type. Breast Cancer Research and Treatment . 2008;111(3):559–568. doi: 10.1007/s10549-007-9814-2. PubMed DOI

Hemminki K., Bermejo J. L., Granström C. Endometrial cancer: population attributable risks from reproductive, familial and socioeconomic factors. European Journal of Cancer . 2005;41(14):2155–2159. doi: 10.1016/j.ejca.2005.03.031. PubMed DOI

La Vecchia C. Ovarian cancer: epidemiology and risk factors. European Journal of Cancer Prevention . 2017;26(1):55–62. doi: 10.1097/cej.0000000000000217. PubMed DOI

McCarthy A. M., Friebel-Klingner T., Ehsan S., et al. Relationship of established risk factors with breast cancer subtypes. Cancer Medicine . 2021;10(18):6456–6467. doi: 10.1002/cam4.4158. PubMed DOI PMC

Hemminki K., Sundquist K., Sundquist J., Försti A., Hemminki A., Li X. Familial risks and proportions describing population landscape of familial cancer. Cancers . 2021;13(17):p. 4385. doi: 10.3390/cancers13174385. PubMed DOI PMC

Yang H. P., Murphy K. R., Pfeiffer R. M., et al. Lifetime number of ovulatory cycles and risks of ovarian and endometrial cancer among postmenopausal women. American Journal of Epidemiology . 2016;183(9):800–814. doi: 10.1093/aje/kwv308. PubMed DOI PMC

Marsden J. Hormonal contraception and breast cancer, what more do we need to know? Post Reproductive Health . 2017;23(3):116–127. doi: 10.1177/2053369117715370. PubMed DOI

MacKintosh M. L., Crosbie E. J. Prevention strategies in endometrial carcinoma. Current Oncology Reports . 2018;20(12):p. 101. doi: 10.1007/s11912-018-0747-1. PubMed DOI PMC

Kim M., Suh D. H., Lee K. H., et al. Major clinical research advances in gynecologic cancer in 2018. J Gynecol Oncol . 2019;30(2):p. e18. doi: 10.3802/jgo.2019.30.e18. PubMed DOI PMC

Pfeiffer R. M., Webb-Vargas Y., Wheeler W., Gail M. H. Proportion of U.S. Trends in breast cancer incidence attributable to long-term changes in risk factor distributions. Cancer Epidemiology, Biomarkers & Prevention . 2018;27(10):1214–1222. doi: 10.1158/1055-9965.epi-18-0098. PubMed DOI PMC

Vaccarella S., Franceschi S., Engholm G., Lönnberg S., Khan S., Bray F. 50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence. British Journal of Cancer . 2014;111(5):965–969. doi: 10.1038/bjc.2014.362. PubMed DOI PMC

Anttila A., Ronco G., Clifford G., et al. Cervical cancer screening programmes and policies in 18 European countries. British Journal of Cancer . 2004;91(5):935–941. doi: 10.1038/sj.bjc.6602069. PubMed DOI PMC

Partanen V. M., Anttila A., Heinävaara S., et al. NordScreen-an interactive tool for presenting cervical cancer screening indicators in the Nordic countries. Acta Oncologica . 2019;58(9):1199–1204. doi: 10.1080/0284186x.2019.1615637. PubMed DOI

Klint A., Tryggvadóttir L., Bray F., et al. Trends in the survival of patients diagnosed with cancer in female genital organs in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncologica . 2010;49(5):632–643. doi: 10.3109/02841861003691945. PubMed DOI

Pukkala E., Martinsen J. I., Lynge E., et al. Occupation and cancer-follow-up of 15 million people in five Nordic countries. Acta Oncologica . 2009;48(5):646–790. doi: 10.1080/02841860902913546. PubMed DOI

Njor S. H., Schwartz W., Blichert-Toft M., Lynge E. Decline in breast cancer mortality: how much is attributable to screening? Journal of Medical Screening . 2015;22(1):20–27. doi: 10.1177/0969141314563632. PubMed DOI

IARC. Breast Cancer Screening . Lyon, France: IARC Press; 2016.

Sebuødegård S., Botteri E., Hofvind S. Breast cancer mortality after implementation of organized population-based breast cancer screening in Norway. Journal of the National Cancer Institute: Journal of the National Cancer Institute . 2020;112(8):839–846. doi: 10.1093/jnci/djz220. PubMed DOI

Giordano L., von Karsa L., Tomatis M., et al. Mammographic screening programmes in Europe: organization, coverage and participation. Journal of Medical Screening . 2012;19(1):72–82. doi: 10.1258/jms.2012.012085. PubMed DOI

Allemani C., Weir H. K., Carreira H., et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2) The Lancet . 2015;385(9972):977–1010. doi: 10.1016/s0140-6736(14)62038-9. PubMed DOI PMC

Allemani C., Matsuda T., Di Carlo V., et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. The Lancet . 2018;391(10125):1023–1075. doi: 10.1016/s0140-6736(17)33326-3. PubMed DOI PMC

De Angelis R., Sant M., Coleman M. P., et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-A population-based study. The Lancet Oncology . 2014;15(1):23–34. doi: 10.1016/s1470-2045(13)70546-1. PubMed DOI

Santucci C., Carioli G., Bertuccio P., et al. Progress in cancer mortality, incidence, and survival: a global overview. European Journal of Cancer Prevention . 2020;29(5):367–381. doi: 10.1097/cej.0000000000000594. PubMed DOI

Hemminki J., Försti A., Hemminki A., Hemminki K. Survival trends in solid cancers in the Nordic countries through 50 years. European Journal of Cancer . 2022;175:77–85. doi: 10.1016/j.ejca.2022.08.015. PubMed DOI

Hemminki K., Kanerva A., Försti A., Hemminki A. Cervical, vaginal and vulvar cancer incidence and survival trends in Denmark, Finland, Norway and Sweden with implications to treatment. BMC Cancer . 2022;22(1):p. 456. doi: 10.1186/s12885-022-09582-5. PubMed DOI PMC

Pukkala E., Engholm G., Hojsgaard Schmidt L. K., et al. Nordic Cancer Registries-an overview of their procedures and data comparability. Acta Oncologica . 2018;57(4):440–455. doi: 10.1080/0284186x.2017.1407039. PubMed DOI

Engholm G., Ferlay J., Christensen N., et al. NORDCAN--a Nordic tool for cancer information, planning, quality control and research. Acta Oncologica . 2010;49(5):725–736. doi: 10.3109/02841861003782017. PubMed DOI

Larønningen S., Ferlay J., Beydogan H., Bray F., Engholm G., Ervik M. Association of the Nordic Cancer Registries . Cancer Registry of Norway; 2022. NORDCAN: Cancer incidence, mortality, prevalence and survival in the nordic countries.

Storm H. H., Klint A., Tryggvadóttir L., et al. Trends in the survival of patients diagnosed with malignant neoplasms of lymphoid, haematopoietic, and related tissue in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncologica . 2010;49(5):694–712. doi: 10.3109/02841861003631495. PubMed DOI

Engholm G., Gislum M., Bray F., Hakulinen T. Trends in the survival of patients diagnosed with cancer in the Nordic countries 1964-2003 followed up to the end of 2006. Material and methods. Acta Oncologica . 2010;49(5):545–560. doi: 10.3109/02841861003739322. PubMed DOI

Lundberg F. E., Andersson T. M., Lambe M., et al. Trends in cancer survival in the Nordic countries 1990-2016: the NORDCAN survival studies. Acta Oncologica . 2020;59(11):1266–1274. doi: 10.1080/0284186x.2020.1822544. PubMed DOI

Tichanek F., Försti A., Liska V., Hemminki A., Hemminki K. Survival in colon, rectal and small intestinal cancers in the nordic countries through a half century. Cancers . 2023;15(3):p. 991. doi: 10.3390/cancers15030991. PubMed DOI PMC

Bürkner P. An R package for Bayesian multilevel models using Stan. Journal of Statistical Software . 2017;80:1–28.

Bürkner P. Advanced Bayesian multilevel modeling with the R package (brms) The R Journal . 2018;10(1):395–411. doi: 10.32614/rj-2018-017. DOI

Carpenter B., Gelman A., Hoffman M., et al. Stan: a probabilistic programming language. Journal of Statistical Software . 2017;76(1) doi: 10.18637/jss.v076.i01. PubMed DOI PMC

Ginsburg O., Bray F., Coleman M. P., et al. The global burden of women’s cancers: a grand challenge in global health. The Lancet . 2017;389(10071):847–860. doi: 10.1016/s0140-6736(16)31392-7. PubMed DOI PMC

Hemminki K., Försti A. Incidence, mortality and survival trends in breast cancers coincident with introduction of mammography in the nordic countries. Cancers . 2022;14(23):p. 5907. doi: 10.3390/cancers14235907. PubMed DOI PMC

Nordenskjöld A. E., Fohlin H., Arnesson L. G., et al. Breast cancer survival trends in different stages and age groups-a population-based study 1989-2013. Acta Oncologica . 2019;58(1):45–51. doi: 10.1080/0284186x.2018.1532601. PubMed DOI

Cardoso F., Costa A., Senkus E., et al. 3rd ESO–ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3) The Breast . 2017;31:244–259. doi: 10.1016/j.breast.2016.10.001. PubMed DOI

Dursun P., Ayhan A. Gynecologic oncologist perspective about ESMO-ESGO-ESTRO consensus conference on endometrial cancer. International Journal of Gynecological Cancer . 2017;27(4):826–831. doi: 10.1097/igc.0000000000000931. PubMed DOI

Shin D. W., Jung K. W., Ha J., Bae J. Conditional relative survival of patients with endometrial cancer: a Korean National Cancer Registry study. Journal of Gynecologic Oncology . 2022;33(2):p. e23. doi: 10.3802/jgo.2022.33.e23. PubMed DOI PMC

Hemminki K., Försti A., Hemminki O., Liska V., Hemminki A. Long-term survival trends for primary liver and pancreatic cancers in the Nordic countries. JHEP Reports . 2022;4(12) doi: 10.1016/j.jhepr.2022.100602.100602 PubMed DOI PMC

Ledermann J. A., Raja F. A., Fotopoulou C., Gonzalez-Martin A., Colombo N., Sessa C. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology . 2013;24(6):vi24–32. doi: 10.1093/annonc/mdt333. PubMed DOI

Cohen P. A., Jhingran A., Oaknin A., Denny L. Cervical cancer. The Lancet . 2019;393(10167):169–182. doi: 10.1016/s0140-6736(18)32470-x. PubMed DOI

Bruni L., Saura-Lázaro A., Montoliu A., et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019. Preventive Medicine . 2021;144 doi: 10.1016/j.ypmed.2020.106399.106399 PubMed DOI

Lehtinen M., Baussano I., Paavonen J., Vanska S., Dillner J. Eradication of human papillomavirus and elimination of HPV-related diseases-scientific basis for global public health policies. Expert Review of Vaccines . 2019;18(2):153–160. doi: 10.1080/14760584.2019.1568876. PubMed DOI

Walsh R. J., Tan D. S. P. The role of immunotherapy in the treatment of advanced cervical cancer: current status and future perspectives. Journal of Clinical Medicine . 2021;10(19):p. 4523. doi: 10.3390/jcm10194523. PubMed DOI PMC

Razzaghi H., Saraiya M., Thompson T. D., Henley S. J., Viens L., Wilson R. Five-year relative survival for human papillomavirus-associated cancer sites. Cancer . 2018;124(1):203–211. doi: 10.1002/cncr.30947. PubMed DOI PMC

Shin D. W., Bae J., Ha J., Lee W. M., Jung K. W. Trends in incidence and survival of patients with vulvar cancer in an Asian country: analysis of the Korean Central Cancer Registry 1999-2018. Gynecologic Oncology . 2022;164(2):386–392. doi: 10.1016/j.ygyno.2021.11.017. PubMed DOI

Walters S., Maringe C., Butler J., Brierley J. D., Rachet B., Coleman M. P. Comparability of stage data in cancer registries in six countries: lessons from the International Cancer Benchmarking Partnership. International Journal of Cancer . 2013;132(3):676–685. doi: 10.1002/ijc.27651. PubMed DOI

Lundberg F. E., Birgisson H., Johannesen T. B., et al. Survival trends in patients diagnosed with colon and rectal cancer in the nordic countries 1990-2016: the NORDCAN survival studies. European Journal of Cancer . 2022;172:76–84. doi: 10.1016/j.ejca.2022.05.032. PubMed DOI

Survival in Elderly Ovarian Cancer Remains Challenging in the Nordic Countries