Trends in gynaecological cancer incidence in Singapore over the last two decades.

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Background: Singapore has witnessed a significant rise in cancer incidence among women over recent decades, particularly in breast cancer. Understanding temporal trends in the incidence of other gynaecological cancers, as well as factors driving these patterns, is important for characterising evolving epidemiological shifts and informing efforts to improve women’s health. Methods: This population-based study analysed 20,630 cervical, ovarian, fallopian tube, and uterine cancer cases diagnosed between 2000 and 2021 from the government administrative and health records via the TRUST platform (https://trustplatform.sg/). We first examined the temporal trend of age-standardized incidence rate (ASIR) and estimated average annual percentage changes (AAPC) using joinpoint regression analysis by age group. Decomposition analysis was performed to assess the increase in cancer cases attributable to changes in population age structure, population size, and cancer risk due to epidemiological factors. Results: Over the 22-year period, the total number of gynaecological cancer cases more than doubled, with the largest absolute increase observed in uterine cancer. The ASIR for cervical cancer decreased from 10.68 to 6.91 per 100,000, whereas the ASIR increased from 10.79 to 13.24 per 100,000 for ovarian cancer and from 9.43 to 21.47 per 100,000 for uterine cancer. The AAPC was −2.26% (95% CI: −3.16% to −1.40%) for cervical cancer, 0.37% (95% CI: −0.13% to 0.87%) for ovarian cancer, and 3.47% (95% CI: 2.69% to 4.27%) for uterine cancer. The AAPCs were more pronounced for the younger age groups (<40 years old) for cervical 4.60% (95% CI: 2.02% to 6.17%) and uterine 5.78% (95% CI: 4.04% to 8.03%) cancers. The increasing incidence in uterine cancer was observed across all age groups over the entire study period. Decomposition analysis showed that change in cancer risk contributed the most to the observed increase in uterine cancer and decrease in cervical cancer. Conclusions: The change in gynaecological cancer incidence in Singapore varies across cancer types and is multifactorial, with change in cancer risk playing a significant role. Our analysis revealed important temporal patterns and a notable rise in cancer risk for uterine cancer, likely influenced by screening, environmental and lifestyle factors.