Global determinants of gynecologic cancer incidence and mortality: A cluster-based analysis with predictive insights

Gynecologic cancers, including cervical, ovarian, and endometrial cancers, remain a significant global health challenge. In 2022, 9 175 141 new cancer cases were reported among females, with 1 473 427 (16.1%) attributed to gynecologic cancers, reflecting an incidence rate of 30.4 per 100 000. These cancers were responsible for 680 372 deaths, representing 15.9% of total female cancer mortality at a rate of 17.3 per 100 000. Identifying the drivers of incidence and mortality is critical for addressing disparities and advancing the United Nations Sustainable Development Goals (SDGs), particularly those targeting health equity and gender equality.

To identify and analyze the socioeconomic, healthcare, lifestyle, and environmental determinants driving gynecologic cancer incidence and mortality globally. The study leveraged a cluster-based approach across 68 countries, representing 34.9% of global nations and spanning diverse geographic and economic contexts.

Eighty-seven variables were analyzed using Principal Component Analysis (PCA), consolidating them into 17 key components that explained 74.4% of the total variance. These components informed a hierarchical clustering process that grouped countries into four profiles based on shared characteristics. Cluster-specific backward regression models examined the influence of these components on standardized incidence and mortality rates (Adjusted Rate Standardized, ARS). Monte Carlo simulations validated projections, providing robust insights into disparities.

The study revealed significant cluster-specific variability in factors influencing gynecologic cancer outcomes. Cluster 1 excelled in lifestyle-driven cancer prevention, whereas systemic barriers in Cluster 4 necessitate urgent healthcare investment and policy reform. Intermediate clusters exhibited variability influenced by social stability, environmental health, and healthcare infrastructure. The analysis underscored disparities in key predictors such as HPV vaccination coverage, healthcare expenditure, public health policies, and access to preventive services.

This study highlights the importance of tailored, cluster-specific strategies to reduce disparities in gynecologic cancer outcomes. Interventions should prioritize equitable access to preventive care, lifestyle modifications, and healthcare investments, particularly in resource-constrained regions. The findings align with SDG targets on health and well-being (SDG 3) and gender equality (SDG 5), offering actionable insights to accelerate progress toward WHO's 90-70-90 goals and the elimination of cervical cancer as a public health threat.