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  • The major strength of the study is the use

    2019-08-20

    The major strength of the study is the use of reliable population based data from a well validated registry program representing different parts of India which enabled a nation-wide snapshot of MM incidence profile. A possible limitation is the < 10% coverage of the total population of India by these 27 PBCRs. Nonetheless, these PBCRs constitute the only source of authentic population based cancer incidence data in India. As these registries represent various parts of the country, they portray India’s cancer profile fairly well. The cancer registry data from India were classified as high quality by GLOBOCAN standards [4].
    Conclusion
    Author contributions
    Conflict of interest
    Funding
    Acknowledgements
    Introduction Uterine cancer—or more specifically corpus uteri cancer—is the most common gynaecological cancer and the fourth most common cancer affecting women in the United Kingdom [1]. In the past 10 years the incidence of uterine cancer in Scotland has increased by 32%, representing the greatest relative increase among all cancer types [2]. Similar trends have been reported in other developed countries. In the United States of America, uterine cancer is set to become the third most common female malignancy, surpassing lung and colorectal cancers [3,4]. This increase in incidence is attributed to low-grade endometrioid or type 1 cancers, thought to be driven by excess oestrogen and Vorinostat (SAHA, MK0683) associated with obesity [5]. Several authors, however, have highlighted that the changing patterns in hysterectomy could play an important part in influencing time trends in uterine cancer [6,7]. In Scotland, the numbers of hysterectomies performed for benign conditions have more than halved since the mid-1990s [7], leaving a larger population of women at risk of developing uterine cancer. Similar patterns are seen in England and Wales [8]. Inclusion of women who have had a hysterectomy in the population denominator leads to under-estimation of incidence and risk of uterine cancer [[9], [10], [11]]. A lack of information regarding hysterectomy prevalence means that the total population of women is commonly used as the denominator in estimates of uterine cancer incidence. Thus, the true incidence of uterine cancer and accurate data on time trends are not known. We have tested the hypothesis that correcting for changing trends in hysterectomy prevalence will influence recent time trends in uterine cancer incidence.
    Materials and methods
    Discussion Patterns of changing prevalence of hysterectomy varied with age. Estimated hysterectomy prevalence between 1996 and 2015 decreased among women <65 years old while increasing in older women as a consequence of the age-period-cohort effect [18,19]. Hysterectomy prevalence was particularly high in the cohort born in 1942–1950 and likely to have undergone a hysterectomy between 1982 and 2000; hysterectomies were commonly performed among women aged 40–50 years [6]. Approximately 60% of British women with heavy menstrual bleeding referred to a gynaecologist underwent a hysterectomy prior to 1991 [20]. Subsequent introduction of effective non-surgical therapies—including endometrial ablation and the levonorgestrel-releasing intrauterine coil—resulted in a reduction in hysterectomies. The annual number of hysterectomies performed in England fell by two thirds between 1995 and 2005 [8]. The hysterectomy prevalence estimates obtained in Scotland were lower than those reported by previous UK studies in earlier time periods [6], and were half the prevalence reported by a recent German study [21]. These differences could be due to time trends described above, and lower starting hysterectomy prevalence and/or a sharper decrease in hysterectomy incidence over time in Scotland.