Cervical cancer incidence and mortality in Sri Lanka, 1992-2021: age-period-cohort analysis

Abstract Cervical cancer remains a significant public health concern in Sri Lanka, ranking as the second most prevalent malignancy among women despite global prevention efforts. The disease disproportionately affects lower-resource regions, with inadequate screening coverage and human papillomavirus (HPV) vaccination implementation posing persistent challenges. This study analyzed cervical cancer trends in Sri Lanka (1992-2021) among women aged ≥15 years using Global Burden of Disease data. We employed joinpoint regression for trend assessment and applied the intrinsic estimator technique to identify key demographic patterns through age-period-cohort decomposition, essential for developing targeted interventions. Crude incidence rates increased from 7.98 to 9.91 per 100,000 (annual percent change [APC], 0.82%, 95% confidence interval [CI]: 0.65-0.99%) between 1992 and 2021, while age-standardized incidence rates decreased from 9.81 to 7.98 per 100,000 (APC -0.59%, 95% CI: -0.74 to -0.44%). Similarly, age-standardized mortality rates declined from 5.47 to 3.53 per 100,000 (APC, -1.34%, 95% CI: -1.51% to -1.16%), though crude mortality rates increased (APC,0.58%, 95% CI: 0.39% to 0.75%). Strong age effects were observed, with risk peaking at ages 70-74 years, while cohort effects showed decreasing trends with a 48% risk reduction in recent cohorts compared to the 1912 birth cohort. Period effects were not statistically significant, yet showed increasing trends for incidence (p = 0.09) and mortality (p = 0.27). This paradoxical pattern-decreasing age-standardized rates alongside increasing crude rates-reveals growing disease burden due to demographic shifts. The strong age and cohort effects, coupled with increasing non-significant period effects, directly indicate screening program ineffectiveness, underscoring the urgent need for more robust and expanded prevention strategies to meet WHO's 2030 elimination targets, particularly in aging populations with limited healthcare access. Key messages • Despite declining age-standardized rates, rising crude rates highlight a growing cervical cancer burden in Sri Lanka, exceeding WHO’s 2030 elimination threshold. • Strengthening prevention with nationwide screening for women aged 35–45 is crucial to reverse trends and achieve WHO targets for cervical cancer elimination in Sri Lanka.