Table 5. Summary of the trends in age-standardized incidence and mortality for major and sub-major cancer sites.

	Cancer site	ICD-10	Sex	Incidence	Mortality	Possible interpretation
						Phenomenon [references, if any]	Related factors [references, if any]
Major	Stomach	C16	Male	Decreased continuously (1985–2005, 2009–2015)	Decreased continuously (1958–1992, 1996–2018)	- Long-term decrease in incidence and mortality - Steeper decrease in mortality than incidence - Acceleration of mortality reduction in males	- Decrease in the prevalence of Helicobacter pylori infection combined with improvements in sanitation, diet (reduced salt intake), and food preservation techniques[11,32,33] - Early detection and improvements in prognosis,[11] especially after 2000[70] - Coverage of H. pylori eradication in 2013[35] (not consistent in females or incidence)
			Female	Decreased continuously (1985–2015)	Decreased continuously (1958–2018)
	Colon/rectum	C18–C20	Male	Increased until 1990s (1985–1994), levelled off thereafter (1994–2015)	Increased until 1990s (1958–1996), decreased thereafter (1996–2018)	- Increase and peaking out of incidence and mortality - Levelling of incidence - Recent slight decrease in mortality[11,70]	- Spread of Westernized lifestyles in 1970s[3,11,74,75] - Introduction of organized screening (fecal occult blood test) in 1992[11,74] - Improvements in prognosis[11,70]
			Female	Increased until 1990s (1985–1996), slowly increased thereafter (2003–2015)	Increased until 1990s (1958–1992), intermittently decreased thereafter (1992–2009, 2014–2018)
	Liver	C22	Male	Increased until 1990s (1985–1991), decreased thereafter (1991–2015) (accelerated in 2008)	Increased until 1990s (1974–1996), decreased thereafter (1996–2018) (accelerated in 2010)	- Divergence between incidence and mortality since 1980s - Decrease in incidence and mortality since 1990s - Acceleration of the decrease in incidence and mortality[11] - Decrease in mortality	- Improvements in differential diagnosis by the introduction of imaging techniques and biomarkers - Long-term decrease in in the prevalence of hepatitis virus (mainly HCV)[11,37] - Therapeutic improvements including pegylated interferon and direct acting antivirals[11] - Improvement in survival after 2000 (Liver cancer[70])
			Female	Increased until 1990s (1985–1995), decreased thereafter (1995–2015) (accelerated in 2010)	Decreased (1958–1975) and increased (1989–1999) until 1990s, decreased thereafter (1999–2018) (accelerated in 2008)
	Pancreas	C25	Male	Increased continuously (1985–2015)	Increased continuously (1958–1987, 2002–2018) (slowed down in 1987)	- Increase in incidence and mortality - Divergence between incidence and mortality	- Increase in risk factors such as type 2 diabetes[56] - Improvements in diagnostic measures such as computed tomography imaging and biopsy for histologic confirmation[57] - Improvement in survival after 2000[70]
			Female	Increased continuously (1985–2015)	Increased continuously (1958–1988, 1994–2018) (slowed down in 1988)
	Lung, trachea	C33–C34	Male	Increased until 2010s (1985–2010), decreased thereafter (2010–2015)	Increased until 1990s (1958–1996), decreased thereafter (1996–2018)	- Decrease in mortality and incidence of squamous and small-cell lung cancer after 1990s[46–48] - Increase in incidence (especially adenocarcinoma)[46–48] - Decrease in mortality	- Decrease in smoking prevalence[46–48] - Shift from non-filtered to filtered cigarettes[48] - Improvement in diagnostic measures such as CT[46,47] - Improvement in prognosis for patients with chemotherapy[76] - Improvement in survival after 2005[70]
			Female	Increased continuously (1985–2015)	Increased until 1990s (1958–1998), decreased intermittently thereafter (1998–2003, 2014–2018)
	Breast	C50	Female	Increased until 2010s (1985–2010), levelled off thereafter (2010–2015)	Increased continuously but gradually slowed down (1964–2018)	- Long-term Increase in incidence and mortality - Slowing down of mortality and Increase in the incidence of carcinoma in situ[11,31] - Increase in local cases and decrease in regional cases[31] - Divergence between incidence and mortality	- Effect of reproductive factors (younger menarche, older age at birth, lower parity)[11,29,30] - Dissemination of screening[11,31] - Improvement in diagnostic technology[31] - Improvement in survival from 1993 to 2006[71]
	Cervix uteri	C53	Female	Decreased until 1990s (1985–1991), increased thereafter (1991–2015)	Decreased intermittently until 1980s (1958–1973, 1978–1989), increased thereafter (1989–2018)	- Increase in incidence and mortality - Increase in mortality - Divergence between incidence and mortality	- Increasing prevalence of human papillomavirus (HPV) infection among young women[78] - Poor uptake of screening[11] - Improvement in prognosis after 2002, especially in cases of “localized” and “adjacent organs”[79] or stage III[77] likely due to the introduction of concurrent chemotherapy and radiation and dissemination of clinical guidelines
	Corpus uteri	C54	Female	Increased continuously (1985–2015)	Decreased until 1970s (1958–1972), increased continuously thereafter (1972–2018)	- Increase in incidence and mortality - Divergence between incidence and mortality	- Long-term effect of reproductive factors (older and fewer births)[11] - Improvement in prognosis for patients of stage I or II receiving adjuvant chemotherapy[80]
	Prostate	C61	Male	Increased continuously (1985–2015) (accelerated between 2000–2004)	Increased until 1990s (1958–1997), decreased from 2000s (2005–2018)	- Rapid increase in incidence in the early 2000s prominent in localized cases[26] - Slowing down of the increase in prostate cancer incidence in 2004 - Sharp increase in incidence in the absence of a clear change in mortality - Divergence between incidence and mortality - Levelling of and decrease in mortality since 1990s	- Spread of prostate-specific antigen (PSA) screening[26] - Convergence of the spread of PSA screening - Potential overdiagnosis[11,58,59] - Improvement in survival after 2000[70] - Improvement of prognosis since 1990s by the introduction of hormone therapy[63] and other refinements in treatment and disease management[64]
Sub-major	Esophagus	C15	Male	Increased continuously (1985–2015)	Increased (1958–1971, 1994–1998), decreased (1971–1977) intermittently until 1990s, decreased thereafter (1998–2018)	- Long-term increase in incidence in males - Decrease in mortality - Divergence between incidence and mortality	- Increase in incidence of gastroesophageal reflux disease associated with decrease in the prevalence of Helicobacter pylori infection[36] - Expansion of endoscopic procedure of upper gastrointestinal tract[82] and advances in treatment[81] - Improvement in survival after 2000[70]
			Female	Decreased until 1990s (1985–1996), increased thereafter (1996–2015)	Decreased continuously (1969–2018) (slowed down in 1989)
	Gallbladder and bile ducts	C23–C24	Male	Decreased continuously (1985–2015)	Increased until 1980s (1958–1987), decreased from 1990s (1995–2018)	- Long-term decrease in incidence and mortality -Similarity of the incidence and mortality trends to liver cancer	- Changes in risk factors such as gallstones, body fatness or obesity, and chronic infections [41–43] - Control over communicable diseases[44] - Overlapping of risk factors and misclassification between intra- and extra-hepatic cholangiocarcinoma[45]
			Female	Decreased continuously (1985–2015)	Increased until 1980s (1958–1985), decreased from 1990s (1992–2018)
	Ovary	C56	Female	Increased continuously (1985–2015)	Increased until 1990s (1958–1996), decreased intermittently thereafter (1996–2000, 2011–2018)	- Long-term increase in incidence - Divergence between incidence and mortality	- Changes in reproductive factors (eg younger menarche, older age at birth, lower parity[29,30] and increase in endometriosis) - Improvement of prognosis since 1990s by the introduction of new chemotherapies,[83] molecular target drugs, and also aggressive debulking surgery[84] - Improvement in survival after 2000[70]
	Urinary bladder	C67	Male	Increased until 2000s (1985–2003), decreased thereafter (2003–2015)	Increased (1958–1980, 1988–1999), decreased (1980–1988, 1999–2018) intermittently	- Decrease in incidence in males after 1990s - Absence of steep decrease in mortality	- Decrease in prevalence of tobacco smoking[86] - Improvement in survival in 1995–2004 predominantly observed for cases with “regional” stage,[85] which could have been masked due to the predominance of “localized” stage[25,85]
			Female	Decreased continuously (1985–2015)	Decreased continuously (1969–2018) (slowed down in 1990)
	Kidney and other urinary organs (except bladder)	C64–C66 C68	Male	Increased continuously (1985–2015)	Increased continuously until 2010s (1958–2016), decreased thereafter (2016–2018)	- Long-term increase in incidence and mortality - Long-term increase in incidence - Divergence between incidence and mortality	- Tobacco smoking[49,50] - Changes in other potential risk factors (eg hypertension, diabetes)[90,91] - Improvement of diagnostic imaging techniques[88] -Improvement in therapy, surgery, and noninvasive tumor imaging in renal cell carcinoma since the late 1990s[87,89]
			Female	Increased continuously (1985–2015)	Increased continuously until 2000s (1958–2006), levelled off thereafter (2006–2018)
	Thyroid	C73	Male	Increased until 2000s (1985–2007), levelled off thereafter (2007–2015)	Increased until 1990s (1958–1997), decreased thereafter (1997–2018)	- Increases in incidence of small papillary lesions - Divergence between incidence and mortality	- Increased medical surveillance of thyroid nodules and symptoms combined with improvement of diagnostic imaging techniques including ultrasonography, leading to a potential overdiagnosis[60,61] - Improved diagnosis, treatment, and disease management[60,61]
			Female	Increased intermittently until 2000s (1985–1991, 2002–2008), levelled off thereafter (2008–2015)	Increased until 1970s (1958–1977), decreased thereafter (1977–2018)
	Malignant lymphoma	C81–C85 C96	Male	Increased continuously (1985–2015) (accelerated in 2000)	Increased until 2000s (1958–2001), decreased temporarily (2001–2005), levelled off thereafter (2005–2018)	- Long-term increases in incidence and mortality - Divergence between incidence and mortality	- Westernization of lifestyles[66] - Improvements in diagnosis and coding of registry data[65,66] - Improvement in prognosis[65], consistent with increase in survival after 2000[70]
			Female	Increased continuously (1985–2015)	Increased until 2000s (1958–2001), decreased temporarily (2001–2006), levelled off thereafter (2006–2018)

ICD-10, International Classification of Diseases, 10th revision.