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Time Trends in the Incidence and Mortality of Ovarian Cancer in Ireland, Northern Ireland, and Israel, 1994–2013
  1. Lital Keinan-Boker, MD*,,,
  2. Barbara G. Silverman, MD,§,
  3. Paul M. Walsh, PhD,
  4. Anna T. Gavin, MD and
  5. Catherine Hayes, MD
  1. *School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa; and
  2. Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel;
  3. Public Health and Primary Care, Institute for Population Health, Trinity College Dublin Education Centre, Tallaght Cross, Dublin, Ireland;
  4. §School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
  5. National Cancer Registry Ireland, Cork, Ireland; and
  6. Northern Ireland Cancer Registry, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom.
  1. Address correspondence and reprint requests to Lital Keinan-Boker, MD, PhD, MPH School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Abba Hushy Blvd., Haifa 31905, Israel. E-mail:;


Objectives The aims of this study were to compare time trends in ovarian cancer incidence and mortality in populations with (1) similar genetics but different health care systems (Ireland and Northern Ireland [NI]) and (2)different genetics but similar health care system (Israeli Jews and Arabs) and to interpret the results.

Methods Age-standardized rates of ovarian cancer incidence and mortality for 1994–2013 in the 3 countries were obtained from national cancer registries and national statistics. Time trends in incidence, mortality, and incidence-to-mortality ratio were assessed by linear regression models applied to each country and between populations (Ireland-NI, Ireland–Israeli Jews, Israeli Jews–Arabs). Joinpoint analysis was used to calculate the annual percentage change (APC).

Results Ovarian cancer incidence and mortality rates in 1994 were similar in the countries studied. Thereafter a reduction in incidence and mortality was observed in Ireland (incidence APC1994–2013 = −0.75%, P < 0.05; mortality APC1994–2013 = −0.67%, P < 0.05), NI (incidence APC1998–2013 = −1.5%, P < 0.05; mortality APC2005–2013 = −3.8%, P < 0.05), and Israeli Jews (incidence APC1994–2013 = −2.2%, P < 0.05; mortality APC1994–2013 = −1.2%, P < 0.05). Trends in Israeli Arabs remained stable. Significant incidence trend differences between Ireland and Israeli Jews (P = 0.009) and between Israeli Jews and Arabs (P = 0.004) were observed. The only significant trend difference for mortality was between Israeli Jews and Arabs (P = 0.038). Incidence-to-mortality ratios showed stable trends in all groups except for Israeli Jews (APC1994–2013 = −1.0%, P < 0.05).

Conclusions Time trends in ovarian cancer incidence (decreasing) and mortality (decreasing) were similar in Ireland, NI, and Israeli Jews, following global trends, with a more prominent incidence decline in Israeli Jews. Decreasing mortality trends are driven by falling incidence in the countries studied rather than improved survival.

  • Incidence trends
  • Ireland
  • Israel
  • Mortality trends
  • Northern Ireland
  • Ovarian cancer

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  • L.K.-B. was a visiting professor.

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (