Cancers of the female reproductive system - namely cancer of the cervix uteri (cervical cancer), cancer of the corpus uteri (which includes mostly adenocarcinomas originating in the endometrium and some other rarer cancers, such as sarcomas), ovarian, vulvar, vaginal, fallopian tube cancers, and choriocarcinoma - are an important cause of cancer morbidity and mortality worldwide. Cervical, endometrial, and ovarian cancers are relatively common (), whereas vulvar, vaginal, fallopian tube cancers, and choriocarcinomas are very rare.
Fig. 1 Cancer incidence and mortality among females. GLOBOCAN, 2008 . ASR (W): world age-standardized incidence rate.
Cervical cancer is the third most common cancer in women worldwide, behind breast and colorectal cancers; it is also the seventh most common cancer overall, with an estimated 530,232 new cases in 2008 () [1
]. More than 85% of the global burden of cervical cancer occurs in less developed regions, where it accounts for 13% of all cancers in women. High standardized incidence rates (greater than 20 per 100,000 women) are found in Eastern, Western, and Southern Africa, South-Central Asia, South America, Melanesia, and Central Africa. Rates are lowest in Western Asia, North America, and Australia/New Zealand (less than 6 per 100,000 women) [1
]. The overall mortality : incidence ratio of cervical cancer is 52%; it was responsible for 275,000 deaths in 2008, about 88% of which occurred in less developed regions ().
Table 1 Statistics on selected cancer sites among women worldwide, GLOBOCAN, 2008 
Fig. 2 Cancer incidence and mortality among women in more and less developed regions of the world. ASR (W): world age-standardized incidence rate. GLOBOCAN, 2008 .
Endometrial cancer is the sixth most common cancer in women worldwide, with an estimated 288,387 new cases in 2008, and a standardized incidence rate of 8.2 per 100,000 women (). While the global burden, in terms of the number of cases, is evenly distributed between less developed and more developed regions (), incidence and mortality rates are higher in more developed regions (). North America and Western Europe show some of the highest standardized incidence rates (greater than 10 per 100,000 women), with the lowest rates occurring in Asia and Africa [2
]. Overall, the mortality : incidence ratio of endometrial cancer is 26%, and it was responsible for 73,854 deaths in 2008.
Cancers of the ovary and ovarian adnexae, including fallopian tube cancer, constitute the eighth most common cancers among women worldwide (), with 224,747 incident cases (standardized incidence rate 6.3 per 100,000 women); 140,163 deaths are estimated to have occurred in 2008. Both more developed and less developed regions of the world are affected (), although the incidence rates are at least twice as high in Europe and North America than in Asia and Africa [1
]. The mortality : incidence ratio is 62% ().
The worldwide number of new cancers of the female genitalia is unknown for most countries. However, it can be estimated based on the incidence rates in countries where information is available [3
]. In 2002, the estimated number of new cancers of the female genitalia worldwide was 40,000. The age-standardized incidence rates of vulvar cancer worldwide are estimated to vary between 0.5 and 1.5 per 100,000, without a clear geographical pattern. The standardized incidence rates of vaginal cancer are estimated to be between 0.3 and 0.7 per 100,000 in most countries [4
Choriocarcinomas constitute about 0.6% of all cancers of the female reproductive system. In 2002, there were about 5,800 cases reported worldwide, the vast majority occurring in less developed regions. Age-standardized incidence rates range from 0.04 in Southern Africa and Northern Europe to 0.43 per 100,000 women in South-East Asia [6
]. In Vietnam, the incidence rate has been reported to be 1.98 per 100,000 women [7
So far, the etiology of cancers of the female reproductive system has been primarily attributed to lifestyle factors. As women contribute substantially to the labor market, it is important to assess whether environmental factors are also at play. This review summarizes the epidemiology of cancers of the female reproductive system and associated lifestyle factors. It also assesses the available evidence for occupational factors associated with these cancers.