Spatiotemporal Patterns of Cancer among Women in Central Serbia: Relevance for Risk-Informed Health Planning
DOI:
https://doi.org/10.66050/jp6s4065Keywords:
cancers, women, Central Serbia, Hot Spot AnalysisAbstract
Malignant diseases are among the most prevalent health conditions affecting the female population in the Republic of Serbia. This study provides an overview of the most common malignant diseases – cancers in women in the central part of Serbia from 1999 to 2021, including breast, cervical, uterine, colorectal, bladder, ovarian, pancreatic, lung, and bronchial cancers from a geographic perspective. The spatial hot spots were identified using the well-known Getis-Ord Gi* statistic. New and consecutive hot spots for lung and bronchus cancer incidence were detected in Zlatiborski, Moravički, Mačvanski, and Beogradski counties, with oscillating and sporadic hot spots in the others. Consecutive hot spots for lung and bronchus cancer mortality were identified in Beogradski, Kolubarski, Podunavski, and Šumadijski counties, whereas oscillating hot spots were identified in Braničevski and Pomoravski counties. New hotspots for ovarian cancer incidence were concentrated in Zlatiborski and Moravički counties, whereas cold spots for uterine cancer incidence were identified in Kolubarski, Šumadijski, and Mačvanski counties. Pancreatic cancer incidence exhibited consecutive and sporadic patterns across multiple regions, while bladder cancer incidence showed widespread hot spots. The results provide valuable evidence on regions most severely affected and underscore the necessity of targeted preventive and intervention strategies. This analysis contributes to improving public health outcomes in Serbia and offers a model for similar studies in other countries.
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References
1. Akter, R., Roy, T., & Aktar, R. (2023). The Challenges of Women in Post-disaster Health Management: A Study in Khulna District. International Journal of Disaster Risk Management, 51–66. https://doi.org/10.18485/ijdrm.2023.5.1.5
2. Alford, S. H., Leadbetter, S., Rodriguez, J. L., Hawkins, N. A., Scholl, L. E., & Peipins, L. A. (2015). Cancer screening among a population-based sample of insured women. Preventive Medicine Reports, 2, 15–20. https://doi.org/10.1016/j.pmedr.2014.11.004
3. Al-Ramlawi, A. H., Al-Agha, J. F., & El-Ashgar, N. M. (2025). The Impact of Political Variables on the Quality of Health Services in Governmental Hospitals - Case Study: Al-Shifa Medical Complex. International Journal of Disaster Risk Management, 517–528. https://doi.org/10.18485/ijdrm.2025.7.2.29
4. Bačević, N., Valjarević, A., Nikolić, M., Stevanović, V., Dragojlović, J., Radaković, M., Kićović, D., Marković, R., Marković, S., & Lukić, T. (2024). Determination of changes in the total amount of precipitation using the Mann-Kendall trend test in Central Serbia for the period from 1949 to 2018. Időjárás, 128(4), 451–472. https://doi.org/10.28974/idojaras.2024.4.4
5. Barry, J., Breen, N., & Barrett, M. (2012). Significance of increasing poverty levels for determining late-stage breast cancer diagnosis in 1990 and 2000. J Urban Health, 89(4), 614–627. doi: 10.1007/s11524-011-9660-8.
6. Columbia University's Mailman School of Public Health. (n.d.). Hot spot spatial analysis. Retrieved from https://www.publichealth.columbia.edu/research/population-health-methods/hot-spot-spatial-analysis
7. Cote, M. L., Ruterbusch, J. J., Olson, S. H., Lu, K., & Ali-Fehmi, R. (2015). The growing burden of endometrial cancer: A major racial disparity affecting Black women. Cancer Epidemiol Biomarkers Prev, 24, 1407–1415. https://doi.org/10.1158/1055-9965.EPI-15-0316
8. Cvetković, V. M., Aleksova, B., Renner, R., Gačić, J., Ivanov, A., & Milašinović, S. (2025). Community-Based Disaster Risk Reduction: Overcoming Barriers to Build Stronger Communities. International Journal of Disaster Risk Management, 113–130. https://doi.org/10.18485/ijdrm.2025.7.2.7
9. Davis, C. T., Williams, V. M., Marin, E., Parker, M. R., & Glass, J. (2002). Health literacy and cancer communication. CA Cancer J Clin., 52(3), 134–149. doi: 10.3322/canjclin.52.3.134. PMID: 12018928.
10. Djebari, S., & Bestandji, S. (2025). The Role of Spatial Analysis in Notifiable Disease Monitoring and Health Risk Management: A Case Study of Constantine. International Journal of Disaster Risk Management, 215–234. https://doi.org/10.18485/ijdrm.2025.7.1.12
11. Djebari, S., & Bestandji, S. (2025). The Role of Spatial Analysis in Notifiable Disease Monitoring and Health Risk Management: A Case Study of Constantine. International Journal of Disaster Risk Management, 215–234. https://doi.org/10.18485/ijdrm.2025.7.1.12
12. DuBois, T. D., Henry, K. A., Siegel, S. D., & Lynch, S. M. (2024). Geographic disparities in cancer incidence among US adults aged 20 to 49 years, 2016–2020. Preventing Chronic Disease, 21, 230335. https://doi.org/10.5888/pcd21.230335
13. Ekpanyaskul, C., Khuhaprema, T., Wiangnon, S., & Sangrajrang, S. (2010). Case-control study of occupational categories and breast cancer risk in Thailand. Asian Pac J Cancer Prev, 11(3), 793–797. PMID: 21039056.
14. Gareis, C.E. (2021). A Review of the Social Determinants of Health Concerning Cancer-Related Outcomes Among Hispanics/Latinos in the United States. PCOM Capstone Projects. 44. https://digitalcommons.pcom.edu/capstone_projects/44
15. Getis, A., & Ord, J. K. (1992). The analysis of spatial association by use of distance statistics. Geographical Analysis, 24(3), 189–206. https://doi.org/10.1111/j.1538-4632.1992.tb00261.x
16. Han, Y., Langston, M., Fuzzell, L., Khan, S., Lewis-Thames, M. W., Colditz, G. A., et al. (2020). Breast cancer mortality hot spots among Black women with de novo metastatic breast cancer. JNCI Cancer Spectrum, 5(1), pkaa086. https://doi.org/10.1093/jncics/pkaa086
17. Henley, S. J., Miller, J. W., Dowling, N. F., Benard, V. B., & Richardson, L. C. (2018). Uterine cancer incidence and mortality—United States, 1999–2016. MMWR Morbidity and Mortality Weekly Report, 67, 1333–1338. https://doi.org/10.15585/mmwr.mm6748a1
18. Ignjatović, A., Stojanović, M., Milošević, Z., Anđelković Apostolović, M., Filipović, T., & Rančić, N., Marković, R., Topalović, M., Stojanović, D., & Otašević, S. (2021). Cancer of unknown primary – Incidence, mortality trend, and mortality-to-incidence ratio is associated with human development index in Central Serbia, 1999–2018: Evidence from the national cancer registry. Eur J Cancer Care (Engl), (1). https://doi.org/10.1111/ecc.13526
19. Ilic, M., Vlajinac, H., Marinkovic, J., & Vasiljevic, S. (2013). Joinpoint regression analysis of female breast cancer mortality in Serbia 1991–2010. Women & Health, 53(5), 439–450. https://doi.org/10.1080/03630242.2013.806388
20. Institute of Public Health of Serbia "Dr Milan Jovanović Batut". Malignant cancers for the Republic of Serbia (2020/2022; 2019/2021; 2018/2020; 2016/2020; 2017/2020; 2016/2020). Institute of Public Health of Serbia "Dr Milan Jovanović Batut".
21. Institute of Public Health of Serbia "Dr Milan Jovanović Batut". Cancer incidence and mortality in Central Serbia (2015/2017; 2014/2016; 2013/2015; 2012/2014; 2011/2013; 2010/2012; 2009/2011; 2008/2010; 2007/2010; 2006/2009; 2005/2008; 2004/2007; 2003/2006; 2002/2005; 2001/2005; 2000/2004; 1999/2002). Institute of Public Health of Serbia "Dr Milan Jovanović Batut".
22. Janković, S., Vlajinac, H., Bjegović, V. et al. (2007). The burden of disease and injury in Serbia, European Journal of Public Health, 17 (1): 80–85. https://doi.org/10.1093/eurpub/ckl072
23. Jiang, F., Fu, Z., Lu, Z., et al. (2023). Cancer survival analysis and spatial distribution during 2014–2016 in Shandong Province, China. Scientific Reports, 13, 10324. https://doi.org/10.1038/s41598-023-37252-4Ng CJ, Teo CH, Abdullah N, et al. Relationships between cancer pattern, country income, and geographical region in Asia. BMC Cancer. 2015;15:613. doi: 10.1186/s12885-015-1615-0.
24. Jovanović, M., Živaljević, V., Diklić, A., Slijepčević, N., Taušanović, K., Stevanović, K., & Paunović, I. (2017). Adrenocortical carcinoma’s incidence and mortality in central Serbia. Srpski Arhiv za Celokupno Lekarstvo, 145(1-2), 38–42. https://doi.org/10.2298/SARH160201006J
25. Kamangar, F., Dores, G. M., & Anderson, W. F. (2006). Patterns of cancer incidence, mortality, and prevalence across five continents: Defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol, 24(14), 2137–2150. https://doi.org/10.1200/JCO.2005.05.2308
26. Kanav, A., Yadav, B., Sharma, R., & Kumar, J. (2024). Spatio-temporal analysis of COVID-19 hotspots in India using geographic information systems. International Journal of Geoinformatics, 20(1), 72–87. https://doi.org/10.52939/ijg.v20i1.3027
27. Kaur, B. (2020). Disasters and exemplified vulnerabilities in a cramped Public Health Infrastructure in India. International Journal of Disaster Risk Management, 15–22. https://doi.org/10.18485/ijdrm.2020.2.1.2
28. Kesic, V., Poljak, M., & Rogovskaya, S. (2005). Awareness of cervical cancer screening among women in Serbia. Gynecologic Oncology, 99(3), S222–S225. https://doi.org/10.1016/j.ygyno.2005.07.083
29. Kričković, E., Cvetković, V.M., Kričković, Z., & Lukić, T. (2025b). Spatial-Temporal Trends of Cancer Among Women in Central Serbia, 1999–2021: Implications for Disaster and Public Health Preparedness. Healthcare, 13(17): 2169. doi:10.3390/healthcare13172169
30. Kričković, E., Lukić, T., & Jovanović-Popović, D. (2023). Geographic-medical overview of noncommunicable diseases (cardiovascular diseases and diabetes) in the territory of the AP Vojvodina (Northern Serbia). Healthcare, 11(1), 48. https://doi.org/10.3390/healthcare11010048
31. Kričković, E., Lukić, T., Kričković, Z., Stojšić-Milosavljević, A., Živanović, M., & Srejić, T. (2025a). Spatiotemporal and trend analysis of common cancers in men in Central Serbia (1999–2021). Open Geosciences,17(1), 20250802. doi:10.1515/geo-2025-0802
32. Kričković, E., Lukić, T., Srejić, T., Stojšić-Milosavljević, A., Stojanović, V., & Kričković, Z. (2024). Spatial-temporal and trend analysis of traffic accidents in AP Vojvodina (North Serbia). Open Geosciences, 16(1), 20220630. doi:10.1515/geo-2022-0630
33. Kričković, E., Novković, I., Lukić, T., & Kričković, Z. (2022). Using DPSEEA framework to investigate the relation between arsenic concentrations values in waters and cancer rates in AP Vojvodina (North Serbia). Pol. J. Environ. Stud., 31(3), 2117–2129. https://doi.org/10.15244/pjoes/143918
34. Kumari, B., & Pandey, A. C. (2020). MODIS-based forest fire hotspot analysis and its relationship with climatic variables. Spat. Inf. Res, 28(7), 87–89. https://doi.org/10.1007/s41324-019-00275
35. Li, N., Deng, Y., Zhou, L., Tian, T., Yang, S., Wu, Y., Zheng, Y., Zhai, Z., Hao, Q., Song, D., Zhang, D., Kang, H., & Dai, Z. (2019). Global burden of breast cancer and attributable risk factors in 195 countries and territories, from 1990 to 2017: Results from the Global Burden of Disease Study 2017. J Hematol Oncol, 12, 140. https://doi.org/10.1186/s13045-019-0828-0
36. Lilleborge, M., Falk, R. S., Sørlie, T., Ursin, G., & Hofvind, S. (2021). Can breast cancer be stopped? Modifiable risk factors of breast cancer among women with a prior benign or premalignant lesion. Int J Cancer. https://doi.org/10.1002/ijc.33680
37. Lovett, DA., Alan, J., Pootsa, JT., Clementsa, SA., Greena, ES., Samarasunderab, E., & Bell, D. (2014). Using geographical information systems and cartograms as a health service quality improvement tool. Spat Spatio-Temporal Epidemiol, 10, 67-74. doi: 10.1016/j.sste.2014.05.004.doi: 10.1016/j.sste.2014.05.004.
38. Markovic, M., Kesic, V., Topic, L., & Matejic, B. (2005). Barriers to cervical cancer screening: A qualitative study with women in Serbia. Social Science & Medicine, 61(12), 2528–2535. https://doi.org/10.1016/j.socscimed.2005.05.001
39. Markovic-Denic, L., Cirkovic, A., Zivkovic, S., Stanic, D., & Skodric-Trifunovic, V. (2014). Cancer mortality in central Serbia. J BUON, 19(1), 273–277. PMID: 24659675
40. Maryanaji, Z. (2020). The effect of climatic and geographical factors on breast cancer in Iran. BMC Research Notes, 13, 519. https://doi.org/10.1186/s13104-020-05368-9
41. Micić, T. (2016). Geospatial analysis of incidence and mortality caused by lung cancer in the male population in the territory of central Serbia (1999–2013). Proceedings of the GIS Day – 2016, Belgrade. https://doi.org/10.13140/RG.2.2.21030.11846
42. Micić, T., Lukić, T., Hrnjak, I., Nađ, I., & Marković, S. B. (2013). Medical-geographic analysis of incidence and mortality from brain tumors in the population of Central Serbia in the period 1999–2010. Research Review of the Department of Geography, Tourism and Hotel Management, 42(1), 37–47. UDC 91:61(497.11)
43. Mihajlović, J., Pechlivanoglou, P., Miladinov-Mikov, M., Živković, S., & Postma, M. J. (2013). Cancer incidence and mortality in Serbia 1999–2009. BMC Cancer, 13, 18. https://doi.org/10.1186/1471-2407-13-18
44. Mihalj, I., Šušak, S., Palanački Malešević, T., Važić, T., Jurca, T., Pavić, D., Simeunović, J., Vulin, A., Meriluoto, J., & Svirčev, Z. (2024). Particulate air pollution in Central Serbia and some proposed measures for the restoration of degraded and disturbed mining areas. Geographica Pannonica, 28(3), 205–220. https://doi.org/10.5937/gp28-50537
45. Moore, J. X., Royston, K. J., Langston, M. E., Griffin, R., Hidalgo, B., Wang, H. E., Colditz, G., Akinyemiju, T. (2018). Mapping hot spots of breast cancer mortality in the United States: Place matters for Blacks and Hispanics. Cancer Causes & Control, 29(8), 737–750. https://doi.org/10.1007/s10552-018-1051-y
46. Moore, J. X., Royston, K. J., Langston, M. E., Griffin, R., Hidalgo, B., Wang, H. E., Colditz, G., & Akinyemiju, T. (2018). Mapping hot spots of breast cancer mortality in the United States: Place matters for Blacks and Hispanics. Cancer Causes Control, 29(8), 737–750. https://doi.org/10.1007/s10552-018-1051-y
47. Musa, G. J., Chiang, P. H., Sylk, T., Bavley, R., Keating, W., Lakew, B., Tsou, HC., & Hoven, CW. (2013). Use of GIS mapping as a public health tool- From cholera to cancer. Health Serv Insights, 9(6), 111-6. https://doi.org/10.4137/HSI.S10471
48. Naumovic, T., Miljus, D., Djoric, M., Zivkovic, S., & Perisic, Z. (2015). Mortality from cervical cancer in Serbia in the period 1991–2011. Journal of BUON, 20(1), 231–234. PMID: 25778321
49. Nikolić, A., Mitrašinović, P., Mićanović, D., & Grujičić, S. (2023). Trends in morbidity and mortality from colorectal cancer in men and women in central Serbia for the period 1999–2020. Zdravstvena zaštita, 52(2), 46-63. https://doi.org/10.5937/zdravzast52-44967
50. Okpan, O., Okwose, I., Edwards, H. O.-E., & Sanni, F. (2025). Examining the Challenges in Implementing Occupational Health and Safety in the Selected Construction Companies Across Nigerian Coastal Cities. International Journal of Disaster Risk Management, 313–332. https://doi.org/10.18485/ijdrm.2025.7.2.17
51. Olson, B., Gribble, B., Dias, J., Curryer, C., Vo, K., Kowal, P., & Byles J. (2016). Cervical cancer screening programs and guidelines in low- and middle-income countries. Int J Gynaecol Obstet, 134(3), 239–246. https://doi.org/10.1016/j.ijgo.2016.03.011
52. Ord, J. K., & Getis, A. (1995). Local spatial autocorrelation statistics: Distributional issues and an application. Geographical Analysis, 27(4), 286–306. https://doi.org/10.1111/j.1538-4632.1995.tb00912.x
53. O'Rourke, M., & Djukic, J. (2008). Welcome to Serbia: Feel free to smoke. Tob Control, 17(6), 428–430. https://doi.org/10.1136/tc.2008.027425
54. Pacific Northwest National Laboratory. (n.d.). Getis-Ord analysis landing page. Retrieved from https://pachterlab.github.io/voyager/articles/getisord_landing.html
55. Premović, P., Arsenović, D., Pavić, D., Cvetković, V. M., & Lukić, T. (2025). Assessing the Impact: Mortality from Infectious Disease in Trnava (1911 - 1941) through a Medical Geography Lens. International Journal of Disaster Risk Management, 33–50. https://doi.org/10.18485/ijdrm.2025.7.2.3
56. Radaković, G. M., Tošić, A. I., Bačević, R. N., Mlađan, D., Marković, S. B., & Gavrilov, M. B. (2018). The analysis of aridity in Central Serbia from 1949–2015. Theor Appl Climatol, 133, 887–898. https://doi.org/10.1007/s00704-017-2220-8
57. Shin, M. B., Martinez, B., & Tsui, J. (2022). Geospatial hotspot analysis of cervical cancer among Asian American Native Hawaiian Pacific Islander (AANHPI) population in Los Angeles County [Abstract]. In Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiology, Biomarkers & Prevention, 31(1 Suppl), Abstract nr PO-005.
58. Shrestha, A. D., Neupane, D., Vedsted, P., & Kallestrup, P. (2018). Cervical cancer prevalence, incidence, and mortality in low- and middle-income countries: A systematic review. Asian Pac J Cancer Prev, 19(2), 319–324. https://doi.org/10.22034/APJCP.2018.19.2.319
59. Sipetic-Grujicic, S., Murtezani, Z., Ratkov, I., Grgurevic, A., Marinkovic, J., Bjekic, M., & Miljus, D. (2013). Comparison of male and female breast cancer incidence and mortality trends in Central Serbia. Asian Pac J Cancer Prev, 14(10), 5681–5685. https://doi.org/10.7314/APJCP.2013.14.10.5681
60. Sokale, I. O., Thrift, A. P., Montealegre, J. R., Chido-Amajuoyi, O. G., Adekanmbi, V. T., & Oluyomi, A. O. (2024). Using geospatial analysis to identify priority communities for cervical cancer prevention in Texas. AJPM Focus, 3(4), 100247. https://doi.org/10.1016/j.focus.2024.100247
61. Statistical Office of the Republic of Serbia (2023). Demographic Yearbook 2022; Statistical Office of the Republic of Serbia: Belgrade, Serbia.
62. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin., 71(3), 209–249. https://doi.org/10.3322/caac.21660
63. Tatalovich, Z., Zhu, L., Rolin, A., Lewis, D. R., Harlan, L. C., & Winn, D. M. (2015). Geographic disparities in late-stage breast cancer incidence: Results from eight states in the United States. International Journal of Health Geographics, 14, 31. https://doi.org/10.1186/s12942-015-0025-5
64. Toliman, P. J., Kaldor, J. M., Tabrizi, S. N., & Vallely, A. J. (2018). Innovative approaches to cervical cancer screening in low- and middle-income countries. Climacteric, 21(3), 235–238. https://doi.org/10.1080/13697137.2018.1439917
65. Tomić Naglić, D., Mandić, A., Zirojević, M. et al. (2025). Hormone replacement therapy in surgical menopause after gynecological malignancies. Biomol Biomed. 25(4):751-760. doi: 10.17305/bb.2024.11220. PMID: 39556012; PMCID: PMC11959398.
66. Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J., & Jemal, A. (2017). Global cancer in women: Burden and trends. Cancer Epidemiol Biomarkers Prev, 26(4), 444–457. https://doi.org/10.1158/1055-9965.EPI-16-0858
67. Vizuete-Jaramillo, E., Meza-Figueroa, D., Reyes-Castro, P. A., & Robles-Morua, A. (2022). Using a sensitivity analysis and spatial clustering to determine vulnerability to potentially toxic elements in a semiarid city in Northwest Mexico. Sustainability, 14(17), 1046. https://doi.org/10.3390/su141710461
68. WHO. (2024). Cervical cancer: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
69. Williams, F., Jeanetta, S., & James, A. S. (2016). Geographical location and stage of breast cancer diagnosis: A systematic review of the literature. J Health Care Poor Underserved, 27(3), 1357–1383. https://doi.org/10.1353/hpu.2016.0102. Erratum in: J Health Care Poor Underserved. 2017, 28(1), 620. doi: 10.1353/hpu.2017.0044. PMID: 27524773.
70. World Cancer Research Fund. (n.d.). Global cancer data by country: Cancer incidence in women 2022. Retrieved from https://www.wcrf.org/cancer-trends/global-cancer-data-by-country/
71. Yi, M., Li, T., Niu, M., Luo, S., Chu, Q., & Wu, K. (2021). Epidemiological trends of women's cancers from 1990 to 2019 at the global, regional, and national levels: A population-based study. Biomark Res, 9(1), 55. https://doi.org/10.1186/s40364-021-00310-y.
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