Divergent long-term burden trajectories and mortality drivers of female-specific cancers in the United States.

203 Background: Female-specific cancers contribute substantially to the cancer burden among women in the United States, yet comparative long-term assessments of burden trajectories and mortality drivers remain limited. Methods: Using Global Burden of Disease data (1990–2023), we conducted a population-based longitudinal analysis of breast, cervical, ovarian, and uterine cancers among U.S. females, assessing prevalence, incidence, mortality, and disability. Temporal trends were evaluated using estimated annual percentage change (EAPC) overall, by period and age group, and logarithmic decomposition of mortality into incidence and mortality-to-incidence ratios (MIR) components. Results: From 1990 to 2023, age-standardized incidence and mortality rates increased for uterine cancer (incidence EAPC, 1.67% 95% CI, 1.58–1.76; mortality EAPC, 1.01% 0.82–1.20), whereas both incidence and mortality declined for breast, cervical, and ovarian cancers. Specifically, incidence EAPCs were −1.16% (−1.25 to −1.06) for breast cancer, −1.67% (−1.94 to −1.40) for cervical cancer, and −1.43% (−1.60 to −1.27) for ovarian cancer; corresponding mortality EAPCs were −1.64% (−1.72 to −1.57), −0.99% (−1.09 to −0.89), and −1.39% (−1.55 to −1.22), respectively. Decomposition analysis showed that rising incidence accounted for 181% of the uterine cancer mortality increase, whereas incidence reductions explained 63%, 158%, and 98% of the mortality decreases in breast, cervical, and ovarian cancers, respectively, with MIR changes contributing the remainder. Conclusions: Female-specific cancers in U.S. exhibit heterogeneous trends, with uterine cancer mortality driven by rising incidence and declining mortality from other female cancers largely reflecting incidence reductions, underscoring uterine cancer as an emerging priority for prevention and early detection.