Abstract
Background/Objectives: Cancer is a major public health burden in Serbia and a factor influencing long-term disaster readiness by straining health system capacity. This study examined spatial and temporal trends in incidence and mortality for eight major cancers among women in Central Serbia (1999–2021) to inform targeted prevention and preparedness strategies. Methods: Standardised rates from national datasets were analysed using the Mann–Kendall trend test and Sen’s slope estimator. Geographic disparities were mapped in ArcGIS Pro 3.2. Mortality trends were assessed only for statistically reliable series. Results: Breast cancer incidence increased in six counties, while cervical cancer declined in several areas, likely reflecting screening success. Colorectal, bladder, pancreatic, and lung and bronchus cancers showed rising incidence; lung and bronchus cancer mortality increased in 16 counties, indicating growing demand for chronic respiratory care. These shifts may reduce surge capacity during disasters by increasing the baseline burden on healthcare infrastructure. Regional disparities highlight uneven system resilience. Conclusions: Aligning cancer control measures—especially for high-burden cancers like lung—with emergency preparedness frameworks is essential to strengthen health system resilience, particularly in resource-limited regions.
Conclusions
As shown in this study, cancers are highly prevalent among the female population in Central Serbia. This is the first study in Central Serbia to apply the Mann–Kendall test to analyse cancer trends among the female population from 1999 to 2021. Additionally, it is one of the pioneering geographic-medical studies in the region that examines cancer in the female population.
Despite their advantages, the Mann–Kendall test and Sen’s slope estimator have notable limitations. Both methods assume monotonic trends and may fail to detect non-linear, cyclical, or abrupt changes in cancer incidence, which can arise from sudden policy changes, environmental exposures, or advances in screening technologies. They are also sensitive to strong serial correlation in the data, which, if unaddressed, can increase the likelihood of falsely identifying a trend. Furthermore, these methods evaluate temporal patterns independently of spatial autocorrelation, meaning they do not account for the possibility that neighbouring regions may exhibit similar cancer trends due to shared risk factors. For a comprehensive geospatial analysis of cancer patterns, the Mann–Kendall test and Sen’s slope are most effective when used in conjunction with spatial statistical techniques and models that can accommodate non-linearities and spatial dependencies.
Research of this type requires interdisciplinary collaboration among oncologists, geographers, epidemiologists, and experts in information technology. The use of GIS tools and statistical methods enables a detailed analysis of complex patterns that would remain invisible without such an approach. In this way, not only is a better understanding of the spatial aspects of health achieved, but also the foundations are laid for future research and the improvement of public health at both national and local levels. For this reason, this type of research represents a crucial step toward developing more precise, equitable, and sustainable strategies for controlling and preventing malignant diseases, especially in developing countries where healthcare resources are limited and spatial inequalities are often pronounced. The research was conducted according to the STROBE statement (Supplementary Materials).
Additionally, this study highlights the importance of integrating cancer surveillance into broader disaster risk reduction and public health resilience strategies. As chronic diseases increasingly influence the health vulnerabilities faced by populations, particularly women, their inclusion in national preparedness and adaptation plans becomes essential. The increasing incidence of cancer, especially lung, pancreatic, and colorectal cancers, highlights the necessity for improved screening, environmental monitoring, and access to early diagnostics in areas with high risk.
To effectively harness the promise of geospatial epidemiology, future research must integrate more detailed spatial data, examine relationships with environmental and socioeconomic factors, and include clinical information such as tumour staging and treatment outcomes. Enhancing data systems, promoting interdisciplinary collaboration, and securing ongoing institutional and financial backing will be essential for converting research insights into successful cancer control strategies. Furthermore, this study lays the groundwork for understanding cancer trends in Central Serbia and creates opportunities for more targeted, equitable, and informed interventions. It is crucial to view cancer as a multifaceted challenge, encompassing medical, spatial, and social aspects, to achieve lasting health security and resilience.
From a scientific perspective, this study demonstrates the value of applying non-parametric statistical methods and geospatial technologies to long-term epidemiological data, providing a replicable framework for analysing cancer trends in other regions with similar data limitations. It contributes to the expanding field of spatial epidemiology by bridging gaps between medical research, environmental science, and public health planning. On the other side, from a societal perspective, the findings demand immediate attention from policymakers and public health officials to tackle cancer not just as a medical issue, but also as an environmental and structural dilemma. These insights can help allocate resources, direct local interventions, and inform awareness initiatives focused on early detection and prevention, particularly for vulnerable populations such as women in underserved areas. Ensuring equitable access to healthcare, diagnostics, and preventive services is crucial for reducing geographic health disparities and strengthening the resilience of health systems against chronic disease challenges.
How to cite
Kričković, E., Cvetković, V. M., Kričković, Z., & Lukić, T. (2025). Spatial–Temporal Trends of Cancer Among Women in Central Serbia, 1999–2021: Implications for Disaster and Public Health Preparedness. Healthcare, 13(17), 2169. https://doi.org/10.3390/healthcare13172169
