The disease burden of cervical cancer in China is equally heavy. China has the second largest cervical cancer disease burden in the world, both in terms of the total number of incidence and mortality. Projections show that without effective control and intervention, the number of cervical cancer cases in China will reach 116,000 in 2040, an increase of 5.7% compared to 2020, and the number of deaths will reach 75,000, an increase of 26.3% compared to 2020 [1] (Figure 1 ).

Figure 1. Estimated incidence and mortality from cervical cancer among women aged 0-85 years in China, 2020-2040.

Incidence

Cervical cancer is the sixth most common malignant tumor among female population in China. The 2021 Catalan Institute of Oncology/International Agency for Research on Cancer (ICO/IARC) report on HPV and its related diseases in China showed that the incidence of cervical cancer ranked third in female tumors among women aged 15-44 years old in China in 2020 [2]. 2022 China’s Guidelines for Standardized Diagnosis and Treatment of Cervical Cancer showed that the incidence of cervical cancer was second only to breast cancer [3]. The 2018 Annual Report of China Tumor Registry (drawing on 2015 data reported from 368 tumor registries) reported 111,000 new cases of cervical cancer nationwide, with a crude incidence rate of 16.56/100,000. Compared with the world age-standardized incidence rate of 10.86/100,000, China’s cervical cancer age-standardized incidence rate was 11.78/100,000[4]. The GLOBOCAN study predicted 109,000 new cases of cervical cancer in China in 2020 based on cancer data from 2010-2012 at China’s tumor registry reporting sites, according to the distribution of the Chinese population in 2020 (in which estimates were made according to the ratio of 60% urban to 40% rural areas), which showed an increase of 3.5% compared with 2018, and accounted for 5.2% of the total number of tumor incidence cases among Chinese women, with a crude incidence rate of 15.6/100,000 and the world age-standardized incidence rate of 10.7/100,000 women [5].

In China, the incidence of cervical cancer is significantly different between regions, with higher rates in rural areas than in urban areas. Based on the data of China’s tumor registry, in 2016, the crude incidence rate in rural areas was 17.52/100,000 women, and the world age-standardized incidence rate was 11.89/100,000 women; in urban areas, the crude incidence rate was 16.64/100,000 women, and the age-standardized incidence rate was 10.89/100,000 women. The number of new cases of cervical cancer in both urban and rural areas has been increasing annually. In 2015, the incidence rate of cervical cancer was highest in the central region (world age-standardized incidence rate of 14.9/100,000), followed by the southwestern (11.6/100,000) and northwestern (11.5/100,000) regions [6].

Although the disease burden of cervical cancer in China has decreased significantly compared with that in the 1970s, cervical cancer remains prevalent and the incident rate has been increasing recently due to the effects of population aging, sexual behavioral patterns, the epidemiological change of the HPV virus, and the low overage of the screening [7, 8, 9]. China’s national tumor registry data from 1988-2015 showed that the incidence rate of cervical cancer slowly decreased from 5.04/100,000 (standardized incidence rate of 3.06/100,000) in 1988 to 2.99/100,000 (standardized incidence rate of 1.73/100,000) in 1998 [7]. However, according to the Annual Report of the Chinese Tumor Registry in 2019, China’s world age-standardized incidence rate of cervical cancer in the 2000-2015 increased at an average rate of 8.9% annually, making cervical cancer one of the fastest-growing new tumors [5]. This is more pronounced in rural areas where the age-standardized incidence rate among women was estimated to increase from 7.35/100,000 in 2007 to 12.88/100,000 in 2019 based on the National Tumor Registry. The age of diagnosis and incidence of cervical cancer also tends to be younger, with the average age of diagnosis of cervical cancer in rural areas decreasing by 5.18 years between 2000 and 2014 [10].

Mortality rate

Cervical cancer is the second leading cause of cancer deaths among women aged 15-44 years in China. According to the report of GLOBOCAN, the number of deaths due to cervical cancer in China in 2020 was about 59,000, an increase of about 23.0% compared with 2018, accounting for 17.3% of the total number of deaths from female tumors globally [1, 4, 7]. China’s tumor surveillance data showed that in 2015, the number of cervical cancer deaths in China was about 34,000, with a crude mortality rate of 5.04/100,000, and a world age-standardized mortality rate of 3.29/100,000 [4].

Figure 2 summarizes the changes in age-standardized mortality rate of cervical cancer in different provinces and cities in mainland China during the past 40 years from 1973 to 2013 [13]. According to the three national cause-of-death survey from 1970-1972 to 2004-2005, the age-standardized mortality rate of cervical cancer decreased from 11.35/100,000 to 2.86/100,000, and the overall age-standardized mortality rate after 2006 leveled off with the declining trend over the past three decades in a stagnant state [8]. However, China has a large population and disparities in the socioeconomic development and healthcare provision across different regions. The mortality rate in the central and western regions is higher than that in the eastern region, with a decreasing trend in the central region and no significant change in the western region during the period 2006-2012. The age-standardized mortality rate for females aged 30-59 years in the eastern region increased by 6% per year during this period (95% CI: 1.6%-10.5%) [8]. This rising trend also deserves special attention, indicating that cervical cancer remains an important health challenge that seriously threatens the health and lives of women in our country.

Figure 2. Age-standardized cervical cancer mortality in mainland China excluding Taiwan, Hong Kong and Macao between 1973 and 2013.

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Content Reviewer: Kelly Hunter, Zhangyang Pan

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