China's Cervical Cancer Progress Stalls as Rural and Older Women Face Growing Risks
China's cervical cancer rates have plateaued nationally but reveal widening disparities, with older and rural women facing increasing risks while younger urban women benefit from improved screening, highlighting the urgent need for equitable prevention strategies to meet global elimination targets.
China's cervical cancer trends show national stabilization but reveal concerning disparities that threaten global elimination efforts, according to new research published in Cancer Biology & Medicine. While overall incidence and mortality rates have plateaued since 2016, older women and those in rural areas continue to face growing risks, creating an urgent need for more equitable prevention strategies.
The study, conducted by researchers from the National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, analyzed data from 22 long-term cancer registries across China from 2000 to 2020. The findings reveal that China's age-standardized incidence rate tripled from about 3 per 100,000 in 2000 to over 10 per 100,000 by 2016, with an average annual increase of 6.5%. However, both incidence and mortality have since stabilized nationally.
Beneath this national plateau lie significant disparities. Urban women under 35 years showed declining incidence after 2009, likely due to improved awareness and early detection. Meanwhile, rural women aged 35-64 years continued to experience increases, while women aged 65 and older showed steadily rising incidence and mortality in both urban and rural areas. These trends highlight the uneven distribution of preventive care benefits across different demographic groups.
When compared internationally, China's progress lags behind countries such as Australia and the Republic of Korea, where integrated HPV vaccination and screening programs have sharply reduced cervical cancer rates. The study, available at https://doi.org/10.20892/j.issn.2095-3941.2025.0386, used Joinpoint regression analysis to examine trends and benchmark China's performance against other Asia-Pacific countries.
China accounts for nearly one-fifth of the world's female population, making the country's progress crucial to global cervical cancer elimination efforts. Despite large-scale screening programs and the introduction of HPV vaccination in 2016, coverage remains low—only about half of women aged 35-64 have been screened and less than 10% of girls have completed HPV vaccination. These persistent gaps in access, especially in rural and aging populations, limit progress toward the WHO's "90-70-90" targets for vaccination, screening, and treatment.
Professor Wenqiang Wei, corresponding author of the study, emphasized that "China's stabilization in cervical cancer rates is an encouraging signal, but we cannot overlook the inequities beneath it. Older women and those in rural regions remain at disproportionate risk, largely due to limited access to vaccination, screening, and timely treatment."
The findings provide critical evidence for refining China's national cervical cancer elimination roadmap. Researchers recommend expanding school-based HPV vaccination, scaling up primary HPV testing with self-sampling options, and ensuring standardized treatment across healthcare levels. Integrating AI-assisted cytology and digital registries could further improve early detection. As China approaches the peak of its national burden around 2040, strengthening coordination between public health programs and local governments will be vital to narrow the urban-rural gap and determine whether cervical cancer elimination becomes a regional reality.