Epidemiology and Prevention of HPV-Driven Cervical Cancer in Urban-Rural China - A Population-Based Study of 60,280 Women

Sep 22, 2026

Cervical cancer remains a major public health burden in China, with clear urban–rural differences in HPV infection rates and screening participation. A cross-sectional study analyzed screening outcomes from 60,280 women aged 35–64 who joined Putian’s free program between 2021 and 2023. HPV genotyping (14 high-risk subtypes), liquid-based cytology (TCT), and histopathology assessed infection patterns and screening performance. Overall HPV prevalence was 9.27%, led by genotypes HPV 52, 58, and 16; cancer incidence peaked at 55–59.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Materials and methods

Participants

HPV testing and screening assessments

Epidemiological indicators and effectiveness evaluation

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Epidemiology and prevention of HPV-driven cervical cancer in urban–rural China: a populationbased study of 60,280 women LizhenZeng1, Zhanfei Chen2, Kangying Wang2 & Chiying Yi3􀀍 Cervical cancer continues to pose a significant public health burden in China, where marked differences persist in HPV infection rates and screening participation between urban and rural populations. We investigated HPV epidemiology and evaluated prevention approaches in Putian, a southeastern Chinese region representative of broader demographic patterns. This cross-sectional study analyzed screening results from 60,280 women aged 35–64 years who participated in Putian’s free cervical cancer screening program between 2021 and 2023. We employed HPV genotyping (14 high-risk subtypes), liquid-based cytology (TCT), and histopathological examination to assess infection rates, subtype distribution, and screening effectiveness. The data provided insights into both epidemiological patterns and diagnostic performance within this population. The overall human papillomavirus (HPV) infection prevalence was 9.27%(95% CI: 9.04–9.50), with HPV 52 (35.61%), HPV 58 (16.56%), and HPV 16 (12.38%) emerging as the most prevalent genotypes. Cervical cancer incidence peaked in women aged 55–59 (95 cases per 100,000), with a secondary peak observed in the 50–54 age group (89 cases per 100,000) . In addition, a concerning early-onset pattern appeared in the 40–44 age group (46 cases per 100,000). The national incidence rate averaged 56 cases per 100,000 . HPV 16/18 infections accounted for the majority of cervical cancer cases, with HPV 58/33/52 representing secondary highrisk genotypes. ThinPrep cytologic test (TCT) screenings revealed clinically significant underdiagnosis and overdiagnosis rates. Only 1.33% of women participated in self-screening initiatives. Urban–rural disparities in HPV 52/58/33 prevalence persist alongside low screening rates, underscoring the urgency of implementing targeted vaccination strategies, particularly the 9-valent HPV vaccine, and adopting advanced triage methods such as methylation testing in Putian. Keywords Cervical lesions, Epidemiological characteristics, Human papillomavirus, Prevention and control strategies, Putian Cervical cancer is the fourth most prevalent cancer in women worldwide, primarily caused by persistent infection with high-risk human papillomavirus (HPV) . Global estimates for 2020 reported 604,000 new cervical cancer cases and 342,000 deaths, with China representing 18% of cases and 17% of fatalities, reflecting its significant public health burden1–3. The World Health Organization’s (WHO) elimination strategy targets 90% HPV vaccination coverage for girls under 15 and 70% screening coverage for women aged 35–45 by 20304. Despite these goals, China recorded nearly 110,000 new cervical cancer cases in 2020, demonstrating an ongoing increase that demands urgent intervention3. HPV infection patterns show clear geographical and age-related differencesHPV 16 and 18 are responsible for 70% of cervical cancers, while HPV 52 and 58 are more prevalent in Asian populations5–7. In China, cervical cancer mortality rates are 1.5 times higher in rural areas than in urban centers, mainly due to healthcare access disparities8. Although China introduced free rural screening programs in 2009, persistent challenges include urban–rural inequities, the diagnostic limitations of techniques like liquid-based cytology (TCT), and insufficient HPV vaccination rates9, 10. High-income countries maintain vaccination coverage exceeding 70%, 1Department of Gynecology and Obstetrics, Putian Maternal and Child Health Care Hospital, The Affiliated Hospital(GROUP) of Putian University, Putian, Fujian, China. 2Department of Clinical Laboratory, The Affiliated Hospital (Group) of Putian University, Putian, Fujian, China. 3Department of Health, Putian Maternal and Chil

FAQs

What data sources and tests were used to evaluate HPV infection and cervical cancer in this study?

The study used HPV genotyping covering 14 high-risk subtypes, liquid-based cytology (TCT), and histopathological examination to assess infection rates, subtype distribution, and screening effectiveness.

What were the key findings on HPV prevalence and dominant genotypes?

Overall HPV infection prevalence was 9.27% (95% CI: 9.04–9.50). The most prevalent genotypes were HPV 52 (35.61%), HPV 58 (16.56%), and HPV 16 (12.38%).

How did screening participation and urban–rural differences affect prevention priorities?

Only 1.33% of women participated in self-screening initiatives, and urban–rural disparities persisted in HPV 52/58/33 prevalence. The results highlight the urgency of targeted vaccination strategies and advanced triage approaches, such as methylation testing.

Sep 22, 2026

Uploaded by Emma Wilson