China's Cervical Cancer Progress Stalls Amid Growing Rural and Elderly Disparities

China's cervical cancer trends show national stabilization but reveal deepening health disparities that threaten global elimination goals, according to a comprehensive study published in Cancer Biology & Medicine. While overall incidence and mortality rates have plateaued since 2016, older women and rural populations continue to experience rising risks, creating an urgent need for equitable prevention strategies.

The research team from the National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College analyzed two decades of data from 22 cancer registries across China. Their findings, detailed in the study available at https://doi.org/10.20892/j.issn.2095-3941.2025.0386, show that China's age-standardized incidence rate tripled from approximately 3 per 100,000 women in 2000 to over 10 per 100,000 by 2016, with an average annual increase of 6.5%. The subsequent national plateau masks concerning demographic patterns that could undermine progress toward World Health Organization elimination targets.

Professor Wenqiang Wei, corresponding author of the study, emphasized the underlying inequities: "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 research reveals stark contrasts between population groups. Urban women under 35 years showed declining incidence after 2009, benefiting from improved awareness and early detection programs. However, rural women aged 35-64 continued to experience increasing incidence, while women aged 65 and older demonstrated steadily rising incidence and mortality rates across both urban and rural areas.

When compared internationally, China's progress lags significantly behind countries like Australia and the Republic of Korea, where integrated human papillomavirus vaccination and high-quality screening programs have achieved consistent declines in cervical cancer rates. China's current coverage rates remain alarmingly low—only about half of women aged 35-64 have been screened, and less than 10% of girls have completed HPV vaccination since its introduction in 2016.

The implications extend beyond China's borders, as the country accounts for nearly one-fifth of the world's female population. China's success or failure in addressing these disparities will significantly impact global efforts to eliminate cervical cancer as a public health problem. The WHO's "90-70-90" targets—aiming for 90% of girls fully vaccinated, 70% of women screened, and 90% of identified cases treated—remain distant goals under current conditions.

Researchers recommend several critical interventions to accelerate progress, including expanding school-based HPV vaccination programs, scaling up primary HPV testing with self-sampling options, and ensuring standardized treatment across healthcare levels. The integration of artificial intelligence-assisted cytology and digital registries could further improve early detection capabilities. As China approaches the projected peak of its national cervical cancer burden around 2040, the study underscores that decisive and equitable interventions will determine whether elimination becomes achievable.