Since the government initiated an ultrasound-based mass breast cancer screening program for rural women in 2009, both the coverage rate of breast cancer screening and the five-year survival rate have shown a steady increase. However, the rising trend of breast cancer incidence and mortality in China has not yet been effectively curbed. This may be related to the low knowledge rate of breast cancer, the poor performance of current breast cancer screening technology, and the imperfection of the comprehensive prevention and control system encompassing screening, diagnosis, and treatment. In the future, we should strengthen the health education of vulnerable groups, carry out high-quality breast cancer prevention and control research on the application of innovative technology, and establish a comprehensive prevention and control strategy for breast cancer suitable for China's national conditions.

Timely diagnostic follow-up subsequent to abnormal results is crucial for the efficacy of breast cancer screening programs. We aimed to identify the frequency and women-level factors of loss or delay in the follow-up for screening abnormalities in China. This mixed-methods cohort study comprised a retrospective analysis of ultrasound based breast screening data collected from Boluo (site A), Lilin (site B), and Ordos (site C) in China from 2018 to 2021, and qualitative, semistructured interviews conducted with program leaders from the three local Maternal and Child Health (MCH) hospitals, respectively. According to the screening protocol, we assessed the follow-up of two screening results: (1) mammography after suspicious results in the ultrasound and (2) biopsy after positive results in the ultrasound or supplement mammography. The rates and timeliness of follow-up with diagnostic examinations were compared across the different sites and procedures, and logistic regression was employed to explore the women-level factors influencing failure or delay in follow-up. Of 7,939 women with abnormal screening results, 5,943 (74.86

BACKGROUND:Breast cancer and reproductive system cancers remain significant public health threats for Chinese women. This study aimed to evaluate the latest epidemiological patterns and trends of four female-specific cancers in China. METHODS:The year- and age-specific estimates of the incidence, mortality, and disability-adjusted life-years (DALYs) associated with breast, cervical, ovarian, and uterine cancers in China from 1990 to 2021 were generated from the Global Burden of Disease, Injuries, and Risk Factors 2021 study. The epidemiological characteristics were analyzed with age-period-cohort models. A Bayesian age-period-cohort model was applied to forecast disease burden from 2022 to 2050. RESULTS:In 2021, China reported 385.84 thousand (95% uncertainty interval [UI], 294.10-489.01 thousand) incident cases of female breast cancer, followed by cervical cancer (132.79 thousand [95% UI, 95.96-172.60 thousand]), uterine cancer (72.02 thousand [95% UI, 53.31-100.00 thousand]), and ovarian cancer (41.24 thousand [95% UI, 30.30-54.55 thousand]). Breast cancer ranked as the primary cause of cancer-related deaths, followed by cervical cancer. The age-specific incidence rate for breast, cervical, ovarian, and uterine cancers are projected to occur in the age groups 60-64 years, 55-59 years, 65-69 years, and 60-64 years, respectively. Breast, ovarian, and uterine cancer cases are projected to rise by 2050, which will exceed those recorded in 2021. CONCLUSIONS:Various inequities have been identified across four types of cancers affecting women, which underscores the need for tailored national cancer control strategies. Emphasis should be placed on primary prevention and screening for breast and cervical cancers, whereas efforts for uterine and ovarian cancers should focus on implementing early diagnosis and treatment measures. PLAIN LANGUAGE SUMMARY:This study examines the burdens and trends of breast, cervical, ovarian, and uterine cancers among Chinese women from 1990 to 2021. In 2021, breast cancer emerged as the most prevalent, followed by cervical, uterine, and ovarian cancers, with breast cancer also exhibiting the highest mortality rate. The age groups projected to exhibit the highest incidence rates for breast, cervical, ovarian, and uterine cancers are 60-64 years, 55-59 years, 65-69 years, and 60-64 years, respectively. Projections indicate that by 2050, the incidence of breast, ovarian, and uterine cancers will surpass 2021 levels, which underscores the necessity for targeted prevention, early detection, and treatment strategies.

BACKGROUND:Human papillomavirus (HPV) vaccination is a promising step toward cervical cancer elimination. This study was conducted to investigate the knowledge, attitude, and HPV vaccine uptake among female adults in mainland China based on a large e-commerce platform. METHODS:We conducted a cross-sectional online survey of female adults between March 4 to April 20, 2022. The survey consisted of sociodemographic information, related knowledge, vaccination uptake, and attitudes toward vaccination. We included women aged 18-45 years in the final analysis. Logistic regressions were conducted to explore influencing factors associated with related knowledge, HPV vaccination uptake, and willingness to be vaccinated. RESULTS:In total, 3,572 female adults (34 years, IQR 30-39) were included in the analysis. The majority of the participants were highly educated (78.7%) with a high monthly family income (79.0%). The median HPV knowledge score was 8.25 out of 11. More than 75% of respondents were unvaccinated, while 95.8% of unvaccinated female adults are willing to be vaccinated. Variables such as age, insurance, vaccination history, and whether one had heard of the HPV vaccine influence HPV vaccination practice (all p-values < 0.05). The main barriers to vaccination were vaccine inaccessibility and the high cost of the vaccine. CONCLUSION:The findings of our study highlight a moderate knowledge level, poor vaccination rate, and strong willingness to be vaccinated among Chinese female adults who were better educated and wealthier. Targeted health education and practical support should be provided in the future, to reduce gaps between vaccine uptake and vaccine acceptance.

Background: Globally, China has the highest lung cancer burden. Several studies have depicted the burden of tracheal, bronchus, and lung cancer (TBLC) at the national level. However, a countrywide regional distribution and a comprehensive attributable risk analysis were missing.Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to analyse the incidence, mortality, and disability-adjusted life years (DALYs) of TBLC and attributable risk factors by region, sex, and age. We used a Joinpoint model to determine the time trends during 1990–2021 by average annual percentage change (AAPC).Findings: There were 0·93 million new TBLC cases in China, with 0·81 million deaths and 18·91 million DALYs in 2021. The TBLC age-standardised incidence rate in females showed an upward trend (AAPC: 1·1%) during 1990–2021. Contrastingly, it decreased in males from 2010–2021 (AAPC: -0·2%). Smoking was the leading contributor to TBLC-related death in males, accounting for 78·4% of deaths in 2021. Ambient particulate matter pollution was the leading risk factor for TBLC-related deaths in females in highly developed regions and economically underdeveloped areas.Interpretation: Preliminary effectiveness of tobacco and air pollution control has shown results in males and developed regions, while smoking and air pollution control should be enhanced, particularly in females and less developed regions in China. TBLC screening among high-risk populations should be widely adopted.Funding: The Research Unit of Intelligence Diagnosis and Treatment in Early Non-small Cell Lung Cancer, Chinese Academy of Medical Sciences; National Natural Science Foundation of China.Declaration of Interest: The authors declare no competing interests

Globally,lung cancer is the most prevalent cancer(11.4％of all cancers)and the leading cause of cancer deaths(18％of all cancers)[1,2].With one-fifth of the global population,China is a top con-tributor to the lung cancer burden,accounting for 37％of new cases and 30％of deaths worldwide[2].

BackgroundWomen with breast cancer and improved survival face some specific quality of life (QOL) issues. Electronic health (eHealth) is a useful tool aiming to enhance health services. However, evidence remains controversial about the effect of eHealth on QOL in women with breast cancer. Another unstudied factor is the effect on specific QOL functional domains. Therefore, we undertook a meta-analysis about whether eHealth could improve the overall and specific functional domains of QOL in women with breast cancer. MethodsPubMed, Cochrane Library, EMBASE, and Web of Science were searched to identify appropriate randomized clinical trials from database inception to March 23, 2022. The standard mean difference (SMD) served as the effect size and the DerSimonian-Laird random effects model was constructed for meta-analysis. Subgroup analyses were conducted according to different participant, intervention, and assessment scale characteristics. ResultsWe initially identified 1954 articles excluding duplicates and ultimately included 13 of them involving 1448 patients. The meta-analysis revealed that the eHealth group had significantly higher QOL (SMD 0.27, 95% confidence interval [95% CI] 0.13-0.40, p < 0.0001) than the usual care group. Additionally, although not statistically significant, eHealth tended to improve the physical (SMD 2.91, 95% CI -1.18 to 6.99, p = 0.16), cognitive (0.20 [-0.04, 0.43], p = 0.10), social (0.24 [-0.00, 0.49], p = 0.05), role (0.11 [0.10, 0.32], p = 0.32), and emotional (0.18 [0.08, 0.44], p = 0.18) domains of QOL. Overall, consistent benefits were observed in both the subgroup and pooled estimates. ConclusionseHealth is superior to usual care in women with breast cancer for improved QOL. Implications for clinical practice should be discussed based on subgroup analysis results. Further confirmation is needed for the effect of different eHealth patterns on specific domains of QOL, which would help improve specific health issues of the target population.

Abstract Background Improving the coverage rate of cervical cancer screening is a challenge mission for cervical cancer elimination. This study attempted to assess the knowledge, willingness, and uptake of cervical cancer screening services among Chinese females and determined associated factors. Methods This is a cross-sectional online survey conducted in China from March to April 2022. Information on demographic characteristics, knowledge, willingness, and uptake of cervical cancer screening was collected through a large e-commerce platform. Women aged 18–65 were included in the analysis. Logistic regression analysis was employed to detect the possible factors associated with knowledge, willingness, and screening participation. Results A total of 4518 women (37.83 ± 9.14 years) were included in the final analysis, of whom 87.16% (n = 3938) lived in urban areas. About 93.40% (n = 4220) of the respondents reported hearing of cervical cancer screening. The median score of knowledge about cervical cancer was 16 out of 26. Over 84% (n = 3799) of the respondents were willing to receive regular cervical cancer screening. Nearly 40% (n = 1785) had never received cervical cancer screening. Among the screened women, 21.26% (n = 581), 35.24% (n = 1151), and 42.37% (n = 1158) were screened through a national cervical cancer screening program, employee physical examination, and self-paid physical examination, respectively. Knowledge was positively associated with willingness and screening participation. Age, marital status, occupation, monthly household income, and HPV vaccination history could influence screening participation (all p < 0.05). Conclusions Though women had high-level awareness and strong participation willingness in cervical cancer screening, the overall screening coverage among Chinese women was still low. Besides, the knowledge about cervical cancer was still limited. Comprehensive health education should be enhanced by utilizing social media platforms and medical workers. It is also important to promote national free cervical cancer screening with high-performance screening methods.

Rationale and Objectives: This study assessed the role of second-look automated breast ultrasound (ABUS) adjunct to mammography (MAM) versus MAM alone in asymptomatic women and compared it with supplementing handheld ultrasound (HHUS). Materials and Methods: Women aged 45 to 64 underwent HHUS, ABUS, and MAM among six hospitals in China from 2018 to 2022. We compared the screening performance of three strategies (MAM alone, MAM plus HHUS, and MAM plus ABUS) stratified by age groups and breast density. McNemar's test was used to assess differences in the cancer detection rate (CDR), the false-positive biopsy rate, sensitivity, and specificity of different strategies. Results: Of 19,171 women analyzed (mean [SD] age, 51.54 [4.61] years), 72 cases of breast cancer (3.76 per 1000) were detected. The detection rates for both HHUS and ABUS combined with MAM were statistically higher than those for MAM alone (all p < 0.001). There was no significant difference in cancer yields between the two integration strategies. The increase in CRD of the integrated strategies was higher in women aged 45-54 years with denser breasts compared with MAM alone (all p < 0.0167). In addition, the false-positive biopsy rate of MAM plus ABUS was lower than that of MAM plus HHUS (p = 0.025). Moreover, the retraction in ABUS was more frequent in cases detected among MAM-negative results. Conclusion: Integrated ABUS or HHUS into MAM provided similar CDRs that were significantly higher than those for MAM alone in younger women (45-54 years) with denser breasts. ABUS has the potential to avoid unnecessary biopsies and provides specific image features to distinguish malignant tumors from HHUS.

Abstract Background Mammographic density (MD) is a strong risk factor for breast cancer. We aimed to evaluate the association between MD and breast cancer related risk factors among average-risk women in rural China. Methods This is a population-based screening study. 12518 women aged 45–64 years with complete MD data from three maternal and childcare hospitals in China were included in the final analysis. ORs and 95%CIs were estimated using generalized logit model by comparing each higher MD (BI-RADS b, c, d) to the lowest group (BI-RADS a). The cumulative logistic regression model was used to estimate the OR trend (95%CI) and P trend by treating MD as an ordinal variable. Results Older age (ORtrend = 0.81, 95%CI: 0.79–0.81, per 2-year increase), higher BMI (ORtrend = 0.73, 95%CI: 0.71–0.75, per 2 kg/m2), more births (ORtrend = 0.47, 95%CI: 0.41–0.54, 3 + vs. 0–1), postmenopausal status (ORtrend = 0.42, 95%CI: 0.38–0.46) were associated with lower MD. For parous women, longer duration of breastfeeding was found to be associated with higher MD when adjusting for study site, age, BMI, and age of first full-term birth (ORtrend = 1.53, 95%CI: 1.27–1.85, 25 + months vs. no breastfeeding; ORtrend = 1.45, 95%CI: 1.20–1.75, 19–24 months vs. no breastfeeding), however, the association became non-significant when adjusting all covariates. Associations between examined risk factors and MD were similar in premenopausal and postmenopausal women except for level of education and oral hormone drug usage. Higher education was only found to be associated with an increased proportion of dense breasts in postmenopausal women (ORtrend = 1.08, 95%CI: 1.02–1.15). Premenopausal women who ever used oral hormone drug were less likely to have dense breasts, though the difference was marginally significant (OR = 0.54, P = 0.045). In postmenopausal women, we also found the proportion of dense breasts increased with age at menopause (ORtrend = 1.31, 95%CI: 1.21–1.43). Conclusions In Chinese women with average risk for breast cancer, we found MD was associated with age, BMI, menopausal status, lactation, and age at menopausal. This finding may help to understand the etiology of breast cancer and have implications for breast cancer prevention in China.

The burden of breast cancer is increasing fast in low resource areas of China.Uultrasonography is widely used as a primary method for breast cancer screening in China.However,effective ultrasonography is highly dependent on the operators'professional skills and long-term efficacy of the ultrasonography screening needs to be evaluated with high-quality prospective cohort studies.The development of automated breast volume scanner and artificial intelligence technology is expected to promote the performance of breast cancer screening in regions with low health resources;the efficacy of the two means in breast cancer screening needs to be further verified and the implementation of the new process needs to be explored.Given the economic and medical heterogeneity across different regions of China,it is necessary to explore screening strategies suitable for different situations,especially for regions with low health resources.

The appropriate management strategies for BI-RADS category 4a lesions among handheld ultrasound (HHUS) remain a matter of debate. We aimed to explore the role of automated breast ultrasound (ABUS) or the second-look mammography (MAM) adjunct to ultrasound (US) of 4a masses to reduce unnecessary biopsies. Women aged 30 to 69 underwent HHUS and ABUS from 2016 to 2017 at five high-level hospitals in China, with those aged 40 or older also accepting MAM. Logistic regression analysis assessed image variables correlated with false-positive lesions in US category 4a. Unnecessary biopsies, invasive cancer (IC) yields, and diagnostic performance among different biopsy thresholds were compared. A total of 1946 women (44.9 ± 9.8 years) were eligible for analysis. The false-positive rate of category 4a in ABUS was almost 65.81% (77/117), which was similar to HHUS (67.55%; 127/188). Orientation, architectural distortion, and duct change were independent factors associated with the false-positive lesions in 4a of HHUS, whereas postmenopausal, calcification, and architectural distortion were significant features of ABUS (all p < 0.05). For HHUS, both unnecessary biopsy rate and IC yields were significantly reduced when changing biopsy thresholds by adding MAM for US 4a in the total population (scenario #1:BI-RADS 3, 4, and 5; scenario #2: BI-RADS 4 and 5) compared with the current scenario (all p < 0.05). Notably, scenario #1 reduced false-positive biopsies without affecting IC yields when compared to the current scenario for ABUS (p < 0.001; p = 0.125). The higher unnecessary biopsy rate of category 4a by ABUS was similar to HHUS. However, the second-look MAM adjunct to ABUS has the potential to safely reduce false-positive biopsies compared with HHUS.

目的:了解我国部分农村地区妇女乳腺癌筛查工作现状及效果,探讨影响筛查效果的因素,为提高乳腺癌筛查水平提供参考.方法:采用问卷调查和网络直报系统收集2018年6省(自治区)乳腺癌筛查工作的组织管理、服务提供以及筛查效果数据,采用单因素x2检验和泊松回归分析乳腺癌筛查效果及其影响因素.结果:2018年6省154个县共有1156287例农村妇女接受乳腺癌筛查,早期乳腺癌检出率为24.39/10万,贫困县(17.51/10万)低于非贫困县(40.18/10万);乳腺癌检出率为47.91/10万,贫困县(37.62/10万)低于非贫困县(71.53/10万).多因素分析显示,非贫困县中,初筛地点以及筛查服务参与机构类型是其筛查效果的影响因素;在贫困县中,经费来源途径是其筛查效果的影响因素.结论:我国农村地区特别是贫困地区乳腺癌筛查效果仍不理想,应加大对经济欠发达地区政策倾斜和经费投入,因地制宜选择筛查参与机构,多措并举加强人员能力建设,不断提高筛查质量.

Objective: To systematically summarize and evaluate the current cervical cancer screening guidelines worldwide. Methods: "Cervical cancer/cervical intraepithelial neoplasia", "screening", and "guidelines/recommendations" were searched as keywords in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data for cervical cancer screening guidelines. The language was limited to Chinese and English. A total of 29 guidelines were included before September 1, 2020. The basic information and recommendations of the guidelines issued were summarized. Results: Among the 29 cervical cancer screening guidelines, most guidelines targeted on the population aged 25-65 years. Cytology and human papillomavirus (HPV) testing are two commonly used methods for the cervical cancer screening, and HPV testing is increasingly recommended as the primary screening methods. Most guidelines recommended five years interval for the HPV testing-based screening or co-testing (HPV testing and cytology) based screening and three years for the cytology-based. For managing population with abnormal cervical cancer screening, triage or screening repeatedly to identify high-risk populations were more recommended. Direct colposcopy or treatment were allowed for women with higher risk of cervical intraepithelial neoplasia (CIN) during the screening procedure. Several guidelines involving HPV vaccination population recommended them the same strategy as the general population without vaccination. Conclusion: Currently, most of the cervical cancer screening guidelines applied to the population with the average risk of the CINs and were issued by the developed countries. Primary methods for the cervical cancer screening have gradually changed from the cytology to the HPV testing. There is a lack of recommendations targeting special population on cervical cancer screening in the current guidelines.

目的 对2016-2018年鄂尔多斯市妇女乳腺癌筛查结果进行分析,评价超声在基层乳腺癌筛查中的检出情况.方法 该项目由鄂尔多斯市9个旗(区)的妇幼保健院组织开展,以鄂尔多斯市辖区内35～64岁具有本地户籍或在当地居住6个月以上的常住妇女为筛查对象.采用乳腺临床检查和乳腺超声为初筛方法、乳腺X线摄影检查为补充方法的筛查方案.乳腺临床检查阳性或超声检查BI-RADS 0、4、5类者补充乳腺X线摄影检查,乳腺X线摄影检查BI-RADS 0、4、5类者进行组织病理学检查,乳腺超声、X线摄影检查结果为BI-RADS 1～3类者3年后进行下一次筛查.采用SAS 9.4进行x2检验,两两比较采用Bonferroni校正法校正检验水准,并进行趋势x2检验.结果 共纳入118 812名筛查对象进行分析,其中105 506人接受乳腺临床检查,116 013人接受乳腺超声检查.筛查人群超声阳性率为1.02％(1 182/116013),可疑阳性率为0.14％(159/116 013).筛查共发现67例乳腺癌,其中超声阳性或可疑阳性人群中发现65例,超声检查的乳腺癌检出率为56.03/10万.超声初筛并进行乳腺X线摄影复筛后,128人需进行病理活检,仅35人(27.34％)完成,确诊24例乳腺癌,乳腺癌检出率为20.84/10万.有8名乳腺超声检查结果阴性的妇女自行进行病理检查确诊为乳腺癌,乳腺癌漏诊率为10.67％.结论 在卫生资源不足地区采用超声初筛补充进行乳腺X线摄影复筛的模式会造成乳腺癌漏诊.基层开展乳腺癌筛查应提高超声和乳腺X线摄影检查的诊断水平以及活检能力,使用乳腺X线摄影复筛时应考虑乳腺X线摄影诊疗能力以及妇女依从性.

目的 分析2016-2020年鄂尔多斯市适龄女性乳腺癌筛查项目实施现状及乳腺病变筛查阳性的影响因素.方法 数据来源于鄂尔多斯市9个旗(区)2016-2020年开展的乳腺癌筛查项目,纳入35～64周岁具有本地区农村户籍且自愿接受筛查的女性为筛查对象.分析适龄女性的乳腺癌筛查阳性率、检出率和依从率,比较筛查人群中遵循不同筛查策略的检出效果,同时采用多因素logistics回归模型分析筛查阳性的影响因素.结果 共有177 107名女性参加乳腺癌筛查,其中173 808名接受超声检查的女性纳入分析.超声检查阳性率为1.18％(2 044/173 808),超声阳性且接受X线检查者的阳性率为23.74％(151/636),超声与X线的一致率为35.39％(367/1 037),乳腺癌检出率为56.38/10万(98/173 808).基于各环节实际筛查数据比较遵循不同筛查策略的筛查效果,与现有策略相比,并联策略的相对灵敏度为1.54(95％CI:1.45～1.62),相对特异度为0.40(95％CI:0.30～0.50).多因素logistics回归结果显示,未绝经、既往接受过乳腺癌筛查者的筛查阳性率较低(均P＜0.05).结论 鄂尔多斯乳腺癌超声初筛阳性率较高,但乳腺癌检出效果偏低,提示鄂尔多斯乳腺癌筛查服务效果仍需进一步提高,未来应注重加强对筛查各环节随访和管理质量,以帮助提高整体筛查效率,同时未来应关注对绝经和既往未筛查妇女等高危人群的健康宣教以提高筛查覆盖.

BACKGROUND:Primary human papillomavirus (HPV) screening is recommended for the detection of cervical intraepithelial neoplasia (CIN) in the general population; however, the triage for HPV-positive women remains a challenge. This study aimed to evaluate the age-specific effectiveness of primary HPV screening versus primary cytology screening for identifying optimal strategies for women of different ages. METHODS:The dataset of the prevalence round screening was derived from the National Cervical Cancer Screening Program in China. Primary cervical screening protocols included cytology only, HPV testing with cytology triage, and HPV testing with HPV-16/18 genotyping plus cytology triage. The primary outcomes were age-specific detection rate, colposcopy referral rate and positive predictive value (PPV) for CIN2+. Multivariate Poisson regression was used to evaluate the relative effectiveness of HPV testing and cytology according to age groups. The I2 statistic with a random-effect model was used to test the heterogeneity in relative effectiveness of HPV testing versus cytology between age groups. RESULTS:This study included 1,160,981 women. HPV testing with HPV-16/18 genotyping plus cytology triage significantly increased the CIN2+ detection by 36% (rate ratio [RR]: 1.36, 95% confidential interval [CI] 1.21-1.54) for women aged 35-44 years and by 34% (RR: 1.34, 95% CI 1.20-1.51) for women aged 45-54 years compared with cytology only. HPV testing with cytology triage had similar CIN2+ detection rate compared with cytology only. The PPVs were substantially increased for both HPV testing groups. Among women aged 55-64 years old, HPV testing with HPV-16/18 genotyping plus cytology triage increased the colposcopy referral rate by 19% (RR 1.19, 95% CI 1.10-1.29) compared with cytology only, but did not increase the CIN2+ detection (1.09, 0.91-1.30). The effectiveness of HPV testing with cytology triage did not change in older women. The between-age-group heterogeneity in the effectiveness was statistically significant for HPV testing with HPV-16/18 genotyping plus cytology triage versus cytology only. CONCLUSIONS:Our results suggested that the effectiveness of primary HPV screening with different triage strategies differed among age groups. HPV testing with HPV-16/18 genotyping plus cytology triage could be used for women aged 35-54 years to detect more lesions, and HPV testing with cytology triage could balance the CIN2+ detection and the number of colposcopies for women aged 55-64 years. Longitudinal data including both prevalence and incidence screening rounds are warranted to assess age-specific triage strategies.

Background Randomized controlled trials have shown a higher sensitivity and longer negative predictive value of high-risk human papillomavirus (HPV) testing than cytology for cervical cancer screening; however, little is known about the effectiveness of HPV testing in middle-income countries. Understanding the characteristics of HPV testing may increase the priority of HPV testing in health policies. The study aims to evaluate the effectiveness of HPV testing in the national cervical cancer screening programme in China. Methods We performed a nationwide, population-based study using individual data from the national cervical cancer screening programme in rural China between 2015 and 2017. The analyses included 1,160,981 women aged 35–64 years who underwent cytology alone or high-risk HPV testing with cytology or genotyping triage. The main outcome was cervical intraepithelial neoplasia 2 or worse (CIN2+). We used multivariate logistic regressions and performed sensitivity analyses with propensity score matching to compare the screening positive, colposcopy referral, detection rate, and positive predictive value (PPV). Results The screening positive rates for HPV testing and cytology were 10.1% and 4.0%, respectively. The per protocol colposcopy referral rate of HPV testing was significantly lower than that of cytology (3.5% vs 4.0%), and this difference was mostly due to the low referral threshold of cytology (≥ASC-US). Overall, HPV testing detected more CIN2+ (5.5 vs. 4.4 per 1000, adjusted odds ratio [aOR]=1.18, 95% confidence interval 1.11–1.25) and had a higher PPV (13.8% vs 10.9%, aOR 1.29, 95% CI 1.21–1.37) than cytology. The colposcopy referrals of HPV testing in comparison to cytology differed by income status; it significantly increased in lower-middle-income areas (3.7% vs 3.1%, aOR 1.21, 95% CI 1.17–1.25) and significantly decreased in upper-middle-income areas (3.4% vs 4.9%, aOR 0.69, 95% CI 0.67–0.71). Sensitivity analyses demonstrated the reliability and robustness of the results. Conclusions The introduction of HPV testing could improve both the CIN2+ detection rate and efficiency of cervical cancer screening programme, supporting the introduction of primary screening with high-risk HPV testing in China. Further study is needed to investigate the long-term effect of this change.

Cervical cancer is a common malignant tumor that seriously threatens the health of Chinese women. The situation of prevention and control is still serious. In the past decade, the Chinese government has made great efforts to cervical cancer prevention and control and achieved remarkably in HPV vaccine development, sound health screening system, and treatment capacity of early cervical cancer and precancerous lesions. However, due to the large population base, unequal allocation of health resources, and uneven service quality across regions, there is still a significant gap to achieve the WHO's goal of eliminating cervical cancer by 2030. In order to fulfill the Global Strategy to accelerate the elimination of cervical cancer, China urgently needs to learn from the international experience, combined with the real situation of cervical cancer prevention and control and the latest research progress in China and to put forward appropriate action recommendations and implementation approaches, which will contribute to promote the cervical cancer elimination process and to build a paradigm for "Healthy China" cancer prevention.

宫颈癌是妇女常见的生殖系统恶性肿瘤,鉴于其严峻的流行现状,宫颈癌已成为当前我国面临的重要公共卫生问题.我国的宫颈癌防治工作已历经半个多世纪,尤其在2009年启动了针对农村妇女的大规模筛查项目,至今已为近亿名适龄妇女提供免费筛查,目前筛查服务的实施仍面临一系列亟待解决的问题.本文对我国农村地区宫颈癌筛查服务的开展历程与实施现状进行简要综述,并重点分析了筛查服务实施中面临的挑战,以期为进一步提高服务质量提供循证依据.