Projections up to 2100 and a budget optimisation strategy towards cervical cancer elimination in China: a modelling study

Abstract

Background The incidence of cervical cancer in China is increasing rapidly. We aimed to forecast the age-standardised incidence of cervical cancer in China up to 2100, and to determine the optimal strategy to eliminate cervical cancer under different budget scenarios. Methods In our modelling study, we developed an adapted and calibrated hybrid model to estimate the incidence of cervical cancer in urban and rural China until 2100. All 1•15 billion Chinese women living or projected to live during 2015-2100, under the projected trends in ageing, urbanisation, and sexual activity were considered. We assessed several scenarios of budget constraints (a current budget [2012-18], twice the current budget, and no budget constraints), implementation of human papillomavirus vaccination (with different target populations and coverage), and cervical cancer screening characteristics (with different target ages, screening intervals, and coverage). We used a budget optimisation process to select the best available combinations of vaccination and screening. The primary outcomes were the annual incidence of cervical cancer in 2015-2100, and the year of elimination (the first year in which the incidence was expected to be lower than four new cases per 100 000 women). Findings Under the current strategy, by 2100, the age-standardised incidence of cervical cancer is projected to increase to three times the incidence in 2015. However, if China adopts an optimal strategy under the current budget from 2020 onwards (namely, introducing vaccination of 95% coverage for girls aged 12 years, and expanding coverage of once in a lifetime screening for women aged 45 years of 90% in urban areas and 33% in rural areas), the annual agestandardised incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100 000 women (ie, elimination) by 2072 (95% CI 2070-74) in urban China and 2074 (2072-76) in rural China. If the current budget were doubled from 2020 onwards, elimination would be achieved by 2063 (2059-66) in urban China and 2069 (2066-71) in rural China. The earliest possible year of cervical cancer elimination would be 2057 (2053-60) in urban China and 2060 (2057-63) in rural China, if vaccination coverage for girls aged 12 years and coverage of screening at 5-year intervals for women aged 35-64 years was maximised, with no budgetary restrictions. Interpretation Cervical cancer incidence in China will continue to increase under current cervical cancer prevention strategies. However, under our budget optimisation strategy from 2020 onwards, cervical cancer could be eliminated as a public health problem by the early 2070s. Elimination could be achieved by the late 2050s by increasing the budget towards vaccination against human papillomavirus and cervical cancer screening.

Analysis of real-world free cervical cancer screening for eligible women in Beijing China, 2008-2018

“…A modelling study in China suggest that population coverage of screening is more important than the frequency of screening, and the once in a lifetime screening at age 45 years might be the best available strategy, given the insu cient budget. The optimal age at which to screen is driven from the distinctive age-speci c prevalence of CIN2 + and high-risk HPV in Chinese women [18]. We also notice that eligible women accepted screening had lower composition ratio in Beijing, yet the ratio should be more than 70%, which has mentioned by WHO in order to expect eliminating cervical cancer worldwide [19].…”

HPV Genotype Prevalence and Success of Vaccination to Prevent Cervical Cancer

“…The World Health Organization (WHO) has been drafting a strategy to achieve elimination of cervical cancer in all countries through vaccination, screening, and treatment. However, elimination of cervical cancer as a public health problem remains a challenge in many lowand middle-income countries [15].…”

Cost-effectiveness and accuracy of cervical cancer screening with a high-risk HPV genotyping assay vs a nongenotyping assay in China: an observational cohort study

“…China has the highest number of cervical cancer patients, with 98,900 new cases and 30,500 deaths each year [ 3 ] due to inadequate screening, lack of a human papillomavirus (HPV) vaccine and increased HPV infection rates [ 4 ]. Unfortunately, the first HPV vaccine was approved in China in 2017, and less than 30% of women over 21 years have been screened for cervical cancer [ 5 ]. Although nationwide cervical cancer screening programs began in 2009, due to the large population in China, the proportion of women undergoing programmatic screening is still low [ 5 ], and the main procedure for cervical cancer screening is screening at hospitals.…”

“…Unfortunately, the first HPV vaccine was approved in China in 2017, and less than 30% of women over 21 years have been screened for cervical cancer [ 5 ]. Although nationwide cervical cancer screening programs began in 2009, due to the large population in China, the proportion of women undergoing programmatic screening is still low [ 5 ], and the main procedure for cervical cancer screening is screening at hospitals.…”