title: Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: a pooled analysis of 17 population-based studies.
abstract: High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Our study aimed to estimate the prevalence of HR-HPV and cervical intraepithelial neoplasia (CIN) in China and indirectly informs on the cervical cancer burden in the country. A total of 30,207 women from 17 population-based studies throughout China were included. All women received HPV DNA testing (HC2, Qiagen, Gaithersburg, MD), visual inspection with acetic acid and liquid-based cytology. Women positive for any test received colposcopy-directed or four-quadrant biopsies. A total of 29,579 women had HR-HPV testing results, of whom 28,761 had biopsy confirmed (9,019, 31.4%) or assumed (19,742, 68.6%) final diagnosis. Overall crude HR-HPV prevalence was 17.7%. HR-HPV prevalence was similar in rural and urban areas but showed dips in different age groups: at age 25-29 (11.3%) in rural and at age 35-39 (11.3%) in urban women. In rural and urban women, age-standardized CIN2 prevalence was 1.5% [95% confidence interval (CI): 1.4-1.6%] and 0.7% (95% CI: 0.7-0.8%) and CIN3+ prevalence was 1.2% (95% CI: 1.2-1.3%) and 0.6% (95% CI: 0.5-0.7%), respectively. Prevalence of CIN3+ as a percentage of either all women or HR-HPV-positive women steadily increased with age, peaking in 45- to 49-year-old women. High prevalence of HR-HPV and CIN3+ was detected in both rural and urban China. The steady rise of CIN3+ up to the age group of 45-49 is attributable to lack of lesion removal through screening. Our findings document the inadequacy of current screening in China while indirectly raising the possibility that the cervical cancer burden in China is underreported.
authors.affiliation: Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Fang-Hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Adam K
authors.initials: AK
authors.lastname: Lewkowitz
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Hu
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Long-Yu
authors.initials: LY
authors.lastname: Li
authors.forename: Qing-Ming
authors.initials: QM
authors.lastname: Zhang
authors.forename: Rui-Fang
authors.initials: RF
authors.lastname: Wu
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Li-Hui
authors.initials: LH
authors.lastname: Wei
authors.forename: Ai-Di
authors.initials: AD
authors.lastname: Xu
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Zhang
authors.forename: Qin-Jing
authors.initials: QJ
authors.lastname: Pan
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Belinson
authors.forename: John W
authors.initials: JW
authors.lastname: Sellors
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics / Q000472:pathogenicity*; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000821:virology
chemical_list: D004279:DNA, Viral