Urban-rural disparity in cervical cancer in China and feasible interventions for tackling the rural excess

Abstract

According to GLOBOCAN 2012, age-standardized incidence rate (ASIR) of cervical cancer in developed and less developed countries is 9.9 vs. 15.7 per 100,000 population per year. This disparity is related to inequity in access to screening. Urban rural disparity in access to cervical cancer screening is similar in China. We aim to assess urban rural disparity in ASIR.Using population-based tumor registration data collected by us in urban Shijiazhuang city (with incidence data available for 1,217,437 women in 2012) and in Shexian County (with incidence data available for 197,416 women since 2000), we compared ASIR of cervical cancer between the two populations in 2012. We also analyzed the trend of biennial ASIR and averaged age at diagnosis of cervical cancer for 2000-2015 in Shexian County during which China was undergoing rapid changes in sexual mores. Finally, using previously published national death survey data, we compared age-standardized mortality rate (ASMR) of cervical cancer between Shijiazhuang city and Shexian County over the periods of 1973-1975 and 1990-1992.It was found that the ASIR of cervical cancer in rural Shexian County is 3 times higher than in Shijiazhuang city in 2012 (25.0 vs. 8.4 per 100,000 per year, P < .01); and the corresponding ASMR was 2 times higher over the period of 1973-1975 (25.0 vs. 13.0 per 100,000 per year, P < .01) and 8 times higher over the period of 1990-1992 (9.8 vs. 1.2 per 100,000 per year, P < .01). From 2000 to 2015 along with rapid changes in sexual behavior, the biennial ASIR of cervical cancer increased by +3.2% on average, from 19.3 to 28.5 per 100,000 per year (P < .01), and the biennial averaged age at diagnosis decreased from 55.8 to 52.1 (P < .01).Urban-rural disparity in ASIR of cervical cancer in present study is larger than that reported between developed and less developed countries in GLOBOCAN 2012, in which the disparity is considered "due to differences in access to screening." As in China, cytologists and infrastructure required for cervical cancer screening are similarly lacking in rural areas, we suggest cytological screening for cervical cancer be strengthened in disadvantaged rural settings.

Figure 1

Geographic location of urban Shijiazhuang city, rural Shexian County, and the adjoining Xiangyuan, Wuxiang, and Yangcheng counties in Shanxi province where endemic rates of cervical cancer are found.

Figure 2

Age-specific incidence rates of cervical cancer in rural Shexian County and urban Shijiazhuang city in 2012.

Figure 3

Age-standardized incidence rate (biennial) of cervical cancer in Shexian County from 2000 to 2015; averaged biennial percent change = +3.2%, P < .01.

Figure 4

Averaged age at diagnosis (biennial) of cervical cancer in Shexian County from 2000 to 2015.