Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Reproductive Health and Research, Geneva, Switzerland.
Lancet Public Health. 2019 Sep;4(9):e462-e472. doi: 10.1016/S2468-2667(19)30162-8.
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.
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).
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 age-standardised 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.
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.
National Natural Science Foundation of China and Chinese Academy of Medical Science Initiative for Innovative Medicine.
中国宫颈癌的发病率正在迅速上升。我们旨在预测中国宫颈癌的年龄标准化发病率直至 2100 年，并确定在不同预算情况下消除宫颈癌的最佳策略。
在我们的建模研究中，我们开发了一种经过调整和校准的混合模型，以估计 2015-2100 年中国城乡宫颈癌的发病率。考虑了所有 11.5 亿在 2015-2100 年期间生活或预计生活在中国的中国女性，以及老龄化、城市化和性行为的预期趋势。我们评估了几种预算限制情况（当前预算[2012-18 年]、当前预算的两倍和无预算限制）、人乳头瘤病毒疫苗接种（不同目标人群和覆盖范围）和宫颈癌筛查特征（不同目标年龄、筛查间隔和覆盖范围）的实施情况。我们使用预算优化过程来选择最佳的疫苗接种和筛查组合。主要结果是 2015-2100 年宫颈癌的年度发病率，以及消除的年份（预计发病率首次低于每 10 万名妇女 4 例新病例的第一年）。
在当前策略下，到 2100 年，宫颈癌的年龄标准化发病率预计将增加到 2015 年的三倍。然而，如果中国从 2020 年开始采用当前预算下的最佳策略（即，为 12 岁女孩接种疫苗，覆盖率为 95%，并将城市地区 45 岁妇女和农村地区 33%妇女的一次性终生筛查覆盖率扩大到 90%），预计到 2072 年（95%CI 2070-74），中国城市宫颈癌的年度年龄标准化发病率将降至每 10 万名妇女不到 4 例新病例（即消除），到 2074 年（2072-76），中国农村宫颈癌的年度年龄标准化发病率将降至每 10 万名妇女不到 4 例新病例（即消除）。如果从 2020 年开始将当前预算增加一倍，那么到 2063 年（2059-66），中国城市将实现宫颈癌消除，到 2069 年（2066-71），中国农村将实现宫颈癌消除。如果最大化 12 岁女孩接种疫苗和每 5 年对 35-64 岁妇女进行筛查的覆盖率，不考虑预算限制，那么中国城市最早可以在 2057 年（2053-60），中国农村最早可以在 2060 年（2057-63）实现宫颈癌消除。
在中国现行的宫颈癌防治策略下，宫颈癌的发病率将继续上升。然而，根据我们从 2020 年开始的预算优化策略，宫颈癌可以在 21 世纪 70 年代初作为一个公共卫生问题得到消除。通过增加人乳头瘤病毒疫苗接种和宫颈癌筛查的预算，可以在 2050 年代后期实现消除。
国家自然科学基金委员会和中国医学科学院创新医学倡议。
