Review of the Cervical Cancer Burden and Population-Based Cervical Cancer Screening in China

  • Di, Jiangli (Centre for Environment and Population Health, Environment School, Griffith University) ;
  • Rutherford, Shannon (Centre for Environment and Population Health, Environment School, Griffith University) ;
  • Chu, Cordia (Centre for Environment and Population Health, Environment School, Griffith University)
  • Published : 2015.12.03


Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.


Cervical cancer burden;China;population-based cervical cancer screening;program


  1. Chen HY (2009). Obvious bottleneck of cervical cancer screening. China Hospital CEO, 20, 28-29.
  2. Chen WQ, Zheng RS, Zhang SW, et al (2014). Annual report on status of cancer in China, 2010. Chinese J Cancer Res, 26, 48-58.
  3. Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, et al (2014). Challenges to effective cancer control in China, India, and Russia. Lancet Oncol, 15, 489-538.
  4. IARC (2005). IARC handbooks of cancer prevention (Vol. 10). Geneva: IARC Press.
  5. IARC (2012a). Cervix uteri - estimated incidence, all ages. retrieved september 5, 2014, from 2%A0Execute%C2%A0
  6. IARC (2012b). GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. retrieved september 5, 2014, from
  7. Jia Y, Li S, Yang R, et al (2013). Knowledge about cervical cancer and barriers of screening program among women in Wufeng County, a high-incidence region of cervical cancer in China. PloS One, 8, 67005.
  8. Jian WY, Chan KY, Reidpath DD, et al (2010). China's ruralurban care gap shrank for chronic disease patients, but inequities persist. Health Affairs, 29, 2189-96.
  9. Lancet T. (2009). Women's health in rural China. Lancet, 374, 358.
  10. Lazcano-Ponce E, Moss S, de Ruiz PA, et al (1999). Cervical cancer screening in developing countries: Why is it ineffective? the case of mexico. Archives Med Res, 30, 240-250.
  11. Lazcano-Ponce E, Palacio-Mejia LS, Allen-Leigh B, et al (2008). Decreasing cervical cancer mortality in mexico: effect of Papanicolaou coverage, birthrate, and the importance of diagnostic validity of cytology. Cancer Epidemiol Biomarkers Prev, 17, 2808-17.
  12. Liang W, Zheng J, He L, et al (2010). Research on health service demands and utilization of rural migrant workers in Taiyuan. China Health Resour (in Chinese), 13, 67-69.
  13. MOH. (2006). Results assembly about research on policy of women and children's health. beijing: people's medical publishing house.
  14. MOH. (2009). Management plan for rural areas cervical cancer and breast cancer screening examination program. retrieved june 24, 2009, from
  15. MOH (2012a). Notification about carry out major women and children's public health program in 2012. ([2012]79). Beijing: Ministry of Health of the People's Republic of China Retrieved from
  16. MOH (2012b). Record of process of major women and children's public health program in press conference. beijing: record of process of major women and children's public health program in press conference.
  17. MOH (2012c). Report on women and children' health development in China (2011). beijing: ministry of health of the people's republic of China.
  18. MOH (2013). China's health statistics yearbook 2013. Beijing: Peking Union Medical College Press.
  19. MOH, UNICEF, WHO, et al (2006). Jiont review of the maternal and child survival strategies in China. Beijing: Ministry Of Health Of The People's Republic of China.
  20. NBS (2014a). 2013 National economic and social development statistics bulletin. Beijing: National Bureau Of Statistics.
  21. NBS (2014b). National data. retrieved october 12 2014, from
  22. NCC, DPCB, NHFPC (2012). Chinese cancer registry annual report 2012. Beijing: Military Medical Science Press.
  23. NCC, DPCB, NHFPC (2013). Chinese cancer registry annual report 2013. Beijing: Military Medical Science Press
  24. NCWCH CC (2014). The report of resources and operation situations of MCH institutions in 2013 Beijing: National Center For Women And Children's Health, China CDC.
  25. NHFPC (2013a). China health statistics yearbook 2013.
  26. NHFPC (2013b). Notification about carry out major women and children's public health program in 2013. ([2013]65). Beijing: Notification about carry out major women and children's public health program.
  27. NHFPC (2014). Notification about carry out major women and children's public health program in 2014. ([2014] 84). Beijing: Notification about carry out major women and children's public health program.
  28. NOCPC, NCCR, DPCB (2008). Chinese cancer registry annual report 2004. Beijing: Beijing Union Medical University Press.
  29. NOCPC, NCCR, DPCB (2010). Chinese cancer registry annual report 2010. Beijing: Military Medical Science Press.
  30. Qin XZ, Pan J, Liu GG (2014). Does participating in health insurance benefit the migrant workers in China? An empirical investigation. China Econ Rev, 30, 263-278.
  31. Shao S, Zhao F, Wang J, et al (2013). The ecology of medical care in Beijing. PloS One, 8, 82446.
  32. Shen J (2007). Study on the special labour protection of women employees. Xiamen.
  33. Shi JF, Canfell K, Lew JB, et al (2012). The burden of cervical cancer in China: Synthesis of the evidence. Int J Cancer, 130, 641-52.
  34. Shi MX (2003). Research on the legislation issue of female workers' labour protection. China Safety Scie J, 1-4.
  35. Song J, Leng M, Meng F, et al (2010). Research on health service utilization of rural migrant workers in Nanjing. Chinese Primary Health Care (in Chinese), 24, 10-11.
  36. Thulaseedharan JV, Malila N, Hakama M, et al (2013). Effect of screening on the risk estimates of socio demographic factors on cervical cancer - a large cohort study from rural India. Asian Pac J Cancer Prev, 14, 589-94.
  37. Tsu VD, Jeronimo J, Anderson BO (2013). Why the time is right to tackle breast and cervical cancer in low-resource settings. Bulletin of the World Health Organization, 91, 683-90.
  38. WHO (2006). Comprehensive cervical cancer control A guide to essential practice. Geneva: WHO press.
  39. WHO (2007). Cancer control: knowledge into action, WHO guide for effective programmes, early detection. Geneva: WHO Press.
  40. WHO (2011a). Country health information profiles: China. retrieved september 29, 2014, from
  41. WHO. (2011b). The world factbook: China. retrieved september 23, 2014, from
  42. WHO (2012). China. retrieved october 13, 2014, from
  43. WHO, China National Health Development Research Centre. (2012). Health service delivery profile: China. retrieved 29th, Sep, 2014, from
  44. Xia JH, Luo XP, Xue SH, et al (2012). The obstacles of women in rural areas taking part in screening of cervical cancer and sgrategies. China J Women Child Health, 3, 363-6.
  45. Yao HQ, Ren ZZ (2007). Report on economic development in western regions of China. Beijing: Social Sciences Academic Press.
  46. Zhou JY, Qiu LP, Liu L, et al (2011). Analysis of inf luencing factors on compliance with colposcopy in cervical cancer screening project in daxing district, beijing city. Chinese J Health Educat, 27, 498-501.
  47. Zhu LH (2011). Impact of screening tests of cervial cancer and breast cancer screening in rural areas to implementation of program. Maternal Child Health Care China, 26, 5673-5675.

Cited by

  1. Previous cervical cytology and high-risk human papillomavirus testing in a cohort of patients with invasive cervical carcinoma in Shandong Province, China vol.12, pp.6, 2017,
  2. Histopathologic follow-up and HPV test results with HSIL Papanicolaou test results in China's largest academic women's hospital vol.125, pp.12, 2017,
  3. Assessing Knowledge and Attitudes towards Cervical Cancer Screening among Rural Women in Eastern China vol.14, pp.9, 2017,
  4. Effect of EBI3 on radiation-induced immunosuppression of cervical cancer HeLa cells by regulating Treg cells through PD-1/PD-L1 pathway vol.39, pp.3, 2017,
  5. Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women pp.10579249, 2017,
  6. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013 pp.1569-8041, 2017,
  7. Awareness of and willingness to be vaccinated by human papillomavirus vaccine among junior middle school students in Jinan, China pp.2164-554X, 2017,
  8. Prevalence and distribution of human papillomavirus genotypes among women with high-grade squamous intraepithelial lesion and invasive cervical cancer in Ganzhou, China pp.08878013, 2018,
  9. Upregulation of microRNA-129-5p inhibits cell invasion, migration and tumor angiogenesis by inhibiting ZIC2 via downregulation of the Hedgehog signaling pathway in cervical cancer pp.1555-8576, 2018,
  10. The precision prevention and therapy of HPV-related cervical cancer: new concepts and clinical implications vol.7, pp.10, 2018,
  11. Prevalence of human papillomavirus by geographical regions, sexual orientation and HIV status in China: a systematic review and meta-analysis vol.94, pp.6, 2018,
  12. Significant variations in the cervical cancer screening rate in China by individual-level and geographical measures of socioeconomic status: a multilevel model analysis of a nationally representative survey dataset vol.7, pp.5, 2018,
  13. microRNA-383 suppresses the PI3K-AKT-MTOR signaling pathway to inhibit development of cervical cancer via down-regulating PARP2 vol.119, pp.7, 2018,
  14. MicroRNA-374b inhibits cervical cancer cell proliferation and induces apoptosis through the p38/ERK signaling pathway by binding to JAM-2 vol.233, pp.9, 2018,
  15. HPV prevalence and genotype distribution among women in Shandong Province, China: Analysis of 94,489 HPV genotyping results from Shandong’s largest independent pathology laboratory vol.14, pp.1, 2019,
  16. Prognostic Values of Systemic Inflammation Response (SIR) Parameters in Resectable Cervical Cancer vol.17, pp.1, 2019,
  17. Cervical Screening by Pap Test and Visual Inspection Enabling Same-Day Biopsy in Low-Resource, High-Risk Communities vol.133, pp.3, 2019,