Abstract
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.
Highlights
Cervical cancer burden in ChinaCervical cancer continues to be the most common cancer among Chinese women
Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions
Because of its large population with significant regional and socioeconomic disparities, substantial inequity in financial resources, infrastructure, health care staff, and access to health care, China carries a heavy global burden of cervical cancer, and significant disparities exist in cervical cancer burden across different regions
Summary
Cervical cancer continues to be the most common cancer among Chinese women. Because of its large population with significant regional and socioeconomic disparities, substantial inequity in financial resources, infrastructure, health care staff, and access to health care, China carries a heavy global burden of cervical cancer, and significant disparities exist in cervical cancer burden across different regions. The low proportion of the population covered and the poor quality of data represented in the NCCR hinders accurate data interpretation; the data reported significantly lags behind the actual situation (it can only reflect the situation of cervical cancer three years ago), so the true and timely burden of cervical cancer in China estimated solely on the basis of cancer registration data is difficult For all these reasons, it is not clear that the sharp increase of cervical cancer incidence and mortality from 2009 to 2010 can be attributed to the rapid expansion of coverage and improved data quality and improved data collection and reporting, or to the implementation of the NCCSPRA in 2009 which increased resources and capacity to improve screening and detection and monitoring in these areas. Central China, with an area of 28.2 million square kilometres, has a GDP of US$2630 (Jian et al, 2010; Goss et al, 2014), and 48.7% of the population live in urban
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