Guidelines for Cervical Cancer Screening in China (I)

1Background & Goal

Target: WHO accelerate-elimination strategy; China Action Plan 2023–2030.
Burden: 109k new & 59k deaths in China 2020 (18.2%/17.3% of world).
Endpoint: CIN3+ risk as main clinical endpoint (ASCCP principle).

2Epidemiology Essentials

15.0%

HPV prevalence ≥20 y

2 peaks

17–24 & 40–44 y

52/58/53/16/51

common types

hrHPV+ in cancer

88.7%

hrHPV+ in HSIL

86.0%

hrHPV+ in LSIL

69.8%

hrHPV+ in normal

15.6%

3.1%

CIN1 · ASR prev.

1.3%

CIN2 · ASR prev.

1.2%

CIN3+ · ASR prev.

97.6%

hrHPV · SCC

74.5%

hrHPV · adeno

+5.4%/yr

mortality rise

Screening principle: early detection of precancer & early cancer; organized + opportunistic.
Why 25 y start: <25 HPV mostly transient; cancer rare; avoid adverse pregnancy effects of overtreatment.
Regional gap: HPV prevalence higher in central/west than east; rural mortality rising faster.
Type split: hrHPV in SCC 97.6% vs adenocarcinoma 74.5%.
Screening modes: organized population screening · opportunistic screening.
Rising burden: ASR incidence 2.53 → 11.34/100k (1999→2016), +8.5%/yr.
Younger onset: rural mean age at diagnosis fell 5.18 y (2000–2014).

3Screening Methods — Recommendations

hrHPV nucleic acid — primary screening of choice.

1类

Cytology where HPV unavailable; switch when feasible.

Cotesting (HPV+cytology) for resource-rich / opportunistic / special.

1类

VIA for resource-limited areas without HPV/cytology.

HPV primary screening preferred; cytology transition; co-testing in adequate-resource settings.

4Age & Screening Interval

<25

no routine screening (transient HPV; low cancer rate)

25–64

HPV/co-test every 5 y · cytology every 3 y

>65

stop if adequate negative history; else continue

Special

<25 high-risk · pregnancy · post-hysterectomy · HIV

<25 high-risk (multi-partner / early sex / HIV / smoking): screen 1 y after sexual debut, shorter intervals (2B).
Never/inadequately screened: screen at pre-pregnancy or first antenatal visit (2A).
Post-hysterectomy: CIN-precursor → annual co-test ×3 then 3-y ×25 y (2A); benign → no routine (2B).

5Emerging Methods & Methylation Position

Methylation · HPV integration · viral load · immunocytochemistry · AI — promising but need large prospective data.
Vaccinated women: same screening strategy as general population (2B).
Immunocompromised: early screening per HIV strategy (2A).

Methylation

emerging screening tool

HPV integration

emerging

TCT+HPV

co-screening

HR-HPV+

triage

ASC-US/LSIL

triage

Methylation triage role: co-screening with TCT+HPV; triage HR-HPV+ / ASC-US / LSIL (per companion consensus).
Evidence needed: large prospective studies to define clinical position.
Future: multi-marker panels · liquid biopsy · individualized treatment.
Methylation evidence: objective, repeatable, sample-parsimonious — complements HPV/cytology in triage pathways.

Methylation is listed among emerging screening tools with application prospects — validated triage role per companion consensuses; direction of travel toward molecular precision screening.