Epidemiology and prevention of HPV-driven cervical cancer in urban–rural China: a population-based study of 60,280 women

Cervical cancer continues to pose a significant public health burden in China, where marked differences persist in HPV infection rates and screening participation between urban and rural populations. We investigated HPV epidemiology and evaluated prevention approaches in Putian, a southeastern Chinese region representative of broader demographic patterns. This cross-sectional study analyzed screening results from 60,280 women aged 35-64 years who participated in Putian's free cervical cancer screening program between 2021 and 2023. We employed HPV genotyping (14 high-risk subtypes), liquid-based cytology (TCT), and histopathological examination to assess infection rates, subtype distribution, and screening effectiveness. The data provided insights into both epidemiological patterns and diagnostic performance within this population. The overall human papillomavirus (HPV) infection prevalence was 9.27% (95% CI: 9.04-9.50), with HPV 52 (35.61%), HPV 58 (16.56%), and HPV 16 (12.38%) emerging as the most prevalent genotypes. Cervical cancer incidence peaked in women aged 55-59 (95 cases per 100,000), with a secondary peak observed in the 50-54 age group (89 cases per 100,000). In addition, a concerning early-onset pattern appeared in the 40-44 age group (46 cases per 100,000). The national incidence rate averaged 56 cases per 100,000. HPV 16/18 infections accounted for the majority of cervical cancer cases, with HPV 58/33/52 representing secondary high-risk genotypes. ThinPrep cytologic test (TCT) screenings revealed clinically significant underdiagnosis and overdiagnosis rates. Only 1.33% of women participated in self-screening initiatives. Urban-rural disparities in HPV 52/58/33 prevalence persist alongside low screening rates, underscoring the urgency of implementing targeted vaccination strategies, particularly the 9-valent HPV vaccine, and adopting advanced triage methods such as methylation testing in Putian.