Epidemiological characteristics and risk factors of high-risk HPV infection, cervical cancer, and precancerous lesions among women in Southwestern China.
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BACKGROUND: Cervical cancer poses a significant threat to women's reproductive and overall health. In Chengdu, southwestern China, free cervical cancer screening is provided to women in both urban and suburban areas, using high-risk human papillomavirus (HR-HPV) testing combined with cytology triage. This study aimed to investigate the epidemiological characteristics and risk factors of HR-HPV infection, cervical cancer, and high-grade precancerous lesions based on large-scale screening data from Chengdu. METHODS: This retrospective study analyzed cervical cancer screening data from January 1, 2021, to December 31, 2022, in Chengdu. A total of 107,120 women aged 35-64 years who underwent screening with HR-HPV testing combined with cytology triage were included. Screening participation and detection outcomes were analyzed to evaluate program implementation and to describe the distribution of HR-HPV and cervical lesions. Multivariable logistic regression was performed to identify factors independently associated with HR-HPV infection and cervical cancer/precancerous lesions. RESULTS: The overall prevalence of HR-HPV infection was 10.54%, with HPV 16/18 accounting for 1.26%. The crude detection rate of cervical cancer and high-grade precancerous lesions (≥ HSIL/CIN2-3) was 399.55 per 100,000, of which the detection rate of cervical cancer was 19.60 per 100,000. The early diagnosis rate through screening reached 97.66%. The distribution of HPV 16/18 and other HR-HPV types varied across different cervical lesion groups, with HPV 16/18 being the predominant types associated with cervical cancer. Multivariable logistic regression analysis showed that age ≥55 years (55-59 years: aOR=1.34, 95% CI: 1.22-1.47; 60-64 years: aOR=1.53, 95% CI: 1.37-1.73), residence in suburban areas (aOR=1.19, 95% CI: 1.11-1.27), menopause (aOR=1.08, 95% CI: 1.01-1.15), having three or more childbirths (aOR=1.18, 95% CI: 1.06-1.31), and three or more abortions (aOR=1.16, 95% CI: 1.06-1.26) were associated with a higher risk of HR-HPV infection. In contrast, later age at first birth (21-25 years: aOR=0.88, 95% CI: 0.83-0.94; ≥26 years: aOR=0.80, 95% CI: 0.74-0.86) and condom use (aOR=0.87, 95% CI: 0.82-0.92) were protective factors. Additionally, age (55-59 years: aOR=1.57, 95% CI: 1.03-2.41), residential areas (suburban areas: aOR=1.82, 95% CI: 1.23-2.69), and menopausal status (yes or uncertainty: aOR=0.72, 95% CI: 0.52-0.99) were also associated with cervical cancer and precancerous lesions. A potential interaction between age and menopausal status was also observed. CONCLUSION: This study characterized the epidemiology of HR-HPV infection, cervical cancer, and high-grade precancerous lesions in Chengdu and identified associated risk and protective factors, providing evidence to inform targeted screening and prevention strategies.