Epidemiological Characteristics and Risk Factors of High-Risk HPV Infection, Cervical Cancer, and Precancerous Lesions Among Women in Southwestern China

Lu Zhang¹Qiwen Zhang¹Bing Pang¹Zhuo Tan¹Denghui Yang¹Jie-Ru Peng^1,2Yao Dong¹Xia Wu³Liu Yang^3*You-lin Qiao^4*Chunxia Yang^1*

• ¹Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
• ²Department of Medical Records Statistics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
• ³Healthcare Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
• ⁴Chinese Academy of Medical Sciences, and Peking Union Medical College, School of Population Medicine and Public Health, Beijing, China

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, residence in suburban areas, menopause, having three or more childbirths, and three or more abortions were associated with a higher risk of HR-HPV infection. In contrast, later age at first birth and condom use were protective factors. Additionally, age, residential areas, and menopausal status 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.