Geographic and temporal variations in cancer incidence attributable to human papillomavirus infection in China: a population-based study.
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BACKGROUND: Current epidemiological data on cancer incidence attributable to human papillomavirus (HPV) infection in China remain unclear. This study provides an updated assessment of the magnitude of and geographic variability in the incidence of HPV-attributable cancer in China in 2013-2017, temporal trends from 1988 to 2017 and projections to 2032. METHODS: Data were extracted from the Cancer Incidence in Five Continents Volumes VII-XII. The population-attributable fraction was calculated by multiplying the high-risk HPV prevalence at each anatomical site by the specific biomarker positivity rate in HPV-positive cases. Joinpoint regression and age-period-cohort models were used to quantify temporal age-standardized incidence rate (ASR) trends and age and birth cohort effects, respectively. Bayesian age-period-cohort models were constructed to project the HPV-attributable cancer incidence through 2032. RESULTS: An estimated 68,955 and 3463 HPV-attributable cancer cases were observed among females and males in China in 2013-2017, respectively, with ASRs of 11.20 (95% confidence interval [CI]: 10.98-11.41) and 0.52 (0.20-0.82) per 100,000. The most common HPV-attributable cancers were cervical cancer (females; ASR [95% CI]: 10.92 [10.83-11.00] per 100,000) and laryngeal cancer (males; 0.21 [0.03-0.37] per 100,000). Among the 25 provinces included, the ASRs of HPV-attributable cervical cancer ranged from 6.15 (5.88-6.42) per 100,000 in Beijing to 17.43 (15.84-19.03) per 100,000 in Hunan (2.8-fold difference). The provincial Human Development Index was inversely associated with the cervical cancer incidence in multivariable linear ecological regression analyses. From 1988 to 2017, the ASRs increased for HPV-attributable cervical cancer (females; average annual percent change [AAPC] and 95% CI: 5.89% [2.82-9.06]) and penile and oropharyngeal cancers (males; 1.98% [0.82-3.15] and 9.65% [5.81-13.62], respectively). Substantial increasing risks across successive generations born between 1908 and 1978 were observed for HPV-attributable cervical cancer among females and oropharyngeal cancer in both sexes. Under a counterfactual continuation of historical trends through 2017, without incorporating subsequent vaccination or screening expansion, the ASR of HPV-attributable cervical cancer is projected to reach 19.53 (95% uncertainty interval [UI]: 9.99-34.36) per 100,000 in 2028-2032, compared with 10.92 (95% CI: 10.83-11.00) per 100,000 in 2013-2017. CONCLUSIONS: In China, the incidence of HPV-attributable cancer varies considerably according to cancer type and geography. These findings highlight the need for region-specific HPV vaccination and cancer screening strategies, particularly in areas with high incidence rates.