Epidemiological Features of Human Papillomavirus (HPV) Infection among Women Living in Mainland China

  • Li, Jing (West China School of Public Health, No.4 West China Teaching Hospital, Sichuan University) ;
  • Huang, Rong (West China School of Public Health, No.4 West China Teaching Hospital, Sichuan University) ;
  • Schmidt, Johannes E. (GlaxoSmithKline Vaccines) ;
  • Qiao, You-Lin (Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College)
  • Published : 2013.07.30


Cancer of the cervix is the third most common cancer in women worldwide, more than 85% of the cases occurring in developing countries such as China. In China, since a national cancer registry is already set up but with geographically limited data generated, the burden of cervical cancer is believed to be underestimated. High-risk human papillomavirus (HR-HPV) prevalence among women attending routine cervical cancer screening programs has been shown to correlate well with cervical cancer incidence rates based on independently obtained HPV prevalence data as well as findings for the worldwide cervical cancer burden. Therefore, reviewing data on HR-HPV prevalence in population-based screening studies and hospital-based case studies will be important in the context of better understanding the cervical cancer burden and for the evaluation of the potential impact of HPV vaccination in the country. With the advent of prophylactic vaccines, significant progress is likely to be made in cervical cancer prevention. This article reviews available data on the HPV epidemiology over a 12-year time period (2001-2012) in mainland China under different epidemiological aspects: by age group of study population, by ethnicity, by geographic area, as well as time period. The authors also review the potential acceptability of HPV vaccination among Chinese women.


Human papillomavirus (HPV) infection;cervical cancer;Chinese women


  1. Ablimit T, Turgan M, Abliz G, et al (2011). Study on the distribution of HPV subtypes in Uighur people living in the Karsay township, Moyu county, Xinjiang. Chin J Epidemiol, 32, 477.
  2. Ablimit X, Abduxkur G, Abliz G, et al (2009). The investigation of the factors related to the knowledge of cervical cancer and HPV in Uygur women. J Xinjiang Med Univ, 32, 522-5.
  3. Arbyn M, Castellsague X, de Sanjose S, et al (2011). Worldwide burden of cervical cancer in 2008. Ann Oncol, 22, 2675-86.
  4. Bao YP, Li N, Smith JS, et al (2008). Human papillomavirus type-distribution in the cervix of Chinese women: a meta-analysis. Int J STD AIDS, 19, 106-11.
  5. Bao Y.P, Li N, Wang H, et al (2007). Study on the distribution of human papillomavirus types in cervix among Chinese women: a meta-analysis. Chin J Epidemiol, 28, 941-6.
  6. Belinson J, Qiao YL, Pretorius R, et al (2001). Shanxi Province Cervical Cancer Screening Study: a cross-sectional comparative trial of multiple techniques to detect cervical neoplasia. Gynecol Oncol, 83, 439-44.
  7. Bosch F.X, Lorincz A, Munoz N, et al (2002). The causal relation between human papillomavirus and cervical cancer. J Clin Pathol, 55, 244-65.
  8. Bruni L, Diaz M, Castellsague M, et al (2010). Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis, 202, 1789-99.
  9. Castellsague X, Bosch FX, Munoz N (2004). The male role in cervical cancer. Salud Publica Mex, 45, 345-53.
  10. Castle PE, Schiffman M, Herrero R, et al (2005). A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica. J Infect Dis, 191,1808-16.
  11. Chen W, Zhang X, Molijn A, et al (2009). Human papillomavirus type-distribution in cervical cancer in China: the importance of HPV 16 and 18. Cancer Causes Control, 20, 1705-13.
  12. Chen ZF, Ma HFZ, Ding Y, et al (2011). The investigation of reproductive tract human papillomavirus infection genotypes and distribution in Hans, Uygurs and Hazakhs. Chin J Pract Gynecol Obstetrics, 27, 602-605.
  13. Dai M, Bao YP, Li N, et al(2006). Human papillomavirus infection in Shanxi Province, People's Republic of China: a population-based study. Br J Cancer, 95, 96-101.
  14. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  15. Fu FH, Wang JB, Jiang Y, et al(2010). Survey on Cognition of Cervical Cancer Among Women in Community Beijing. Chin Cancer, 10, 643-6.
  16. Grant LA, Dunne EF, Chesson H, et al (2011). Considerations for human papillomavirus (HPV) vaccination of mid-adult women in the United States. Vaccine, 29, 2365-70.
  17. Gupta A, Arora R, Gupta S, et al (2006). Human papillomavirus DNA in urine samples of women with or without cervical cancer and their male partners compared with simultaneously collected cervical/penile smear or biopsy specimens. J Clin Virol, 37, 190-4.
  18. Hou R, Xu C, Zhang S, et al (2012). Distribution of human papillomavirus genotype and cervical neoplasia among women with abnormal cytology in Beijing, China. Int J Gynaecol Obstet, 119, 257-61.
  19. Hu SY (2011). Studies on risk factors of cervical cancer and its prevention and control. Peking Union Medical College.
  20. Hu SY, Hong Y, Zhao FH, et al (2011). Prevalence of HPV infection and cervical intraepithelial neoplasia and attitudes towards HPV vaccination among Chinese women aged 18-25 in Jiangsu Province. Chin J Cancer Res, 23, 25-32.
  21. Jin Q, Shen K, Li H, et al (2009). Prevalence of human papillomavirus infection in women in Tibet Autonomous Region of China. Chin J Obstetrics Gynecol, 44, 898.
  22. Kulmala SM, Syrjanen S, Shabalova I, et al (2004). Human papillomavirus testing with the hybrid capture 2 assay and PCR as screening tools. J Clin Microbiol, 42, 2470-5.
  23. Li CD, Wu M, Wang JD, et al (2010). A population-based study on the risks of cervical lesion and human papillomavirus infection among women in Beijing, People's Republic of China. Cancer Epidemiol Biomarkers Prev, 19, 2655-64.
  24. Li J, Kang LN, Qiao YL(2011a), Review of the cervical cancer disease burden in mainland China. Asian Pac J Cancer Prev, 12, 1149-53.
  25. Li J, Li LK, Ma JF, et al (2009). Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China. Vaccine, 27, 1210-15.
  26. Li J, Zhang D, Zhang Y, et al (2011b). Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China. Int J Gynaecol Obstet, 112, 131-4.
  27. Li LK, Dai M, Clifford GM, et al (2006). Human papillomavirus infection in Shenyang City, People's Republic of China: A population-based study. Br J Cancer, 95, 1593-97.
  28. Li LM, Rao K Q, Kong LZ, et al (2005). A description on the Chinese national nutrition and health survey in 2002. Chin J Epidemiol, 26, 478.
  29. Li LY, Qiao ZQ, Zhang MF, et al (2007). Study on the value assessment of various screening programs regarding cervical cancer screening strategy in the rural areas of China. Chin J Epidemiol, 28, 964-7.
  30. Li N, Yang L, Zhang K, et al (2011c). Multiple Human Papillomavirus Infections among Chinese Women with and without Cervical Abnormalities: A Population-Based Multi-Center Cross-Sectional Study. Front Oncol, 1, 38.
  31. Li ZM, Luo XP, Mao LZ, et al (2012). Study on human papillomavirus infection states and genotypes of 13 750 women in Chaozhou city, Guangdong. Chin J Obstetrics Gynecol Pediatrics, 8, 357-60.
  32. Lo KW, Wong YF, Chan MK, et al (2002) .Prevalence of human papillomavirus in cervical cancer: a multicenter study in China. Int J Cancer, 100, 327-31.
  33. Ma R (2012). Ethnic Issues and the "Nationality Recognition" Campaign in China in the 1950s. North West Ethno-national Studies, 3, 13-28.
  34. Mayineur N, Li L, Chen F, et al (2011). Epidemiological survey of the relationship between HPV and cervical cancer in Xinjiang Uygur women. Chin Clin Oncol, 16, 322-5.
  35. Moscicki A.B, Schiffman M, Kjaer S, et al (2006). Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine, 24, S3/42-51.
  36. Nicolau SM, Camargo CG, Stavale JN, et al (2005). Human papillomavirus DNA detection in male sexual partners of women with genital human papillomavirus infection. Urology, 65, 251-5.
  37. Nobbenhuis MA, Walboomers JM, Helmerhorst TJ, et al (1999). Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet, 354, 20-5.
  38. Palefsky JM, Holly EA, (2003). Chapter 6: Immunosuppression and co-infection with HIV. J Natl Cancer Inst Monogr, 31, 41-6.
  39. Peng HQ, Liu SL, Mann V, et al (1991). Human papillomavirus types 16 and 33, herpes simplex virus type 2 and other risk factors for cervical cancer in Sichuan Province, China. Int J Cancer, 47, 711-6.
  40. Schiffman M, Wheeler CM, Dasgupta A, et al (2005). A comparison of a prototype PCR assay and hybrid capture 2 for detection of carcinogenic human papillomavirus DNA in women with equivocal or mildly abnormal Papanicolaou smears. Am J Clin Pathol, 124, 722-32.
  41. Shen YH, Chen F, Huang MN, et al (2003). Population-based study of human papillomavirus infection in high-risk area for cervical cancer in Shanxi Province, China. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 25, 381-5.
  42. Smith JS, Lewkowitz AK, Qiao YL, et al (2012). Population-based human papillomavirus 16, 18, 6 and 11 DNA positivity and seropositivity in Chinese women. Int J Cancer, 131, 1388-95.
  43. Smith JS, Lindsay L, Hoots B, et al(2007). Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer, 121, 621-32.
  44. Song D, (2007). Investigation of prevalence of HPV infection and knowledge towards HPV vaccine in women of Shanxi province. Dalian Medical University: Dalian Medical University.
  45. Stanley M, (2010). Pathology and epidemiology of HPV infection in females. Gynecol Oncol, 117, S5-10.
  46. Strickler HD, Burk RD, Fazzari M, et al (2005). Natural history and possible reactivation of human papillomavirus in human immunodeficiency virus-positive women. J Natl Cancer Inst, 97, 577-86.
  47. Sun ZR, Ji YH, Zhou WQ, et al(2010). Characteristics of HPV prevalence among women in Liaoning province, China. Int J Gynaecol Obstet, 109, 105-9.
  48. Wang Y, Ni DX, (2008). Epidemiological analysis of various sexually transmitted diseases in China from 2004 to 2007. Disease Surveillance, 23, 451-83.
  49. Wei YP, Zhao SP, Wei P, et al (2010). Prevalence of high risk human papillomavirus infection in women in rural minority of Guizhou province. Maternal Child Health Care China, 25, 4727-9.
  50. Wheeler CM, Hunt WC, Cuzick J, et al (2012). A population-based study of human papillomavirus genotype prevalence in the United States: Baseline measures prior to mass human papillomavirus vaccination. Int J Cancer.
  51. Wu DM, Cai L, Huang M, et al (2010). Prevalence of genital human papillomavirus infection and genotypes among women from Fujian province, PR China. Eur J Obstet Gynecol Reprod Biol, 151, 86-90.
  52. Wu R F, Dai M, Qiao YL, et al (2007). Human papillomavirus infection in women in Shenzhen City, People's Republic of China, a population typical of recent Chinese urbanisation. Int J Cancer, 121, 1306-11.
  53. Wu Y, Chen Y, Li L, et al (2006). Associations of high-risk HPV types and viral load with cervical cancer in China. J Clin Virol, 35, 264-9.
  54. Zhang HY, Tiggelaar SM, Sahasrabuddhe VV, et al (2012). HPV prevalence and cervical intraepithelial neoplasia among HIV-infected women in Yunnan Province, China: a pilot study. Asian Pac J Cancer Prev, 13, 91-6.
  55. Zhao FH, Forman MR, Belinson J, et al (2006). Risk factors for HPV infection and cervical cancer among unscreened women in a high-risk rural area of China. Int J Cancer, 118, 442-8.
  56. Zhao FH, Hu SY, Wang SM, et al (2009a). Association between high-risk human papillomavirus DNA load and different histological grades of cervical neoplasia. Chin J Prev Med, 43, 565.
  57. Zhao FH, Lewkowitz AK, Chen F, et al (2012a). Pooled analysis of a self-sampling HPV DNA Test as a cervical cancer primary screening method. J Natl Cancer Inst, 104, 178-88.
  58. Zhao FH, Lewkowitz AK, Hu SY, et al (2012b). Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: a pooled analysis of 17 population-based studies. Int J Cancer, 131, 2929-38.
  59. Zhao FH, Li N, Ma JF, et al(2001). Study of the association between human papillomavirus infection and cervical cancer in Xiangyuan county. Chin J Epidemiol, 22, 375-8.
  60. Zhao FH, Lin M J, Chen F, et al (2010). Performance of high-risk human papillomavirus DNA testing as a primary screen for cervical cancer: a pooled analysis of individual patient data from 17 population-based studies from China. Lancet Oncol, 11, 1160-71.
  61. Zhao FH, Tiggelaar SM, Hu SY, et al (2012c). A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China. Cancer Epidemiol, 36, 384-90.
  62. Zhao FH, Tiggelaar SM, Hu SY, et al (2012d). A multi-center survey of HPV knowledge and attitudes toward HPV vaccination among women, government officials, and medical personnel in China. Asian Pac J Cancer Prev, 13, 2369-78.
  63. Zhao R, Zhang WY, Wu MH, et al (2009b). Human papillomavirus infection in Beijing, People's Republic of China: a population-based study. Br J Cancer, 101, 1635-40.
  64. Zhou QY, Wang YY, Tian F, et al (2011). Relationship between human papillomavirus genotype and cervical disease in women of Gansu province. Chin J Health Birth Child Care, 1, 003.
  65. Zou L, Bao YP, Li N, et al (2011). Life-style and genital human papillomavirus in a cross-sectional survey in Shanxi Province, China. Asian Pac J Cancer Prev, 12, 781-6.

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