China News Service, Beijing, March 4 (Xu Jing and Du Yan) Cervical cancer is the largest reproductive system malignant tumor affecting women's health in the world.

Among the malignant tumors of female reproductive system in China, cervical cancer ranks first in both incidence and mortality.

How to reduce the threat of cervical cancer to women?

What is the current coverage of cervical cancer screening in China?

How to choose the HPV vaccine, and how about the pilot cities for vaccination?

  March 4 is the fifth International HPV Awareness Day.

At the recent roundtable discussion on "Exploring the Innovation of Diversified HPV Vaccination Pilot Models to Help Achieve the Goal of Cervical Cancer Elimination", a number of health experts discussed feasible measures to help achieve the goal of eliminating cervical cancer, as well as pilot HPV vaccination in various places innovative model.

Dangerous but 'controllable': tertiary prevention of cervical cancer

  According to Zhao Fanghui, professor and director of the Epidemiology Research Office of the National Cancer Center and Cancer Hospital of the Chinese Academy of Medical Sciences, cervical cancer is the number one malignant tumor of the reproductive system that affects women's health in the world. In 2020, there will be about 600,000 new cases and 34 China accounts for about one-fifth of the 10,000 related deaths.

  Cervical cancer is caused by persistent infection of human papillomavirus (HPV), and it is one of the few cancers with clear etiology among all tumors.

In addition, it is the only tumor that can be controlled or even eliminated through effective tertiary prevention.

  What is tertiary prevention?

Zhao Fanghui said that the first is to prevent the occurrence of cervical cancer through healthy behaviors and HPV vaccination, the second is to detect patients with early cancer or precancerous lesions through effective screening techniques and methods, early diagnosis and early treatment, and the third is to If symptoms and lesions are found, go to the hospital in time to cure or delay the survival of the patient through effective treatment.

  In 2020, the World Health Organization (WHO) released the "Global Strategy to Accelerate Cervical Cancer Elimination", the main goal of which is to eliminate cervical cancer globally by the end of this century.

  In order to achieve this goal, WHO has set a phased target for 2030, which clearly states that the 90-70-90 target needs to be achieved: that is, 90% of girls complete the HPV vaccination before the age of 15; 70% of women are 35 and 45 years old. Screening with high-efficiency detection methods before the age of

 Responding to new trends: Cervical cancer screening continues to advance

  Zhao Fanghui introduced that the National Cancer Center's tumor registration monitoring data shows that since 2000, the incidence of cervical cancer in China has been on the rise, and the patients are also getting younger.

  In response to this trend, in 2009, China launched a nationwide "two cancer screening" (breast cancer and cervical cancer), a major public health program.

In the past ten years, cervical cancer screening in China has continued to advance, and the current screening rate exceeds 30%, but it is still below the WHO target of 70%.

  In 2021, the State Council issued the "Outline for the Development of Chinese Women (2021-2030)", proposing that the main goal of women's health is that the screening rate of cervical cancer population of school-age women should reach more than 70%, and the treatment rate of cervical cancer patients should reach more than 90%.

  "In addition to continuing to advance screening, there is another way to prevent cervical cancer - vaccination with HPV vaccine." Zhao Fanghui said that China approved the first HPV vaccine in 2016, that is, imported 2-valent vaccine, which will be followed in succession. Imported 4-valent and 9-valent vaccines have been approved, and domestic 2-valent vaccines have also been launched. "China is currently the only country with four cervical cancer vaccines, and we have many choices."

  At present, the HPV vaccines on the Chinese market include 2-valent (imported 2-valent and domestically-produced 2-valent), 4-valent and 9-valent.

Zhao Fanghui introduced that the valence represents the antigenic type of the HPV virus contained in the vaccine.

There are 14 types of high-risk types that cause cervical cancer, of which 16 and 18 are the most important.

Scientific evidence shows that more than 70% of cervical cancers in the world are caused by HPV-16 and 18. In China, 84.5% of cervical cancers are caused by HPV-16/18.

  "Therefore, whether it is 2, 4 or 9, at least 84.5% of cervical cancers in China can be prevented," she said.

  Blocking cervical cancer: pilot cities launch universal vaccination

  In 2021, Chengdu launched the HPV vaccination for school-age girls in the city.

Song Wei, director of the Maternity and Children's Division of the Chengdu Municipal Health and Health Commission, introduced that the World Health Organization recommends that girls in the younger age group (9-14 years old) be given priority for vaccination.

As one of the first 15 national-level pilot cities selected for the Healthy China Action Innovation Model, Chengdu has carried out a full-process pilot project focusing on comprehensive cervical cancer prevention and control, including HPV vaccination, regular screening, and standardized management and Treatment related work.

  Song Wei mentioned that Chengdu, in accordance with the principle of "informed consent, independent choice, and voluntary vaccination", carried out HPV vaccination for 13-14-year-old female students in the city who had not been vaccinated against HPV vaccine that year: the parents or guardians of the students can The three vaccines of domestic 2-valent, imported 2-valent and imported 4-valent are independently selected, and a subsidy of 600 yuan/person for vaccination is given by financial funds.

  In the vaccination plan, Chengdu has put forward two goals, one is to cover the whole city in 23 districts, cities and counties; the other is to reach the HPV vaccination rate of 90% of school-age girls by the end of 2025, and achieve the goal set by the World Health Organization 10 years ahead of schedule.

  It is understood that as of January 26, 2022, more than 110,000 school-age girls aged 13-14 in Chengdu have completed the first dose of HPV vaccine, with an vaccination rate of 90.04%.

  Wang Lu, director of the Aiwei Work Office of the Planning Department of the National Health and Health Commission, said that in the pilot work of promoting the innovative model of the Healthy China Action, it is hoped that through the pilot work in various places, a government-led, departmental collaboration, technical department support, and the whole society will be built and shared. and expand this work model to more cancer types and more actions, so as to jointly promote the implementation of the Healthy China strategy.

At the same time, the health department should also improve the death cause monitoring and tumor registration system, formulate work guidelines for screening and early diagnosis and early treatment, improve the construction of the service system, and jointly organize a policy safety net to protect health.