"The causes and pathogenesis of cervical cancer are well understood. From HPV (Human Papillomavirus) infection to persistent infection, precancerous lesions, and finally cervical cancer, the process typically spans 10 years. Timely detection and treatment within this timeframe can prevent fatalities." Recently, at the 21st National Cervical Cancer Collaboration Group Working Meeting and the Academic Conference on the Progress of Cervical Cancer Prevention and Control in China, Qiao Youlin, a distinguished professor at the School of Population Medicine and Public Health of Peking Union Medical College, Chinese Academy of Medical Sciences, stated that cervical cancer is currently the most likely cancer to be eliminated at the public health level through comprehensive prevention and control measures.
Qiao Youlin (pictured)
Cervical cancer is one of the common malignant tumors that seriously threaten the health of women worldwide. Data shows that in 2022, there were 660,000 new cases of cervical cancer globally, with 350,000 deaths. Over 85% of new cases and deaths from cervical cancer occurred in low- and middle-income countries and regions. In China, there were 150,700 new cases and 55,700 deaths from cervical cancer in 2022.
Qiao Youlin specifically pointed out that the comprehensive prevention and control situation of cervical cancer in low-resource areas in China is not optimistic. "Not only is there a shortage of medical resources, but also poor accessibility to health services, weak public health awareness, and the need for improvement in screening technology."
How to effectively carry out prevention and control work for cervical cancer in low-resource areas has become a challenging issue facing society.
Gap from the target
As early as 2009, the former Ministry of Health, Ministry of Finance, and All-China Women's Federation collaborated to carry out a rural "two-cancer" (cervical cancer and breast cancer) screening project in 31 provinces nationwide. Currently, according to the national maternal and child health statistics survey, the "two-cancer" screening project has expanded to 94% of counties (cities, districts) nationwide, with over 230 million screenings for cervical cancer.
Last year, the National Health Commission, together with the Ministry of Education, Ministry of Civil Affairs, Ministry of Finance, and other departments, issued the "Action Plan to Accelerate the Elimination of Cervical Cancer (2023-2030)," proposing that effective prevention and control of cervical cancer can be achieved through HPV vaccination for young women, cervical cancer screening for eligible women, timely treatment of cervical cancer and precancerous lesions, and other preventive measures, ultimately leading to the elimination of cervical cancer.
For low-resource areas, China has also launched the "Comprehensive Prevention and Control Demonstration Project for Eliminating Cervical Cancer and Breast Cancer in Low-Resource Areas in China."
"However, we still have a significant gap to reach the World Health Organization's '90-70-90' target (by 2030, 90% of girls are vaccinated against HPV before the age of 15; 70% of women are screened with high-performance testing methods before the ages of 35 and 45; 90% of women diagnosed with cervical diseases receive treatment)," Qiao Youlin said. Low-resource areas face challenges in vaccine coverage, screening of eligible women, and standardized treatment, indicating there is still a long way to go to achieve the goal of eliminating cervical cancer.
AI to enhance prevention and control
So, how can the elimination of cervical cancer pathways be implemented in low-resource areas?
Since 1998, Qiao Youlin has been at the forefront of cervical cancer prevention and control in low-resource areas. The first pilot area he chose was Xiangyuan County in Shanxi Province.
In the 1970s, over 8.5 out of 100 women in Xiangyuan County, Shanxi Province, died from cervical cancer. "Due to weak screening capabilities at the grassroots medical institutions and low awareness of the disease among the population, many women were often diagnosed in the advanced stages, missing the optimal treatment window," Qiao Youlin's team introduced advanced liquid-based cytology and HPV screening technologies to Xiangyuan and taught local doctors how to perform colposcopy examinations.
The new screening and diagnostic technologies significantly improved the cervical cancer prevention and control capabilities in Xiangyuan County. Currently, the screening rate for women aged 35-64 in Xiangyuan County is as high as 85%.
However, given China's vast territory, it is very challenging to bring every grassroots doctor, cytopathologist, and colposcopist to the level of a tertiary hospital.
Xu Xiaochao, Director of the Women's Health Division of the Maternal and Child Health Department of the National Health Commission, believes that from the perspective of tertiary prevention of cervical cancer, exploring AI-assisted diagnostic technologies, HPV self-sampling techniques, remote consultations through medical technology platforms, internet-assisted diagnosis, and auxiliary screening will be crucial in enhancing cervical cancer prevention and control capabilities.
Exploring different prevention and treatment strategies
Last year, Tencent's Sustainable Social Value Business Unit Health Inclusion Laboratory joined the comprehensive prevention and control project for female "two-cancers" in low-resource areas under the guidance of the Women's Health Division of the National Health Commission. The plan is to conduct pilot projects in more than 30 areas in seven provinces in central and western China, providing preventive, screening, diagnostic, and related medical services and assistance for cervical cancer and breast cancer to over a million eligible women, using technology to support grassroots work.
"We are here to set an example, exploring how to use simple, easy-to-operate, and efficient testing methods in low-resource areas to improve screening efficiency through digital means," Qiao Youlin said.
According to Zhai Jiahuan, Senior Director of Tencent's Sustainable Social Value Business Unit Health Inclusion Laboratory, to address the issue of low resource utilization efficiency, the project has built a "two-cancer screening platform for grassroots doctors," which has been gradually used in more than ten areas in seven provinces in central and western China, integrating doctor screening management, making it easy for patients to access screening information, eliminating the need for manual data entry that could lead to repeated screenings, missed screenings, and loss of follow-up for positive patients. To address the problem of insufficient primary care capacity, the project has introduced intelligent tools to empower grassroots doctors in diagnosis and screening work.
Currently, the research team is developing an "AI-assisted diagnosis system for cervical electronic colposcopy images" based on artificial intelligence technology to assist doctors in determining the need for biopsies and localization during colposcopy examinations, helping grassroots doctors bridge the last mile of cervical cancer screening.
"Effective screening and timely vaccination are the most effective ways to reduce the incidence of cervical cancer," Zhu Lan said, emphasizing the need to actively explore tailored strategies for eliminating cervical cancer, ultimately ensuring that spring arrives on time for all women.
