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Rising Mortality Rate of Cervical Cancer in Younger Women in Urban China

We appreciate Dr. Zhou and colleague’s interest in our article: “Rising Mortality Rate of Cervical Cancer in Younger Women in Urban China.”1

Considering the rising statistic of cervical cancer mortality in recent 10 years in China,1 Dr. Zhou and colleague point out that it will be a long and arduous task to control the burden of cervical cancer.2 Dr. Zhou and colleague believe the best measures to control the epidemic of cervical cancer in China is population-based screening programs.2 We agree on this point. Both the Pap test and human papillomavirus (HPV) test are effective for the purpose of early detection and identification of the high-risk population. In our opinion, promotion is urgently needed in urban China to improve cervical cancer screening. The awareness of cervical cancer is low in both rural and urban China. Although the screening service is available from hospitals, active utilization is minimal in urban China before the occurrence of symptoms. In rural China, women aged 35 to 59 years benefit from the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA), which provides free screening service since 2009 and contributes to the control of this epidemic in rural area

HPV is involved in nearly all cervical cancers. Prophylactic vaccination for HPV should be an effective way. However, Dr. Zhou and colleague believe HPV vaccination would not outperform screening due to low awareness and vaccine uptake. In our opinion, it is very difficult to achieve a high vaccination rate among Chinese adolescents in near future, as the awareness and knowledge of HPV vaccine remain low in China.3 And, the intentions to vaccinate do not translate easily into completion of vaccination

Metformin may play a role in chemoprevention and treatment for cancer.4, 5 However, it is not practical to start metformin among adolescents for the purpose of cervical cancer prevention, not to mention that its efficacy has yet to be established.6, 7

To control the epidemic of cervical cancer in China, screening is the most feasible and cost-effective method. Promotion of screening in both rural and urban area is needed.


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    Wei M, Zhou W, Bi Y, Wang H, Liu Y, Zhang ZJ. Rising Mortality Rate of Cervical Cancer in Younger Women in Urban China. J Gen Intern Med. 2019;34:281–284.

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    Zhou P, Chen D, Shi L. Cervical Cancer Mortality in Younger Women. J Gen Intern Med. 2019.

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    Zhang Y, Wang Y, Liu L, Fan Y, Liu Z, Wang Y, Nie S. Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies. BMC Public Health. 2016;16:216.

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    Zhang ZJ, Li S. The prognostic value of metformin for cancer patients with concurrent diabetes- a systematic review and meta-analysis. Diabetes Obes Metab. 2014;16:707–10.

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    Zhang ZJ, Bi Y, Li S, Zhang Q, Zhao G, Guo Y, Song Q. Reduced risk of lung cancer with metformin therapy in diabetic patients: a systematic review and meta-analysis. Am J Epidemiol. 2014;180:11–4.

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    Wei M, Liu Y, Bi Y, Zhang ZJ. Metformin and pancreatic cancer survival: Real effect or immortal time bias? Int J Cancer. 2019; https://doi.org/10.1002/ijc.32254.

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    Zhang ZJ. Metformin and cancer in the Hong Kong Diabetes Registry: real effect or immortal time bias? J Gen Intern Med. 2019.

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The work was financially supported by the National Natural Science Foundation of China (grant number 81641123) and the Fundamental Research Funds for the Central Universities (grant number 2042017kf0193).

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Correspondence to Zhi-Jiang Zhang PhD.

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Chen, T., Wei, M., Liu, Y. et al. Rising Mortality Rate of Cervical Cancer in Younger Women in Urban China. J GEN INTERN MED 35, 593 (2020). https://doi.org/10.1007/s11606-019-05174-5

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