Background: Information on temporal trends of cancer attributable to human papillomavirus (HPV) in China is limited. Methods: Cancer incidence and mortality during 2007-2015 were extracted from the Chinese Cancer Registry Annual Report and the national population from the National Bureau of Statistics. HPV-attributable cancer burden and the average annual percentage change during 2007-2015 were estimated and cancer burden during 2016-2030 was projected. Results: HPV-attributable cancer cases have increased by 3.8% (95% CI: 2.9-4.8%) annually from 85,125 to 113,558 and age-standardized incidence rate (ASIR) rose by 3.0% (95% CI: 2.5-3.5%) from 4.67 to 5.83 per 100,000 persons during 2007-2015. Cervical, female anal, and vulva cancer cases have increased by 3.8% (95% CI: 2.8-4.7%), 6.5% (95% CI: 1.2-12.2%), and 3.7% (95% CI: 1.6-5.8%) per year. Male anal and oropharyngeal cancer cases have elevated by 7.5% (95% CI: 2.8-12.5%) and 4.4% (95% CI: 2.4-6.3%) annually. The increases of cervical and anal cancer were most rapid among those aged 50 and older. HPV-attributable cancer deaths and mortality rate have risen by 4.7% (95% CI: 2.9-6.7%) and 3.3% (95% CI: 0.9-5.8%) respectively. HPV-attributable cancer cases and ASIR are projected to reach 214,077 and 9.35/100,000 persons by 2030 respectively, with 87.7% being cervical cancer, and anal cancer cases are expected to triple. Conclusions: HPV-attributable cancer burden has largely increased in the past and will keep rising for the next decade. Cervical cancer control should be the priority and anal cancer prevention should be addressed. Impact: This study supplies fundamental evidence for policy-making on HPV-attributable cancer control.

Background: There are no studies extrapolating the incidence and mortality of cervical cancer in China by comparing incidence and deaths pattern between geographic and age groups. Methods: We applied age–period–cohort models to assess region-level trends in incidence and mortality from 2006 to 2016, with piecewise linear regression in a Bayesian framework to predict these trends to 2030. Results: Between 2006 and 2016, age-standardized incidence rates (ASIR) for females aged 15-84 years increased by 3.7% (95% CI: 3.1~ 4.3%) annually from 11.01 to 16.41 per 100 000 females in China. In the 25-39 age groups, the incidence rates decreased in urban regions and inversely increased in rural regions. The age-standardized mortality rates (ASMR) increased from 3.18 to 4.83, with annual increases of about 3.6% (1.5~5.8%). From 2017 to 2030, the ASIR is expected to increase from 17.13 (15.91~ 18.46) to 23.22 (20.02～27.01) by 2.5% per year (P<0.05). Meanwhile, the average age at diagnosis is predicted to grow from 53.1 to 60.5 years. In the 15-54 age groups, the incidence rates decreased in urban regions but increased in rural regions. The AMIR is expected to increase consistently from 4.82 (4.38～5.31) to 9.13 (7.35～11.39) by 5.0% per year (P<0.05). Conclusions: Cervical cancer incidence and mortality rates are projected to increase in China. In addition, the urban-rural incidence gap is estimated to widen further among young women. Impact: Cervical cancer prevention should consider the trend and diversity in incidence patterns between urban and rural regions.

<p>Table S2 shows trends for age-specific cervical cancer incidence and mortality rates by region in China between 2006 to 2016.</p>

<p>Figure S3 shows age-period-cohort effect on cervical cancer incidence rates in China between 2006 to 2016.</p>

<p>Table S6 shows trends for age-specific cervical cancer incidence and mortality rates by region in China between 2017 to 2030.</p>