Principal Findings
The study included 142,677 participants and the overall prevalence of cervical lesions was 0.55%, which was low compared to similar studies in China [19-21]. Nevertheless, the prevalence of CCA was 0.02%, higher than the prevalence of CCA in China in 2020 (15.6 per 100,000 people). Women aged 35-44 years, those with a high or technical secondary school level education, those living in regions of higher economic development, those with abnormal leucorrhea, and those who are pre-menopausal are at higher risk for cervical lesions. CCA screening and prevention for these women should be strengthened, and harmful habits related to risk factors should be discouraged. Consistent with other studies, our age range was between 35 and 64 years [22-24].
Women aged 35-44 years and 45-54 years had the higher detection rate and risk for cervical lesions, which is consistent with many studies conducted worldwide. This age group is sexually active, so unhealthy sexual behavior combined with the age of reporting cervical lesions greatly improves the detection rate of cervical lesions. A CCA screening study in southern Ethiopia showed[25] that the detection rate of precancerous cervical lesions was the highest among women aged 30-39 years. Similarly, in a study in Guangxi province, China[26], women aged 35-44 years had the highest risk of cervical lesions. However, few studies [27,28] have shown that the risk of cervical lesions increases with age. In the analysis of risk factors for cervical lesions in Beijing women, those under 50 years old had more risk factors for cervical lesions [29].
Furthermore, postmenopausal women have a reduced risk of cervical lesions, meaning that women aged 55–64 years have a reduced risk of cervical lesions. Most women are menopausal after 55 years of age; this reduced risk of developing cervical lesions is due to physiologic changes in the hypoestrogenic state [30]. Few studies have also shown that menopause decreases the risk of cervical lesions [31].
In the present study, compared to women with primary school education or below, those with secondary and high school education had a higher risk of cervical lesions, whereas having a college school education or higher was protective. This finding is different from those of most studies worldwide. Women with primary school education or lower are more conservative when it comes to sexuality because they know less about sex and have fewer exposures to undesirable behaviors owing to their traditionalist environment Moreover, women are exposed to sexual knowledge from high school, and the mature stage of adolescent development, when the desire for sex increases, and exposure to sexual behavior begins, coinciding with secondary school and high school. However, at this stage, there is less knowledge pertaining to sex education and prevention, as well as being short of knowledge and decision-making skills regarding risky sexual behavior [32]. This means that women are not able to protect themselves well during sex, as has been confirmed in some studies worldwide [33]. Accordingly, having secondary and high school education increases the risk of developing cervical diseases. Moreover, women with a college education or higher have greater sexual knowledge and awareness, which is a protective factor against cervical lesions, as confirmed by most studies worldwide [34-36]. Moreover, women with a primary education level or lower are less likely to receive CCA screening after presenting with symptoms of cervical lesions due to their limited knowledge regarding the disease, screening, and prevention. A lack of education is also a common barrier that keeps women away from regular screening, which may also lead to lower detection rates of cervical lesions, as demonstrated in previous studies [37,38].
In this study, the economic development level of the area of residence affected the incidence of cervical lesions. Women living in regions of higher levels of economic development have a high risk of developing cervical lesions, which may be due to their reluctance to seek medical care when symptoms develop because they are likely to be of low socioeconomic status.
In the present study, women with abnormal leucorrhea were shown to be at high risk of cervical lesions. Abnormal leucorrhea is caused by abnormal vaginal discharge due to vaginal microflora imbalance. Yu et al. [39], in 2022, showed that maintaining normal vaginal microbiota by preventing and treating Chlamydia trachomatis and mycoplasma infections is greatly significant in preventing cervical precancerous lesions.
Limitations
This study has a few limitations. First, the authors were not provided with more in-depth information on lifestyle habits, including smoking, number of sexual partners, and other lifestyle factors, which may promote the occurrence of cervical lesions. Second, cervical cytology is more challenging in postmenopausal women due to their hypoestrogenic state. There was no specific screening method for postmenopausal women in this study, which may lead to biased results.