Age-specific burden of cervical cancer and attributable risk factors in Asia, 1990-2023: A global burden of disease study 2023.

BACKGROUND: Despite global elimination initiatives, cervical cancer remains a major public health burden across Asia. We aimed to assess regional and age-specific trends in cervical cancer burden using data from the Global Burden of Disease Study (GBD) 2023. METHODS: We analyzed GBD 2023 to estimate the burden of cervical cancer across 34 Asian countries from 1990 to 2023. Age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALY rate (ASDR) were assessed by region and Socio-demographic Index (SDI), while age-specific rates were evaluated for females aged 15-49, 50-69, and ≥70 years. Cervical cancer was defined as malignant neoplasm of the cervix, and burden attributable to unsafe sex and tobacco use was estimated using population-attributable fractions derived from exposure data and relative risks. Estimates are presented as means with 95% uncertainty intervals (UIs). RESULTS: In 2023, South Asia exhibited the highest cervical cancer burden, with an ASIR of 22.07 (95% UI, 14.68-33.20) per 100,000 population, whereas High-income Asia Pacific had the lowest ASIR at 11.89 (9.94-14.37). A similar pattern was observed for ASDR: South Asia had the highest rate at 377.19 (95% UI, 255.79-558.38) per 100,000 population, while High-income Asia Pacific exhibited the lowest rate at 96.04 (84.08-109.75). From 1990 to 2023, ASIR and ASDR generally declined across Asia, although substantial regional disparities persisted. Across all five regions, the relative contribution of females aged 15-49 years to cervical cancer burden increased, while that of older age groups generally decreased; however, the absolute incidence rates among females aged 15-49 years increased only in Southeast Asia and High-income Asia Pacific. Cervical cancer burden attributable to unsafe sex showed the highest DALY rate among females aged 50-69 years and the highest mortality rate among those aged 70 years or older. Overall, cervical cancer burden exhibited an inverse association with SDI. CONCLUSION: Cervical cancer remains a substantial burden in low-SDI Asian countries, with an increasing relative contribution among females aged 15-49 years. Age-specific and context-specific prevention strategies are urgently needed to reduce inequalities and accelerate elimination efforts in Asia.