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We estimated that the incidence rates of breast cancer and cervical cancer in Guangdong would be 50.81/10⁵ (ASIR would be 35.57/10⁵) and 15.31/10⁵ (ASIR would be 10.41/10⁵) respectively, with corresponding mortality rates of 10.78/10⁵ (ASMR would be 7.15/10⁵) and 6.11/10⁵ (ASMR would be 3.93/10⁵) for these cancers in 2023. Compared to the national estimates for 2022 in China (10), the ASIR and ASMR of breast cancer in Guangdong province remain higher than the national level, while the ASIR and ASMR of cervical cancer are lower than the national level. The lifetime risk of dying from cervical cancer among rural women was higher than that among urban women, while urban women faced higher lifetime risks of both developing and dying from breast cancer than rural women. The lifetime risks of developing and dying from breast cancer in Guangdong province are slightly higher than the national average in China, but both are lower than those in Japan and the United States (11). Conversely, the lifetime risks of developing and dying from cervical cancer in Guangdong province are slightly lower than the national average in China, but both are higher than those in Japan and the United States (11). The burden of breast cancer and cervical cancer in Guangdong accounts for a substantial proportion of the national burden, and breast cancer will remain the primary threat to women’s health in Guangdong in both rural and urban areas for decades. Additionally, greater attention should be directed toward early detection and treatment of breast and cervical cancers for women over 55 years to halt the upward trends in mortality rates among this population.

The ASIR of breast cancer increased more rapidly in rural areas compared to urban areas across all age subgroups, though the overall disease burden remained higher in urban areas. Several factors may contribute to the rising ASIR trend, including the implementation of free breast and cervical cancer screening programs in rural areas since 2009, which has increased detection rates while potentially decreasing mortality through early detection. The heavier disease burden in urban areas likely stems from greater exposure to risk factors such as work stress, obesity, physical inactivity, delayed childbearing, nulliparity, and reduced breastfeeding duration (12–13). For instance, women who did not breastfeed after childbirth had a 3.26-fold increased risk of breast cancer compared to those with a history of breastfeeding. Additionally, women with at least one live birth showed a significantly decreased risk compared to nulliparous women [odds ratio (OR)=0.09] (12). These findings underscore the importance of identifying key risk factors for implementing targeted interventions and screening measures in both rural and urban areas, for both younger and older women. The statistically significant rise in ASMR of breast cancer was observed only in women over 55 years, while no declining trend was evident in women under 55. These patterns suggest that screening benefits have yet to be fully realized in either region, and women over 55 in both rural and urban areas should remain a primary focus for breast cancer prevention and control efforts. Furthermore, considering the increasing ASIR and ASMR among older women, coupled with rising life expectancy and demographic shifts toward an aging population, reconsideration of screening guidelines may be warranted, particularly raising the upper age limit to better protect older women with elevated risk.

The incidence and mortality rates of cervical cancer for women under 55 in both urban and rural areas showed decreasing trends, indicating that cancer prevention and control measures for cervical cancer are beginning to show positive effects in younger age groups. HPV vaccination represents a key primary prevention measure, especially for young women. Research has shown that HPV-16/18 prevalence gradually increased among women aged 35-50 in Guangdong, with two infection peaks observed in women over 50 years (9.6%) and under 25 (8.2%) (14). In November 2021, Guangdong Province issued the Work Plan for Free HPV Vaccination of School-Age Girls (2022–2024), aiming to fully immunize 90% of girls under 15 against HPV by 2030. This initiative is estimated to benefit more than 750,000 individuals annually. The policy has not only increased HPV vaccine accessibility and vaccination rates but also raised public awareness of cervical cancer prevention, establishing a solid foundation for achieving the goal of cervical cancer elimination.

Although screening rates for both breast and cervical cancer in China have increased over time, they remain suboptimal (15–16). Guangdong province initiated a free breast and cervical cancer screening program for rural women in 2009 and expanded it to urban areas in 2020. According to China Chronic Disease and Risk Factor Surveillance (CCDRFS) data from Guangdong, screening coverage has improved substantially. Among women aged 35 years and older, cervical cancer screening rates increased from 19.4% in 2013 to 47.1% in recent years, while breast cancer screening rates rose from 18.6% to 45.0%. However, significant urban-rural disparities persist. Cervical cancer screening rates in urban areas increased from 23.2% to 50.2%, compared to 13.3% to 38.7% in rural areas. Similarly, breast cancer screening rates in urban areas rose from 24.1% to 48.8%, versus 9.7% to 34.5% in rural areas. Despite these improvements, both the ASIR and ASMR for cervical cancer continue to rise among women over 55 years of age in both urban and rural areas, with faster increases observed in the urban populations. These findings suggest that screening and tertiary prevention efforts for cervical cancer must be strengthened for women above 55 years in all regions. Furthermore, as the population ages, the recommended screening age range for cervical cancer should be extended to include older women, given the increasing incidence and mortality rates amongst this group.

This study has several strengths. Firstly, we conducted age and region subgroup analyses to identify high-risk populations. Secondly, the population-based surveillance data used are representative of the province. However, there are also limitations. Firstly, surveillance sites in rural areas were fewer than in urban areas, potentially contributing to fluctuations in trend analysis. Secondly, large cities in Guangdong have significant migrant populations, which may affect the precision of the cancer registry and vital surveillance data. Consequently, mortality figures may be slightly underestimated, necessitating careful interpretation of the data.