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Purpose To describe trends in the incidence rates of primary cervical cancer in a geographically defined Chinese population. To link the changes in cervical incidence patterns with efficient screening and targeted educational strategies. Methods Primary liver cancer cases (N = 2594) were diagnosed between 1981 and 2000 and identified by the Tianjin Cancer Registry. Age-adjusted and age-specific incidence rates were examined. Poisson regression was employed to assess the incidence rate trends. All statistical analyses were conducted using the statistical software package SAS version 8.0. Results Crude and age-adjusted incidence rates in the study period were: 6.4/100,000 and 3.8/100,000, respectively. There were remarkable declining trends in incidence rates. The crude and age-adjusted incidence rates declined from 13.8/100,000 and 10.3/100,000 in 1981 to 3.3/100,000 and 2.0/100,000 in 2000. However, the changes in incidence rates were not consistent across age groups. In general, those aged 40 and older had contributed the most observed incidence decline. Contrary to the incidence patterns in people aged 40 and older, incidence rates in those aged 20–39 years and younger increased during the study period. While the results from Poisson regression analyses suggest overall significant trends of declining incidence rates in cervical cancer, there seemed to be a small upward tail toward the end of the study period. Conclusion The findings also indicated two worrisome aspects. First, the incidence rates seemed to increase in younger women; second, there seemed to be a rebound in incidence rates toward the end of the study period. The findings highlight the importance of targeted education toward high-risk population and shed light toward setting up more efficient screening strategies.