Crusading against women's cancer in rural China

It was only this month that Gerel, a 45-year-old mother of one in Erdos, Inner Mongolia, had her first test for cervical and breast cancer.

She was one of the first residents to get a free screening in a new program in Erdos that is aiming to lead the way in detecting and treating these cancers in rural China, where poverty and cultural sensitivity about sex all too often stop women from getting checked.

With these problems concentrated in the countryside, China has 100,000 new cervical cancer cases every year, 29 percent of the world's total. The incidence rate among women under 30 is close to 10 percent, much higher than in developed countries.

Most cases of cervical cancer develop from HPV, a relatively minor virus that can be treated before cancer forms. The tragedy is that HPV is often not being found in time.

Gerel was typical of many Chinese women in her wariness about getting checked. "What if I have breast cancer? I could lose my breasts. Those are important features for a woman. What might people think of me if it's cervical cancer?" she asked before her screening.

With sex a big factor in cervical cancer, many rural Chinese associate it with promiscuity. Gerel remembers how rumors rocked a relative's family when she was diagnosed with cervical cancer four years ago.

"Many have similar fears, and few understand that cervical cancer is not a death sentence anymore, as long as they have access to early detection, and get early treatment," said an Erdos health official who did not want to be identified.

Fortunately, Gerel's tests came back clean. Though she has mammary-gland hyperplasia ("The expert from Beijing told me it was not so serious"), she has neither cervical cancer nor HPV.

She described the news as "like the morning light. You feel relieved, all of a sudden, worry free."

Hopefully many more women in Erdos will get similar news, after the city's government began funding free breast cancer and cervical cancer screenings for all local women aged 35 to 64. The goal is to screen 340,000 women within this age group for cervical cancer every five years, and for breast cancer every three years.

It will cost Erdos about nine million yuan (1.37 million U.S. dollars) per year, according to He Tao, director of the Erdos Health and Family Planning Commission.

The city is going far beyond what has been offered elsewhere in China. In 2009, the central government announced free cervical cancer screenings targeting 10 million rural women aged 35 to 59 through basic cytology, or smear, tests. At that time, costly and complicated HPV testing was not an option.

Erdos, however, is using a HPV screening method named CareHPV developed specially for use in developing nations. Erdos is the first city in China to use CareHPV for primary screening. Women diagnosed HVP positive will be treated and assessed through cytology at local health centers.

"Using CareHPV for primary screening is the right move," says Rengaswamy Sankaranarayanan, director of screening at the World Health Organization's International Agency for Research on Cancer. "A good screening project shouldn't be a one-time affair, but a sustained program."

CareHPV accuracy reaches 90 to 95 percent, while specialty tests are around 84 percent. "Medical personnel with limited laboratory experience are quite able to perform it correctly and effectively after a simple training procedure, and it takes only one and a half hours to get results," said Qiao Youlin, a cancer epidemiologist with the Chinese Academy of Medical Sciences.

Qiao believes CareHPV is the best candidate test method for HPV or primary screening of cervical cancer among 150 million Chinese women.

Dr. Sankaranarayanan characterizes the Erdos screening program as a major test -- it could provide a model not just for women with less access to healthcare in rural China but also in other low-income countries. Endi