The 46-year-old woman with a high school education talked like a professional medical personnel and a rather prudish one at that.

"Women must learn self-respect, self-love and be careful about their lifestyle that means sticking with one partner and no sleeping around," said a smiling Shao Shulan, a garment worker laid-off since 1992.

"One risk factor is the high number of sexual partners. Women whose partners have contracted a sexually transmitted disease are also at a higher risk."

Shao had just sat through two hours of a talk on awareness and prevention of cervical cancer.

"I will tell my daughter, 22, all about this. She's in college and should be prepared before she begins a family."

Shao was undergoing her first ever screening for cervical cancer, free of charge, with more than 200 other low-income women, at the China-Japan Friendship Hospital in Beijing as part of an International Women's Day activity. Some 2,000 women like Shao from 20 cities went for the free test with support from the China Cancer Foundation.

The routine annual physical check-ups at the garment factory where she worked, did not include screening for cervical cancer, she said.

Unlike most other cancers, the cause of this cancer was clearly identifiable, said an expert at the Cancer Research Institute of the Chinese Academy of Medical Sciences.

"HPV (Human Papilloma Virus) is the necessary cause, found in almost all patients and it is spread through sex," said epidemiologist Dr Qiao Youling.

"The screening methods are well developed, so it is easy to avoid it through the use of organized screening programmes like a pap smear and a test for HPV infection."

Easily detected, easily prevented: No wonder then that the World Health Organization advocates screenings for cervical cancer as the most cost-effective and reliable method of cancer prevention among women, even ahead of breast cancer screenings.

Despite cervical cancer being the most preventable of all common cancers, death from the disease remains frighteningly common. Cervical cancer is widely prevalent and ranks second only to breast cancer, affecting about 140,000 Chinese women each year, or about 20 per cent of the worldwide total, according to Dr Wu Yanping, a statistician with the Cancer Research Institute.

The mortality rate is 11.3 per cent for Chinese city residents, compared with 5 per cent in developed countries, according to the Ministry of Health.

One reason for this high incidence is the absence of proper screening programmes. Although women employees of government institutions and State-owned enterprises have free screenings for breast cancer every year, cervical cancer is not covered by the programme.

Few women care to go for a test at their own expense. Many women from low-income groups cannot afford the comprehensive 500-yuan (US$62.5) test even if they are aware of the disease.

This year, the central government has launched a 15-million-yuan (US$1.85 million), three-year screening project in 13 high-incidence counties to promote early detection and treatment of selected cancers, including cancer of the cervix.

Meanwhile, Chinese scientists are implementing a five-year-plan project (2003-2007) to develop three biochemical tests to identify women at risk, with funding of US$1.68 million from the Bill & Melinda Gates Foundation. These tests are designed for use in the more under developed regions.

"Most victims are women in the cities with low socio-economic status, and their rural sisters in the impoverished mid-west China," said Dr Qiao.

"It's a shame if medical scientists, who have discovered techniques of screening and prevention, lose sight of this social group."

Until this International Women's Day, Shao found herself constantly worrying about whether she would meet the same fate as her neighbour who lost the battle to cervical cancer recently.

"My neighbour really didn't have to die, if only she had money and had gone to the hospital early," Shao said, admitting that till now she had never heard of HPV.

Shao is not alone. Few women in China appear to know much about cervical cancer.

Take Xiangyuan County in the mining province of Shanxi, for example, where the death rate from the disease is 10 times higher than the national average.

"The problem is it's too expensive," said Dr Qiao. Pap smears are cheap at 30 yuan (US$3.70), but the second test liquid-based cytology, which might be the best screening mode in terms of desired sensitivity and specification to identify pre-cancerous lesions of the cervix, costs about 400 yuan (US$49.30).

It is a big sum for someone like Shao who now lives off her 300-yuan (US$37) monthly welfare payment.

"I didn't pay a penny," said Shao. "The doctors said my cervix was quite healthy, no HPV infection found. I'm very relieved. "

Dr Qiao and his colleagues are working on a third basic test a visual inspection using an acetic acid test, which costs only 40 yuan (US$4.90). The results are not reliable yet.

Source: China Daily