Wearing their best babushkas and long flowing dresses, a group of Uygur women crowd into a modest, rural clinic, their hazel eyes twinkling thanks to an unexpected gift: free cervical cancer screening.

A resident of the Kariliga village in Yutian County, Hotan Prefecture in Northwest China's Xinjiang Uygur Autonomous Region, Aijiaerhanmait Niyazi, 52, recalled the last time she had a gynecological exam was more than 22 years ago.

"Since then, I haven't had the chance to see a (gynecological) doctor until today," she said, holding a result of her colposcopic evaluation.

Niyazi is visiting the Women's and Children's Health Station, some 1,300 kilometers north of Urumqi, the seat of the regional government.

The diagnosis is not very promising. "I have to wait for another (a pathological) result to see if I need a further treatment," said Niyazi.

She paused for a second and smiled. "I'm not afraid of anything. I'm grateful. Without this free screening, I could have missed a chance for early detection and treatment. Without that, I could be dying of cervical cancer like some of the sisters in my village," she said.

Before the colposcopic exam, Niyazi had a HPV (Human Pallinoma Virus) test, suggesting she was already infected with the virus.

HPV causes genital warts and cervical cancer. The virus infections are responsible for 99 percent of cervical cancer, the second most menacing cancer next to breast cancer for women worldwide, affecting 470,000 new cases annually, killing 230,000 of them.

Dr Qiao Youlin, a notable epidemiologist with the Cancer Institute at the Chinese Academy of Medical Sciences (CAMS) noticed that "80 percent of the cases occur in developing countries, with about 100,000 occurring in China every year. Most of them are found among rural women like Niyazi in low resource areas, mostly in China's impoverished west, such as Xinjiang."

Xinjiang has a population of 10 million women. "The incidence of cervical cancer is 500 cases per 100,000, much higher than the country's other areas," said Mayinuer Niyazi, 52, deputy president of the regional People's Hospital, where she serves as an obstetrician and gynecological oncologist.

An absence of medics and ineffective screening mechanisms in rural areas are the key attributing factors to such a high incidence.

"There are not many well-trained gynecological oncologists available in the rural areas. And, going to see a gynecologist in the city is something unimaginable for these female farmers unless their condition becomes unbearable," she said.

Cervical cancer is easy to prevent as long as a regular screening is provided, and is curable as long as it is detected early and treated accordingly.

"But many continue suffer from the disease, and have lost their lives to it only because these poor women cannot afford regular screening," Mayinuer said.

In a bid to shield Uygur women from the threat of cervical cancer, Chinese scientists from the CAMS's Cancer Institute, in collaboration with the Cleveland Clinic Foundation in Ohio of America, are conducting a community-based epidemiological study on detection of a spectrum of HPV types and associated cervical cancer, with the sponsorship of the American pharmaceutical company Merck.

Thanks to the project, 1,000 Ugyur female farmers coming from seven townships of Yutian County are receiving free gynecological checkups, including HPV tests, liquid-based cytology, visual inspections with acetic acid and colposcopic exams, to identify pre-cancerous lesions in cervix.

Doctors and scientists from the Cancer Institute have discovered that sanitary conditions in Yutian are shockingly depressing. "Many women don't know what sanitary pads are. They use sand instead of sanitary pads during their periods," said Wu Yanping, a statistician from the institute's Cancer Epidemiology Department.

Out of those 1,000 screened women, she said, nearly 9 percent are high risk type HPV infected. And most suffer some erosion in the cervix at a different level.

To raise awareness of this health problem, experts from Beijing are teaching rural women the knowledge of personal hygiene. They are also teaching them how to perform a self-examination, which is a primary and vital method to identify possible pathological changes in the cells of the cervix.

(China Daily December 21, 2006)