The "pink ribbon" is an international symbol of breast cancer prevention and treatment. October, as World Breast Cancer Awareness Month, draws attention to women's health.                                                                         Cnsphoto

Disagreements About Examination Methods

    To Xu’s surprise, a great deal of disagreement arose as soon as the project began. X-ray mammography is the most common method of breast examination. Mammograms come in three forms, namely Screen Film Radiography, Digital Radiography and Computed Radiography (CR). Screen Film Radiography is the most traditional method and is quite common in China. Digital Radiography has gradually been popularized and promoted in recent years, but it is still less popular in China than in developed countries because of the higher costs involved. The last method, Computed Radiography, is a new approach whose cost is somewhere between Screen Film Radiography and Digital Radiography.

    The screening project organizers adopted CR as their method of choice, and the equipment was supplied by the Kodak Company. However, this choice was questioned by some experts, as they believed CR involved high dosages of radioactive rays, while offering poor diagnostic performance. They argued CR should not be used without associated national regulations and quality control criteria.

    Under pressure from critics, the project came to a standstill. Xu felt greatly wronged. “The CR method we used is the most up-to-date, designed only for mammary gland examinations. It is not like ordinary CR,” he argues. He adds that the American Cancer Society had conducted tests and had concluded that the dose of radioactivity was safe and diagnostic performance was adequate.

    However, critics still maintained great care had to be exercised in choosing the examination method and conducting quality control measures, as both were essential to the project’s success. The US, Britain and some other countries have all promulgated specific regulations and quality control criteria in regards to CR. In contrast, China did not issue national standards on mammogram X-ray imaging quality control until 2007, and these were for clinical diagnosis – not breast cancer screening.

Seeking Private Funds from Hanghua

    The biggest headache for the screening project organizers was not the disagreement over examination methods, but a shortage of funds.

    Although the project was approved by the Ministry of Health and won support of the All-China Women’s Federation, the government never allocated money for it. According to Xu, in 2002 the National Development and Reform Commission was inclined to allocate funds, but the SARS outbreak the following year meant this came to nothing.

    Under such circumstances, the project organizers had no choice but to seek capital from private companies. CACA, represented by Xu, signed a cooperation contract with Tianjin Hanghua Technology Development Company, an enterprise with no previous experience in the medical business. The company participated in the project to generate profits, a fact openly admitted by Wang Husen, who was in charge of the investment. He believes it is natural that those who invest will seek profit: “Why else would we do it?” he asked.