Bridging Cancer Care Gaps in Tribal Assam Through ASHA-Led Early Detection
Joyita Dey, Subhadra Goala, Anita Gadgil, Junashree NaidingPURPOSE
Assam, a northeastern state in India, reports nearly 50,000 new cancer cases annually, with an AAR of 114 per 100,000 people, higher than the national average of 97 per 100,000. Cancer screening and early detection remain particularly challenging in the hilly regions, resulting in presentations at advanced stages. The Government of India prioritised cancer screening activities in the national health agenda in 2016, yet tribal districts in Assam, like Dima Hasao, remain unreached due to lack of transport facilities, a sparsely distributed population, and other sociocultural barriers. We aimed to fill the gap in screening through public-private partnership by taking cancer care closer to people's homes. Cachar Cancer Hospital (CCHRC), a private, non-profit, tertiary care cancer hospital in Southern Assam, implemented an initiative led by community health workers called the Accredited Social Health Activists (ASHAs). We aimed to improve outreach, screening uptake, referral pathways, and early diagnosis of oral, breast and cervical cancer in Dima Hasao. We present our findings of this ongoing work.
METHODS
ASHAs underwent a 1-week training to create cancer awareness, symptom assessment, oral and breast examinations and Human Papilloma Virus self DNA testing. They led the door-to-door awareness campaigns, identified and screened symptomatic individuals, and referred individuals with abnormal findings to the nearest government health centres for subsequent rescreening. Mobile clinics were used to reach the underserved areas. Suspected cancers were referred to CCHRC for further investigations and treatment. Data on diagnosed cancers was collected from the hospital database.
RESULTS
We reached a total of 6,100 individuals at their homes. 22 cancers (11- Head and Neck, 1- Breast, 1- Cervix and 9- Other sites) were detected, with an Age-Standardised Rate (ASR) of 360 per 100,000 population, higher than the reported ASR of 114 per 100,000 population for Assam. We also diagnosed 101 precancers, the majority of which were treated at the primary care level.
CONCLUSION
An ASHA-led population-based early detection and screening programme with help from mobile clinics appears feasible in the tribal hilly terrain of Assam and may substantially improve early cancer detection in remote regions.