Leveraging Community Stakeholders for Early Cancer Detection and Prevention in Rural Assam
Ravi Kannan, Subhadra Goala, Benazir Barlaskar, Basu Kurmi, Anita Gadgil, Ganga Baul, Joyita Dey, BA John KabuiPURPOSE
Assam, a northeastern state in India, reports a cancer incidence of 114 per 100,000 people, higher than the national average of 97 per 100,000. Two-thirds of cases are detected at an advanced stage, highlighting the need for community-based cancer screening. The national programme for non-communicable diseases promotes community-based screening for oral, breast and cervical cancer through Accredited Social Health Activists (ASHAs). Several community-based stakeholders work in silos under various government programmes and can be potentially involved in strengthening cancer awareness messaging. These include Anganwadi workers (AWW), who work for preschool children; women's empowerment groups; local governance bodies; community leaders; and educational institutions (school teachers). We present results of an initiative, leveraging grassroots-level workers in cancer early detection by a non-government, non-profit organisation.
METHODS
ASHAs were trained to create cancer awareness and identify individuals at high risk in Lakhipur health block in Assam. Symptomatic individuals were screened at a primary health care centre for further evaluation and referred to a tertiary care centre if cancer-directed treatment was needed. Additionally, a one-day programme was conducted for all grassroots-level workers to create consistent cancer awareness messaging and identify symptomatic or high-risk individuals.
RESULTS
Training was given to 100% of ASHAs in the area. 86% of other community health workers, 43% of AWWs, 27% of local governing body members, and 15% of women's empowerment groups were trained. Cancer awareness was delivered to 60% of the eligible population, and 5.6% of symptomatic individuals were identified. Of 876 symptomatic individuals reported to Primary Health care, 271 (31%) were identified with low-risk precancerous lesions of the oral cavity and cervix and were treated at the primary level. 166 of the symptomatic individuals (6%) needed referral to a tertiary health centre and presented for treatment. Of these, 34 (20.4%) cancers and 21 (12.6%) precancers were diagnosed and treated. Among symptomatic women, 90% participated in HPV DNA self-sampling, with 5.7% testing positive.
CONCLUSION
Strengthening cancer awareness through engagement of all workers at the grassroots level and decentralising care through primary health centres is feasible. This holds significant promise for early detection and timely referral of suspected cancer cases.