In a rural setting, a model to screen women using a simple and affordable technique has helped in early detection of cervical cancer. Approximately, 7,500 women aged 30 to 50, were screened for cancer of the cervix in K.V. Kuppam block in the last 10 years.
The model developed by Christian Medical College’s Rural Unit for Health and Social Affairs (RUHSA) uses visual inspection method for detection of cervical cancer in women. Among the screened population, it found 3% positivity — early and advanced stages of cervical cancer — in them, according to Rita Isaac, head of RUHSA.
“We started the programme in 2007. We were documenting passively reported cases of cervical cancer in the block. Over a period of two years, we found 50 cases reported passively in and around the block and this was quite high. Hence, we started a screening programme using a simple technique — visual inspection method — that has been recommended for population screening,” she said.
Visual inspection of the cervix with acetic acid (VIA) or Lugols Iodine (VILI) was approved by the World Health Organisation in low resource settings, she said and added that if a woman tests positive, it was followed by confirmation through biopsy.
Initial hiccups
When it started, the team faced difficulty as there was zero awareness about the screening method, she said. “We had intensively educated the community about cervix, and cervical cancer using different methods. From 2007 to 2010, women hesitated to come if they tested positive. Now, we have 100% women coming for confirmation and treatment,” she said.
RUHSA’s 18 peripheral centres organise clinics — including for general health — once a week during which nurses screen the women. Once a month, a team comprising a doctor, public health nurse, social worker and community health worker do the screening. “These clinics are equipped for screening women for cervical cancer and now do it as part of the routine,” she said.
In 10 years, they have screened around 7,500 women out of the eligible population of 20,000. Of this, 235 screened positive. Out of this 235, 90 had pre-invasive lesions, while the remaining were in various stages of cancer. “One aspect of cervical cancer is that if detected at an early stage, which is the pre-invasive stage, it can be cured,” she said.
During the first four or five years, they saw 26% of women testing positive to have early lesions. Now, they are seeing early lesions in 32% of women. “We are seeing an incremental improvement in the number of women coming for the screening. We are seeing patients coming at an earlier stage of the disease,” Dr. Isaac added.
RUHSA has trained local practitioners in and around the block, and has scaled up the model to other centres in the country — two mission hospitals in Chhattisgarh and one in Madhya Pradesh. Women’s groups were trained to be peer educators.
“Treatment linkage is vital. Our model has ensured that the women get treatment. This is a feasible, affordable and accessible model,” she said. -Health care personnel should be trained so that women can have better access to screening of cervical cancer. “We are asking every woman to voluntarily get tested once in three years after 30 years of age,” Dr. Isaac added.