Advancing towards
preventive oncology
There can be life after cancer,
but early detection is a
prerequisite. Be a part of
the change today.

Donate Now

Advancing towards preventive oncology
There can be life after cancer, but early
detection is a prerequisite. Be
a part of the change today.

Donate Now

What is preventive oncology?

Preventive Oncology is a unique discipline in oncology that focuses on critical measures that can prevent cancer development or delay the progression of the malignant process.

Cancer prevention aims to reduce incidence, morbidity, and mortality due to cancer by identifying and eliminating precancerous lesions and early detection of minimally invasive cancers.

What Cachar wanted to achieve through Preventive Oncology

  • Introduce a thorough population-based cancer screening programme in the Cachar district
  • Raise awareness about cancer in the district
  • Utilize self-referral programmes to identify breast, cervical, and oral cancer in its earliest stages.
  • Analyze the viability of at-home screening
  • Increase cancer survival rates using existing healthcare infrastructure

The likelihood of a positive
outcome rises with early detection.

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Case Studies

1. Utilising ASHA at house visit levels in the Assamese communities of Dholai and Cachar for oral, breast, and cervical cancer screening and early detection

The Government of India introduced a new operational guideline in 2016 to screen people aged 30 to 65 for population-based cancers at Primary Health Centers (PHCs). The study was undertaken by hiring Accredited Social Health Activists (ASHAs) from the community instead of Auxiliary nurses for the screening programme. Our goal was to screen people for oral, breast, and cervical cancer as well as diabetes and hypertension at their homes rather than at PHCs.

By preparing ASHA for home-based screening for oral, breast, and cervical cancer and referral and treatment of positive screens, we aimed to launch a comprehensive population-based cancer screening programme in the Cachar district. This screening program's primary goal was to assess if at-home screening was practical and whether ASHAs would be accepted by the community and willing to conduct additional screenings in the future.

Development of mobile application We developed a mobile application for patients to get a better cancer screening experience. We included:
  • Audiovisual of common cancer and prevention
  • Sociodemographic profile
  • Tobacco use and frequency
  • Personal medical history
  • Symptom checklist
  • Clinical note for O/B/C screening by ASHA

Training and orientation of the training team
  • In-house faculty including 15 master trainers and 2 project Medical Officers from CCHRC and the staffs of NICPR were recruited in the project to give training in Dholai PHCs.
  • The duration to train the master trainers was 3 to 4 days, medical officers were 14 days, and MSWs were 3 to 4 days.

[NOTE - The master trainers were auxiliary midwives by qualification and are existing nursing assistants at CCHRC with 4 to 5 years of experience]

Investigation and treatment at CCHRC
Dholai Health Block serves around 200,000 people, with around 66,000 eligible for the screening programme. 45 sub-centres were covered, and 212 ASHA constituted this block. A total of 45 sub-centres were covered, and 199 ASHAs were trained.   No. of individuals screened
  • 4439 out of 46,278 reported to be positive for malignancies by ASHA
    • 3346 (78%) reported to subcentres
    • 1179 (35%) referred to CCHRC of which 639(54.1%) reported to CCHRC in that 144 tested for pre-malignant oral lesion, 32 for head and neck malignancies, 3 for breast malignancy, 5 for cervix pre-cancer and 2 for obvious cervix cancer.
    • 1921 tested for reported hypertension, 777 for diabetes and 335 for hypertension and diabetes.
 

Case Studies

2. Clinical downstaging and early cancer detection by raising consciousness and self-referral programs in the Hailakandi district.
By raising awareness and providing organised referral and treatment facilities for early detection of cancers, we proposed to study a community-based programme to boost early presentation and decrease cancer-specific mortality in the Hailakandi district.

Case Studies

2. Clinical downstaging and early cancer detection by raising consciousness and self-referral programs in the Hailakandi district.
By raising awareness and providing organised referral and treatment facilities for early detection of cancers, we proposed to study a community-based programme to boost early presentation and decrease cancer-specific mortality in the Hailakandi district.
  • Clinical downstaging of breast, cervix, oral and other prevalent cancers in patients from Hailakandi district, Assam. 
  • Increase cancer awareness in the district
  • Detect the early stages of breast, cervix and oral cancer through self-referral programs
  • Build capacity of health care providers 
  • Recognize individuals requiring referrals and further treatments
  • Improve referral pattern and prioritised treatment services
  • Increase survival rate of common cancers with the existing healthcare infrastructure framework

ASHAs were given training at sub-centres by master trainers for 7 days with the help of visual aids, leaflets and videos and were educated on healthy lifestyle, common cancer and importance of screening, early detection and prevention. They were given re-training to run the existing Community Based Assessment Checklist form (CBAC form) in their community.

Katlicherra Health Block covers a population of approximately 2,00,000, in which approximately 66,000 people were eligible for the screening program. 35 sub-centres were covered, with 199 ASHA constituting this block.   A total of 30 sub-centres were covered, and 168 ASHAs were trained.  
  • Out of 13,537 total CBAC filled by ASHA, 1,509 (11.1%) are reported to have symptoms
  • 344 (22.7%) reported to sub-centres
  • 200 (58.1%) that tested for premalignant oral lesions kept in follow up at sub-centres
  • 44 referred to CCHRC for further evaluation, of which 30 patients reported to CCHRC, 11 for head and neck cancer, 1 for breast cancer and 1 for cervical cancer
 

Training of Asha

Training of ASHA was conducted in 3 domains of theory, practical and communication for 14 days.

 

For theory, ASHA staff were taught about the anatomy of the oral cavity, breast and cervix, causes of cancer, modifiable and non-modifiable risk factors, and early signs and symptoms of cancer.

For practical knowledge, ASHA were taught how to conduct oral and visual examination and inspection, collect Lugol’s tests and acetic acid, collect HPV samples, practice clinical breast examinations, measure blood pressure and capillary blood sugar, collect data in tablets, and conduct feasible and effective disinfection procedures in a community setup.

For communication, on-field supervision for ASHA was conducted by the master trainer on how to approach and encourage people for screening and how to handle myths and taboos about cancer.

ASHAs were trained by the master trainer. Screening of individuals by ASHA during home visits. Rescreening of the screened positive by project doctors at subcentres. Further evaluation and treatment of screen positive at CCHRC.

  • 199 (93.9%) ASHA participation in the training program
  • Post-training performance evaluation examination was conducted on 3 domains: Theory, Practical and Communication skills
  • The performance scores ranged between 75-100%