Cancer screening program using technology assisted learning

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There is an estimated burden of over 1 million individuals who were diagnosed with cancer in India in 2012. The three most commonly occurring cancers in India are breast, uterine cervix and oral cancers, together accounting for one third of India’s cancer burden. All three are usually detectable at early stages, and malignancies of the oral cavity and cervix have precancerous stages that are amenable to secondary prevention. Therefore, screening and early detection of these three cancers will help to markedly reduce the cancer burden in India.

The technology used in this project is the ECHO (Extension for Community Health Outcomes) model of the University of New Mexico. ECHO clinics are supported by basic, widely available teleconferencing technology. It links expert specialist teams at an academic ‘hub’ with primary care clinicians in local communities – the ‘spokes’ of the model.

This pilot project is being conducted at the primary health centre (PHC) Gumballi, a tribal village in Karnataka. We are incorporating cancer screening program in the existing infrastructure and manpower in-country, using the ECHO model. The Institute of Cytology and Preventive Oncology (ICPO) helps in empowering the community health workers (CHWs) at the PHC to conduct cancer screening of the population covered by the PHC.

We have used two modes of training health care providers:

  • Initial face-to-face training on cancer screening tests, allowing for hands-on training and practice of skills. ICPO staff visited Gumballi and provided 4 days of intensive training to the community health workers in screening of oral, breast and cervical cancer.

  • Subsequently, fortnightly, ECHO clinics are being conducted to include reiteration of the training, discussing patient cases, resource sharing and expert presentations.

To date, the CHWs have screened 11,342 individuals for oral, breast and cervical cancer, out of the 16,042 eligible population. The screen positives and suspicious cases are being evaluated and treated by a team of specialists from the Kidwai Memorial Institute of Oncology, Bangalore, which is a tertiary care centre for cancer treatment in that region.

This pilot study proves that the cancer screening is feasible at the primary health network with the existing resources which can be replicated to the larger masses and subsequently to the whole country.