Dr, Partha Basu
Head, Department of Gynecologic Oncology

Cervical Cancer Screening
Cancer is emerging as one of the leading causes of morbidity and death not only in the affluent countries but also in the developing nations including India. Cancer control measures like campaign against tobacco, creating public awareness, organizing cancer early detection and screening, are essential to bring down the incidence of cancer and the resulting deaths. Such activities can only be carried out through a community based approach involving the primary health care facilities and the grass root level Organizations. The thrust should be on prevention and early detection.

More that 50% of the cancers are preventable. The most important preventable cause of cancer is tobacco use. Tobacco cessation activities include creating public awareness, offering counseling to the tobacco habitués, preventing exposure to second hand smoke and ensuring enforcement of legislative measures. The target group should be identified, appropriate education materials should be prepared and innovative awareness campaign should be planned keeping in mind the socio-cultural background and taste of the target population. Same principle applies to any campaign aiming at creating awareness about other life-style factors that increase the risk of cancer like obesity, sedentary life, early marriage etc. Probably the most exciting new advancement in the field of cancer in the recent times is the discovery of HPV vaccine that can prevent nearly 70% of cervical cancers, the number one cancer among Indian women. The vaccine has to be administered to young women before they become sexually active and will be available in India soon.

The principle of cancer screening is to detect the disease at precancer stage (e.g. cervical cancer and oral cancer) when appropriate treatment can prevent development of cancer, or at an early stage (e.g. breast cancer) when treatment can cure the disease. Cervical cancer screening if done in an organized manner can reduce the deaths from cervical cancer by 70-80%. All women between 30-60 years should be offered cervical screening irrespective of whether they have any symptom or not. Availability of low cost screening test (VIA) and simple method of treating precancers (cryotherapy) has made it feasible to setup cervical screening facility in the rural areas with very basic infrastructure. The women can also have breast cancer screening by Clinical Breast Examination by trained health workers. All tobacco habitués should be screened to detect white or red patches in the oral cavity. As cervical cancer and breast cancer are the most common cancers among women and oral cancer is the most common cancer in men, a screening program aimed at the control of these three cancers will have a huge impact. Awareness about the common signs of cancer should be done provided facilities for early detection can be established.

Cancer therapeutics needs huge investments to develop the infrastructure and logistics and is possible only in the tertiary care centers. The number of such set ups and more importantly the number of radiation therapy units required to cater to the huge burden of cancer patients in the country is grossly inadequate. Hence cancer control is difficult to achieve only through strengthening the therapeutic centers.

The diagnosis of cancer itself is a huge psychological trauma that the patient and the relatives often find difficult to cope with. Many of the cancer patients undergo resection of some major organs that make them physically challenged and mentally traumatized. Many of them can not pursue their profession and feel socially outcast. Some of them need special attention like care of the stoma, voice rehabilitation, prevention of lymph-edema etc. Psychological support through professional counseling and interaction with survivors is extremely helpful.

The cancer control program has a pivotal role in taking care of the terminally ill patients. Volunteers can be trained to attend to the physical and the psychological needs of such patients. Some of the palliative care organizations are doing remarkable work in organizing home based palliative care where a mobile team consisting of a doctor, a nurse and a social worker can visit the homes of terminal patients and offer pain management, nursing care and psychological support.

There are many NGOs in India who offer primary health care to the beneficiaries and have excellent rapport with the people and credibility in the community. Such NGOs can be motivated and guided to adopt cancer prevention and early detection as an additional service to their beneficiaries with support from the specialized cancer centers. NGOs can develop a team of skilled personnel and appropriate logistics to do cancer awareness, cancer screening and cancer early detection. To deliver the service to the community the Regional Cancer Centers can tie up with the NGOs and conduct the cancer control activities by providing awareness materials, trained persons, instruments and detection facilities to them. The collaborating NGO will in turn disseminate the message, provide physical space and logistics to hold detection clinic and make sure that the positive cases can be recalled for treatment. NGOs working in specialized areas like counseling of the mastectomized women, support to the ostomates, home palliative care service etc. can come together and provide a holistic service to the patients. Such partnership between RCCs and NGOs can fill in the void resulting from the therapy-oriented approach to cancer control.