Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India

Abstract Background: Breast, cervical, and oral cancers contribute to majority of cancer deaths among women in India. However, there is poor implementation of screening programs at primary health care (PHC). There is a need to understand the perspectives of healthcare providers at PHC level for feasibility of implementation of a cost-effective cancer screening program, particularly in the rural and tribal areas that are under served by cancer services. Materials and Methods: A continuous medical education (CME) program on “Prevention and early detection of common cancers” was held for all Medical Officers of Palghar District, Maharashtra. A self-administered questionnaire was used to assess the knowledge, attitude, practices, perspectives regarding common cancers, screening methods, and human papilloma virus (HPV) vaccination. A pre- and post-assessment was carried out before the commencement and on completion of the CME among 76 participants. Results: Knowledge about etiology of common cancers was high; however, awareness of risk factors was low. There were knowledge gaps about HPV vaccination. There was overall improvement about the available screening methods and knowledge of HPV vaccine and dosages after the CME (pretest 65% to posttest 95%). Providers had no experience in performing cervical cancer screening on a routine basis. While the majority of the providers (97%) indicated that screening for cancer was essential and feasible at PHC level; however, training (52%) and resources (53%) would be needed. Conclusion: Healthcare providers though from the underserved tribal areas, were optimistic to implement screening for common cancers and were willing to take training for the same. This emphasizes the need for educating and training the healthcare providers with simple techniques for effective implementation of cancer screening programs in underserved areas.

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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Viruses ◽

10.3390/v10120729 ◽

2018 ◽

Vol 10 (12) ◽

pp. 729 ◽

Cited By ~ 42

Author(s):

Andreas Chrysostomou ◽

Dora Stylianou ◽

Anastasia Constantinidou ◽

Leondios Kostrikis

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Hpv Vaccination ◽

Screening Method ◽

Population Based ◽

Screening Tests ◽

Screening Methods ◽

Hpv Testing ◽

Screening Programs

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

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THE DIFFERENT SCREENING METHODS FOR THE CERVICAL LESION DIAGNOSTIC AND THE ECONOMIC AND SOCIAL IMPLICATIONS OF SCREENING AMONG FEMALE POPULATION

10.32008/geolinks2021/b1/v3/27 ◽

2021 ◽

Author(s):

Codrin Gheorge ◽

Verginica Schröder ◽

Ramona Stoicescu ◽

Irina Dumitru

Keyword(s):

Hpv Vaccination ◽

Social Implications ◽

Cervix Uteri ◽

Screening Methods ◽

Female Population ◽

Vaccination Programs ◽

Screening Programs ◽

Cellular Diagnostics ◽

Budgetary Level ◽

The Impact

"The study aims to compare different screening methods that are currently being used to confirm a cervical intraepithelial lesion (CIN) underlying the inherent advantages of the varied examination procedures. In this study we are looking at the quality contrast of the different paraclinical examinations relative to the cost, invasiveness and cultural acceptance of such procedures. Every year, more than 100,000 women in EU countries are diagnosed with cervix uteri cancers (CCU). This type of cancer can be prevented if precancerous cells are detected and treated. HPV is found in over 90% of cervix uteri cancers. In Europe, more than half of the countries have implemented screening programs for cervical cancer, and most European countries now have national HPV vaccination programs, however target populations vary depending on the epidemiological evidence and the budgetary level of each countries health system. In this study we evaluated and compared the current and modern techniques used for cervix cellular diagnostics. Also, this study helps improve the understanding on the economic and social implications of screening among female population and the impact it has on healthcare system relieving. Romania recorded an incidence of 22.6 cases of cervix uteri cancers / 100.000 women (age standardized rate), and a mortality of 9.6 / 100.000, ranking second highest in the EU zone."

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A limited review of over diagnosis methods and long-term effects in breast cancer screening

Oncology Reviews ◽

10.4081/oncol.2011.11 ◽

2011 ◽

pp. 143-147

Author(s):

Dongfeng Wu ◽

Adriana Pérez

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Early Detection ◽

Breast Cancer Screening ◽

Screening Program ◽

Critical Issue ◽

Long Term Effects ◽

Screening Programs ◽

Probability Modeling

Breast cancer screening programs have been effective in detecting tumors prior to symptoms. Recently, there has been concern over the issue of over-diagnosis, that is, diagnosis of a breast cancer that does not manifest prior to death. Estimates for over-diagnosis vary, ranging from 7 to 52%. This variability may be due partially to issues associated with bias and/or incorrect inferences associated with the lack of probability modeling. A critical issue is how to evaluate the long-term effects due to continued screening. Participants in a periodic screening program can be classified into four mutually exclusive groups depending on whether individuals are diagnosed and whether their symptoms appear prior to death: True-earlydetection; No-early-detection; Over-diagnosis; and Not-sonecessary. All initially superficially healthy people will eventually fall into one of these four categories. This manuscript reviews the major methodologies associated with the over-diagnosis and long-term effects of breast cancer screening.

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Awareness of carcinoma cervix in nursing personnel of a tertiary care institute, Mumbai, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175546 ◽

2017 ◽

Vol 7 (1) ◽

pp. 128

Author(s):

Pooja K. Bandekar ◽

Prashant B. Kale

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Carcinoma ◽

Nursing Staff ◽

Tertiary Care ◽

Screening Methods ◽

Carcinoma Cervix ◽

Indian Women ◽

Screening Programs

Background: Carcinoma cervix is the second most common cancer of women all over the world and commonest cancer among Indian women. Awareness about cervical cancer and its prevention low amongst Indian women. The Pap test is a simple cost-effective technique for screening to help early diagnosis of cervical cancer. Nursing staff should be made aware of cervical cancer, so that they can spread the knowledge to the general public. Objectives of present study were to assess the knowledge level regarding symptoms, risk factors, prevention and screening of cervical carcinoma among nursing staff and to find out the behaviour of respondents regarding prevention and screening of cervical carcinomaMethods: A cross-sectional interview-based survey regarding knowledge of cervical carcinoma was conducted among the nursing staff of a tertiary care institutes of Mumbai.A structured questionnaire with multiple choices was used as a tool for data collection. Provision for open-ended responses was also made in the questionnaire. 100 nurses participated in the current study. Data was entered in Microsoft Excel. SPSS statistical software was used to generate statistical parameters like proportion, mean, standard deviation, etc. The test of significance used was the Z test and a P value of <0.05 was considered as the level of significance.Results: We lack an organized opportunistic screening program for cervical cancer in India. Data indicates a slow, but steady, decline in the incidence of cervical cancer. However, the rates are still too high, particularly in the rural areas. It is extremely essential to screen eligible women when they come to health units for other services. Studies have shown it is possible to train nurses to screen for cervical cancer. Attitudes that screening is to be done by doctors or gynaecologists only needs to change. The survey revealed that the hospital played a limited role as a source of information on Pap smear. This calls for a re-orientation of nurses, paramedicals and health workers and a need for introduction of simpler cervical cancer screening methods such as visual inspections that are more sustainableConclusions: Awareness about cervical cancer has to be improved. Education of the nursing personel will strongly contribute to strengthen cervical cancer screening programs. Nursing staff can and should educate the masses to help increase health awareness in women.

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The status of compliance with guidelines of cancer screening in Japan

European Journal of Public Health ◽

10.1093/eurpub/ckz187.063 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

K Kono ◽

K Matsuda ◽

R Machii ◽

K Saika ◽

H Takahashi ◽

...

Keyword(s):

Gastric Cancer ◽

Cervical Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Screening Methods ◽

General Tendency ◽

Screening Guidelines ◽

Screening Programs ◽

The Status ◽

Gastric Cancer Screening

Abstract Background The Ministry of Health, Labour and Welfare (MHLW) establishes screening recommendations specifying screening methods, age, and interval for gastric, colon, lung, breast, and cervical cancers. Screening programs are provided via local healthcare departments (LHD), who are responsible for managing programs and reporting the screening status through a survey annually. Methods We analyzed screening status provided by LHDs in fiscal 2017 in regards to appropriate screening age and interval. Briefly, current recommended screening age by MHLW is followed: colon, lung, breast cancer screening are age 40 years and older, and cervical cancer for aged 20 and older, and gastric cancer for aged 50 and older. Screening intervals are gastric, breast, and cervical cancer screening are two years, and colon and lung cancer screening are one year. Results The survey was completed by 1736 LHD (response rate: 99.9%). Regarding age-appropriate compliance, in cervical cancer, 96.4% of LHDs reported following recommended target age, while compliance was lower for lung, colon, breast, and gastric cancers at 79.4%, 75.7%, 60.2% and 4.2%, respectively. High compliance with recommendations for screening interval was identified for colon (99.7%) and lung (98.7%) cancers; this was substantially less for breast, cervical, and gastric cancer screening at 39.8%, 34.1%, and 4.6%, respectively. Conclusions In 2016, MLHW changed the starting screening age for gastric cancer from 40 to 50 years old, likely resulting in the lowest compliance in our analysis. Though it may take time for screening facilities to come into compliance with newer recommendations. Many LHDs provide screening without adhering to recommended starting ages, with a general tendency to provide screening at younger than recommended ages. This is a barrier to maximizing effectiveness and minimize harms of screening and warrants closer monitoring to promote efficiency in cancer screening programs. Key messages There is relatively low compliance with cancer screening guidelines in Japan. Establishing an environment of appropriate monitoring and support to achieve the goal of cancer screening is warranted.

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The Colonoscopy Satisfaction and Safety Questionnaire (CSSQP) for Colorectal Cancer Screening: A Development and Validation Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030392 ◽

2019 ◽

Vol 16 (3) ◽

pp. 392 ◽

Cited By ~ 2

Author(s):

Alicia Brotons ◽

Mercedes Guilabert ◽

Francisco Lacueva ◽

José Mira ◽

Blanca Lumbreras ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Occult Blood ◽

Face Validity ◽

Screening Colonoscopy ◽

Fecal Occult Blood ◽

Optimal Care ◽

Screening Programs

Colonoscopy services working in colorectal cancer screening programs must perform periodic controls to improve the quality based on patients’ experiences. However, there are no validated instruments in this setting that include the two core dimensions for optimal care: satisfaction and safety. The aim of this study was to design and validate a specific questionnaire for patients undergoing screening colonoscopy after a positive fecal occult blood test, the Colonoscopy Satisfaction and Safety Questionnaire based on patients’ experience (CSSQP). The design included a review of available evidence and used focus groups to identify the relevant dimensions to produce the instrument (content validity). Face validity was analyzed involving 15 patients. Reliability and construct and empirical validity were calculated. Validation involved patients from the colorectal cancer screening program at two referral hospitals in Spain. The CSSQP version 1 consisted of 15 items. The principal components analysis of the satisfaction items isolated three factors with saturation of elements above 0.52 and with high internal consistency and split-half readability: Information, Care, and Service and Facilities features. The analysis of the safety items isolated two factors with element saturations above 0.58: Information Gaps and Safety Incidents. The CSSQP is a new valid and reliable tool for measuring patient’ experiences, including satisfaction and safety perception, after a colorectal cancer screening colonoscopy.

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HIV Screening of Surgeons and Dentists: A Cost-Effectiveness Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/646826 ◽

1994 ◽

Vol 15 (10) ◽

pp. 635-645 ◽

Cited By ~ 4

Author(s):

Randall L. Sell ◽

Albert J. Jovell ◽

Joanna E. Siegel

Keyword(s):

Cost Effectiveness ◽

Hiv Transmission ◽

Program Effectiveness ◽

Screening Program ◽

Cost Effective ◽

Hiv Positive ◽

Hiv Screening ◽

Case Scenario ◽

Screening Programs ◽

Voluntary Program

AbstractObjective:To assess the cost-effectiveness of human immunodeficiency virus (HIV) screening strategies of surgeons and dentists.Design:We constructed a model to project costs and HIV transmissions prevented over 15 years for four screening scenarios: 1) one-time voluntary screening, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in the first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of practitioner-to-patient transmission are eliminated for all practitioners testing positive. Voluntary screening assumes 90% of HIV-positive and 50% of HIV-negative practitioners are tested, and risks of transmission in the clinical setting are eliminated for 90% of HIV-positive surgeons and dentists. All costs and benefits are discounted at 5% per annum over 15 years.Results:Using “best-case” scenario assumptions, we find for surgeons that a one-time voluntary screening program would be most cost-effective, at $899,336 for every HIV transmission prevented. For dentists, the one-time voluntary program also is the most cost-effective, at $139,571 per transmission prevented. Annual mandatory programs were least cost-effective for both surgeons and dentists, at $63.3 million and $2.2 million per transmission prevented, respectively.Conclusions:HIV screening of surgeons and dentists ranks among the more expensive medical lifesaving programs, even using liberal assumptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transmission prevented; these features should be considered carefully in designing specific HIV screening programs.

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Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

Journal of Global Oncology ◽

10.1200/jgo.2016.007641 ◽

2017 ◽

Vol 3 (5) ◽

pp. 490-496 ◽

Cited By ~ 4

Author(s):

Olalekan Olasehinde ◽

Carla Boutin-Foster ◽

Olusegun I. Alatise ◽

Adewale O. Adisa ◽

Oladejo O. Lawal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Low Income ◽

Screening Program ◽

Cross Sectional Survey ◽

Middle Income ◽

Screening Programs ◽

Middle Income Countries ◽

Low And Middle Income

Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

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Implementation of a community-based cervical cancer screening program using visual inspection with acetic acid and Lugol’s iodine in Kutch District, India.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e12009 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e12009-e12009

Author(s):

Surbhi Grover ◽

Melody Ju ◽

Lilie L. Lin ◽

Shobha Krishnan

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Visual Inspection ◽

Screening Program ◽

Cancer Center ◽

Community Based ◽

Screening Programs ◽

Lugol’S Iodine

e12009 Background: Visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) is increasingly reframed as a bridge modality through which low resource countries can provide cervical cancer screening while waiting for the more effective HPV DNA tests to become affordable. Often the screening programs are organized by government bodies that lack the trust of the local communities and hence such programs suffer from poor participation. Here we aim to describe a locally-sustained VIA/VILI screening program in rural Kutch district in India directed by Kutch Mahlia Vikas Sangathan (KMVS), a local NGO committed to women empowerment. Methods: All capacity-building measures (funding, training, materials, and healthcare workers) were rooted in the local community. Heath workers were sent to Tata Memorial Cancer Center in Mumbai for training. NGO members held information sessions prior the screening camps educating women about the significance of screening. A three-visit screening model using VIA/VILI was implemented. At first visit, all women were consented and screened. VIA/VILI positive women returned for a second visit for biospy. Biopsy positive women then returned for a third visit to arrange for treatment. All the screening camps were conducted in community buildings such as schools with the collaboration of the village leaders. Results: Screening camps were set up in 17 villages in 2010-2011, screening a total of 832 married women upto the age of 50. There were 0 cervical intraepithelial neoplasia (CIN) positive lesions or invasive cancers found. None of the women were lost to follow-up. Conclusions: It is feasible to develop a community level screening program and to provide cancer prevention needs from within a community. Future directions include further evaluation of downstream protocols after VIA/VILI tests, increasing health worker diagnostic and treatment capacity, and determining positive recruitment factors in women attending screening camps. The KMVS screening program has been well-received and has been approached by several other NGO’s and training centers seeking to build similar community-based cervical cancer screening programs.

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