On National Cancer Awareness Day, Dr Shirish Ghadi, Public Health and Nutrition Specialist, Transform Rural India explains why prioritising the strengthening of cancer diagnostic facilities at secondary and tertiary healthcare facilities is essential
“Thank you, sir, for initiating cancer screening services at our Primary Health Centres and Subcentres. Last month, one of our Self-Help Group (SHG) members passed away due to breast cancer. She was unaware of her ailment, and by the time it was detected, it was already too late! If we had known about it earlier, she would still be with us. I will personally ensure that every SHG member from my cluster and women in their family get screened for breast and cervical cancer at the nearest public health facility.”
These were the words of one of the community resource persons from Umed, Maharashtra State Rural Livelihood Mission when we briefed them about Mission Anandi. Our work in regenerative development involves working closely with women in rural India to enhance their income through livelihood. Even as we strive to enhance the annual earnings of women from rural India, just one major illness like cancer, can set back the entire economic progress they have made over the years.
According to a study by ICMR, as of 2016, deaths due to Non-Communicable Diseases were estimated at around 61.8 per cent. For the year 2022, the estimated new cases of cancer were 1,461,427, i.e., 100.4 per 1,00,000 population, with lung cancer among men and breast cancer among women being the major contributors. This incidence of cancer is expected to double by the year 2040 compared to that of 2018. Almost 70 per cent of these cases are estimated to be caused by preventable and modifiable risk factors.
The government initiated the National Cancer Control Program as early as 1975, initially focusing on the provision of treatment. The program has evolved over the years, with an emphasis on the prevention and control of cancers. In 2010, the government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).
Under this program, the government is taking an aggressive approach to population-based screening for the three major cancers, Oral, Breast, and Cervical, in addition to setting up NCD clinics at District Hospitals and Community Health Centres, along with establishing Tertiary Cancer Care Centres. Despite these efforts, the screening numbers, according to the National Family Health Survey-5, stand at only 1.9 per cent and 0.9 per cent for cervical and breast cancer, respectively.
More importantly, rural women are often reluctant to visit higher facilities for diagnosis and treatment, and there is also subjective bias observed in screening results given the different skill levels of the healthcare providers across the system. One of our projects has been tackling this through door-to-door AI screening machines which combine the privacy of their homes, with the comfort of now having to travel. In six months, we were able to screen approximately 120,000 women aged 30 years and above for breast and cervical cancer. Through this effort, we identified 360 suspected cases of cervical cancer and 20 suspected cases of breast cancer. Given the low number of breast cancer suspects (which is much lower than the actual prevalence rate of breast cancer). The introduction of AI tools and other digital solutions has greatly benefited healthcare in recent years. However, with the dependency on steady internet connectivity and electricity, which can be a challenge in some remote rural areas, optimal utilisation of these tools remains a challenge.
Another major obstacle that we faced was the lack of diagnostic facilities to confirm the suspected cases at secondary and tertiary public health facilities. A delay in confirming the diagnosis of suspected cases post-screening defeats the entire purpose of early diagnosis and treatment. Under the Ayushman Bharat scheme, the treatment costs are covered for diagnosed cancer cases, but there is no provision for the diagnosis of suspected cases.
In the absence of signs and symptoms, many rural women are reluctant to visit higher facilities for further diagnosis and treatment. Also, the dependency on men in the family to transport them to higher facilities causes further delays in diagnosis and treatment. Another challenge faced by most healthcare providers is the unwillingness of women to undergo screening for cervical or breast cancer when no signs or symptoms are present. Women’s cancer prevention, for this reason, needs to be given equal priority in terms of generating public awareness, similar to addressing cancers predominantly caused by the use of tobacco and related products. In our intervention areas, we work closely with SHGs, which helps mobilise women for cancer screening and addressing other health issues.
Moving forward, from a systemic perspective, prioritising the strengthening of cancer diagnostic facilities at secondary and tertiary healthcare facilities is essential. Working closely with the SHGs under the National Rural Livelihood Mission, which covers more than 50 per cent of women in rural areas, will significantly boost awareness generation and mobilisation. Conducting outreach camps for SHG members will complement the health department in achieving its screening targets and raising awareness, thus reducing the burden of cancer cases among women. As mentioned earlier, utilizing AI and other digital tools and providing infrastructure and dedicated resources for training individuals to use these tools will also enhance the quality of screening.
This also offers a chance for philanthropic organisations and corporations to complement the government’s efforts. There are opportunities to donate diagnostic tools, and AI tools, outreach cancer mobile units, and conduct awareness generation campaigns through grassroots NGOs and SHGs to reduce the burden of cancer cases among women. These cancers can be prevented through non-addictive modifiable risk factors and early diagnosis and treatment. Dr Shirish Ghadi is the Public Health and Nutrition specialist at Transform Rural India, a solution designer for regenerative development.