Cervix and breast cancers account for 126000 and 80000 new cases respectively each year in India, where these cancers are responsible for over 50% of the cancer burden among women. This study investigates the effectiveness of well planned health education programs (HEP) along with low-cost screening methods e.g. clinical breast examination (CBE), and visual inspection of the cervix painted with 4% acetic acid (VIA), performed by trained primary health workers, in down-staging and thereby reducing the incidence of cervix cancer and mortality due to breast and cervix cancers. This is a cluster randomized study involving 152,239 women between the ages of 35-64 years from the slums of Mumbai, India, staying in 20 geographically defined clusters that have been randomly allocated into an intervention arm (10 clusters, n=75955) to receive 4 rounds of the intervention (HEP+CBE+VIA) at 24 month intervals and a control arm (10 clusters, n=76284). After the completion of 4 rounds of intervention the clusters will be monitored for the next 8 years for incidence and mortality due to breast and cervix cancers. Till Jan. 04, women from 5 intervention-clusters (n=37046) had received 3 rounds of intervention at an average compliance rate of 66% (women from these clusters are currently receiving the 4th round of intervention), while women from the other 5 intervention clusters (n=38909) had received 2 rounds of the intervention at an average compliance rate of 72%. (Women from these clusters are currently receiving the 3rd round of intervention). Women from all 10 control-clusters received one round of health education in the beginning (compliance rate 91%). 104 and 70 cases in the intervention arm and 47 and 38 cases in the control arm of breast and cervix cancers respectively have been detected till date. This study has done extremely well so far and its results are expected to influence the future policies on cancer control programs in India and other resource poor countries.
| Shastri, Surendra S; Mittra, Indraneel; Mishra, Gauravi A et al. (2014) Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst 106:dju009 |
