Kalavathy Mathur chennath 1, Meera Radhakrishnan 1 Assistant Professor Regional Cancer Centre Trivandrum Kerala, India

BACKGROUND Breast cancer is the leading cancer among females globally and also in rural area of Trivandrum District,( the capital city of Kerala, South India) the incidence being 31/100,000 females (an expected number of around 341/ year). Only 22.2% of these breast cancers present in the localized stage for treatment in the neighbouring Regional Cancer Centre (RCC), Trivandrum.

INTRODUCTION An organized breast cancer screening programme among the common rural women of Trivandrum utilizing the grass root level health workers can help in increasing the awareness among these women and also to improve the stage at presentation for treatment So the District local administrative body (District Panchayath) with technical support from RCC started an organized female cancer screening programme focused in all the rural Government Health Centres (PHC/CHC) in the district utilizing the Accredited Social Health Activists (ASHA) workers ASHA workers are female health volunteers selected from common rural women and they act as health advisors and care providers at the grass root level

OBJECTIVE To see the effectiveness of utilizing ASHA workers in organized Breast Cancer Detection Programmes in Rural Trivandrum, Kerala, India

METHODOLOGY Initially an orientation programme was conducted for 2600 ASHA workers of the district who visit every house hold in their locality and give health advices. Special instruction was given for identifying women at high risk for breast cancer like age after 40, family history, Lump in breast etc An early cancer detection programme for women is organized in 75 Govt PHCs in the district over a period of 18 months. Organisation of the programme done through the district literacy mission with support from local panchayath and local PHC.

METHODOLOGY (Contd…) Women in the locality of the PHC are motivated by the ASHA workers in the area to attend the screening programme conducted in the local PHC on prefixed day. Well experienced lady doctors perform breast palpation of every woman attending the clinic and record the findings. Women with well defined breast lumps are subjected to Fine Needle Aspiration Cytology (FNAC) at camp site All high risk category women are given appointment for Bilateral Screening Mammogram in RCC.

METHODOLOGY (Contd…) After correlating the FNAC and Mammogram results, women are referred for further treatment, if indicated. Women with benign lesions are referred to the nearest Medical College Hospital Women with malignant lesions are treated in RCC and if they come from poor socioeconomic background, they are given treatment support from this programme

RESULT A total of 4643 women are subjected to breast examination We could identify 15breast cancers (13 confirmed), 81 Fibroadenosis, 34 Fibroadenoma (26 confirmed microscopically), and 13 cysts in the breast 7 cancers (53.8%) were localized diseases and 6 (46%) were with regional nodes and 2 cases did not turn up for further evaluation

Age Distribution of Women Participated in the Screening

Percentage Age Group Distribution of Breast Cancers Detected Among the Participants

DISCUSSION A rate of.36% of breast cancer among the population of rural women who participated in the cancer detection clinic points to the effectiveness of this kind of a programme. The maximum age distribution of cancer cases among the screened population is higher than the maximum age distribution of breast cancer cases in RCC The % of breast cancer cases with localized disease and regional nodes are 22% and 65% respectively in RCC whereas in this screening programme it was 53.8% and 46%.

CONCLUSION Breast cancer screening programmes utilizing ASHA workers can result in early detection of more number of these cancers at an early stage. LIMITATION OF THE STUDY More sociodemographic details are to be analysed statistically in more number of women and this programme is in progress

CLINIC SITE

TRIVANDRUM DISTRICT, KERALA, INDIA