Parambil Neethu Ambali, Philip Sairu, Tripathy Jaya Prasad, Philip Phinse M, Duraisamy Karthickeyan, Balasubramanian Satheesan
Department of Community Oncology, Malabar Cancer Center, Thalassery, Kerala, India.
Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India.
Indian J Cancer. 2019 Jul-Sep;56(3):222-227. doi: 10.4103/ijc.IJC_397_18.
Community based programs can assist in early detection and improved survival of breast cancer.
To assess the feasibility and explore challenges of a district-wide door-to-door breast cancer screening program "ASWAS" conducted in Kannur district, Kerala, India from 2011 to 2014. METHODS: Aggregate data from survey records were collected in terms of the population screened, referred, diagnosed, and treated. Case records of breast cancer patients who were identified were reviewed and updated. In-depth interviews were conducted with program stakeholders. The contents of the interview were organized into a strength, weakness, opportunity and threat (SWOT) matrix to describe the screening program.
A total of 1,049,410 eligible women above 30 years residing in 81 panchayats were visited door-to-door by 8,200 community volunteers; of them, 93% were screened using a symptom-risk factor checklist. Of those referred with symptoms (n = 5353), 81% attended the cancer camp. In total, 23 breast cancer cases were confirmed. 14 (61%) were in early stages, treated, and are disease free at 3-year follow-up. Those in the advanced stage and old age had poor outcomes. SWOT analysis identified political support, female volunteers, community engagement, dedicated fund for treatment, and teamwork as strengths. Weaknesses included poor healthcare access, maintaining volunteer motivation, and issues around sustainability.
Community participation with the engagement of the health system and local self-government are required for implementing a comprehensive cancer screening strategy. Breast-cancer screening program using local volunteers for early detection is feasible in low-income settings, thereby improving survival.
基于社区的项目有助于乳腺癌的早期发现并提高生存率。
评估在印度喀拉拉邦坎努尔地区于2011年至2014年开展的全区挨家挨户乳腺癌筛查项目“ASWAS”的可行性，并探讨其面临的挑战。
收集调查记录中的汇总数据，内容包括接受筛查、转诊、诊断和治疗的人群。对确诊的乳腺癌患者的病例记录进行审查和更新。与项目利益相关者进行深入访谈。访谈内容被整理成一个优势、劣势、机会和威胁（SWOT）矩阵，以描述该筛查项目。
8200名社区志愿者挨家挨户走访了居住在81个村委会的1049410名30岁以上符合条件的女性；其中，93%的人使用症状-风险因素清单进行了筛查。有症状被转诊的人（n = 5353）中，81%参加了癌症筛查营。总共确诊了23例乳腺癌病例。14例（61%）处于早期，接受了治疗，在3年随访中无疾病。晚期和老年患者的预后较差。SWOT分析确定政治支持、女性志愿者、社区参与、专用治疗基金和团队合作是优势。劣势包括医疗服务获取困难、维持志愿者积极性以及可持续性方面的问题。
实施全面的癌症筛查策略需要社区参与以及卫生系统和地方自治政府的介入。在低收入环境中，利用当地志愿者开展乳腺癌筛查项目以进行早期发现是可行的，从而提高生存率。
