Breast cancer is the most common cancer among women globally - also topping the list of cancers among women in India. However in rural India, women barely know about breast cancer, fear examination and have to defend a host of social and cultural taboos - leading to delayed detection, and a higher risk of mortality.
Sadly in India, nearly 60% of Breast Cancer cases are diagnosed at stage III or IV of the disease, with most patients turning up at healthcare facilities only when the disease has advanced or there are visible changes to the skin. A general lack of awareness about the disease - especially in rural areas – is largely to blame. And the lack of quality care, and access to affordable treatment, compound the issue.
With a chasm in shortage of manpower and facilities, experiments done by grassroots organizations to educate community women and health workers about the disease, and techniques for self and clinical examination, provide a glimmer of hope, and could be the key to tackling this pressing problem. India has just over 2000 oncologists for 10 million patients, and the number of oncologists unevenly favours metropolitan areas. Although nearly 70% of the Indian population live in rural areas, about 95% of facilities for cancer treatment exist in the urban areas of the country.
The answer therefore lies in empowering rural women, and community health workers with the relevant knowledge and skills to catch the disease early in its tracks. Community mobilisation on this issue, with the engagement of local health systems and local government, can go a long way in rolling out a comprehensive cancer screening strategy across India’s rural and remote communities.
By taking on responsibilities like awareness-raising, conducting clinical breast examinations, teaching self-examination skills, making referrals and supporting patients as they subsequently navigate treatment, community health workers could fill the vast void across remote rural areas when it comes to breast cancer screening.
Since mammography screening is simply not feasible in many rural settings, low-cost screening approaches like breast self-examination and clinical breast examination, have an important role to play. Used in combination with advocacy and awareness campaigns to promote early detection of breast cancer, this approach could provide the tipping point rural India so desperately needs to turn the tide on Breast Cancer.
However, building grassroots workers alone is not enough. There is also a desperate need to simultaneously make local healthcare facilities available for further diagnosis and treatment, through private partnerships. There is also a need to promote insurance schemes that cover the cost of high level treatments, and to ensure that as advanced treatments are made available in urban India, so too should they be made available in rural India via government hospitals.
Clearly there is much work to be done, particularly in a complex country like India, where cancer is growing disproportionately.
Last year, Ambuja Foundation along with Association of Breast Surgery, UK (ABS) and its counterpart Association of Breast Surgeons in India (ABSI) and Tata Cancer Care Program, Chandrapur, introduced Continuous Medical Education specific training on Cancer Awareness in the rural communities of Chandrapur, Maharashtra. This has continued into awareness creation and follow-ups in communities with our Sakhis driving the intervention, organizing cancer screening camps along with the local health centres and also assisting prospect patients to hospitals and treatment.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966510/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966510/#:~:text=In%20India%2C%20nearly%2060%25%20of,chest%20wall%20changes%20are%20visible
