EARLY DETECTION
Table 2: Consumables and equipment needed for providing breast and cervical cancer early detection tests in primary health centres
Intervention Equipment/tools Consumables
Visual screening with acetic acid (VIA) or • Examination couch • 3–5% acetic acid
Lugol’s iodine (VILI) • Halogen focus lamp • 3–5% Lugol’s iodine
• Vaginal speculum • Monsel’s paste
• Sponge holding forceps • 0.5% chlorine solution or Gluteraldehyde
• Sharp cutting punch biopsy forceps • Gloves
• Water boiler • Cleanly laundered linen
• Autoclave • Cotton and gauze
• Plastic bucket to hold 0.5% chlorine
solution for decontamination
• Waste bin
Clinical breast examination (CBE) Examination couch • Cleanly laundered linen
• Cotton and gauze
Creating breast awareness Silicon breast model • Cleanly laundered linen
Posters on breast awareness • Cotton and gauze
refer women suspected with lesions for further investigations state in India through the Tamil Nadu Health Systems project
and treatment will improve the prospects of early detection, have significantly enhanced capacity for VIA screening in
improve survival and reduced mortality. Developing and health centres there11,25.
implementing in-service training programmes to guide Introducing an early detection register in the health centre
primary care practitioners in the early identification of to document information on subjects availing such services,
patients with signs and symptoms suspicious of breast and their referral details and final outcome will be useful for
cervical cancer and to improve their skills in administering the clinical audits and to improve compliance of screen-positive
relevant early detection tests will go a long way in facilitating women with further diagnostic investigations and treatment.
early diagnosis and prognosis from these major cancers Inadequate awareness and skills among primary health care
among women globally. practitioners is a major obstacle for a strategy based on early
Effective early cancer detection efforts in primary care clinical diagnosis. Development of evidence-based guidelines,
settings require that people be able to undergo recommended provision of adequate facilities in health centres and provision
early detection procedures in health centres and that primary of in-service, training and monitoring will improve the skills of
health workers be well trained and competent enough to primary health care providers in clinical suspicion and prompt
provide these interventions. The basic equipment and referral women to facilitate the diagnosis of breast and
consumable needs for providing breast and cervical cancer cervical cancers in early stages. Developing adequate facilities
early detection tests in health centres is given in Table 2. for diagnosis and treatment of cancer in secondary or tertiary
Unfortunately, health centres in the public health sector in care facilities in less-developed countries is another important
many less-developed countries are poorly equipped in terms prerequisite for successful earlier clinical diagnosis and, better
of basic infrastructure and required staff. Unless investments outcomes of treatment at considerably lower costs. l
are made to optimize infrastructure, consumables and clinical
practice at the primary care level, the potential for early Dr R Sankaranarayanan is trained in radiotherapy and clinical
detection and referral of these early cancers through primary oncology and is currently the Head of the Early Detection &
care will not be fully realised. For instance, health centres in Prevention Section and the Screening Group at the World
many sub-Saharan African countries lack examination Health Organization-International Agency for Research on
couches, specula, sterilization equipment, light sources, linen Cancer (WHO-IARC) Lyon, France. Dr Sankaranarayanan has a
and basic consumables and it is obvious that early detection keen interest and commitment in cancer control and health
cannot be facilitated by such appalling primary care systems development and response. He co-ordinates a global
infrastructures. On the other hand, the well-developed health programme of research including large randomized controlled
centres in Thailand successfully provide VIA or cytology screening trials, follow up and cross-sectional studies and
screening which has enormous potential to improve cervical training initiatives in affordable and effective cancer early
22-25
cancer control in Thailand . Improved investments in detection approaches, to catalyse worldwide implementation of
primary health care in Bangladesh, Thailand and Tamil Nadu effective population-based early detection programmes,
CANCER CONTROL 2013 71