Qualitative assessment of breast cancer early detection services provided through well woman clinics in the district of Gampaha in Sri Lanka.

BACKGROUND: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. MATERIALS AND METHODS: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. RESULTS: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. CONCLUSIONS: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.

Cancer epidemiology in South Asia - past, present and future.

Pakistan, India, Sri Lanka, Bangladesh, Nepal and Bhutan, with their total population of more than 1,500 million, make up the subcontinent of South Asia. Despite massive diversity across the region, there are sufficient similarities to warrant a collective approach to chronic disease control, including development of cancer control programs. Cancer is already a major problem and there are general similarities in the prevalence patterns. In males, oral and lung cancer are either number one or two, depending on the registry, with the exceptions of Quetta in the far north, Larkana and Chennai. Moderately high numbers of pharyngeal and/or laryngeal cancer are also consistently observed, with prostate cancer now becoming visible in the more developed cities. Breast and cervical cancer share first and second place except in Muslim Pakistan, where oral cancer generally follows breast. The ovary is often included in the five most prevalent types. Markedly increasing rates for breast cancer and distribution shifts in other cancers suggest that, despite improvement in cervical and oral rates, the overall burden will only become heavier over time, especially with increasing obesity and aging of what are still youthful populations. Coordination of activities within South Asia is a high priority for cancer control in the region.

Human papillomavirus infection and cervical cancer prevention in India, Bangladesh, Sri Lanka and Nepal.

Although one-third of the world cervical cancer burden is endured in India, Bangladesh, Nepal and Sri Lanka, there are important gaps in our knowledge of the distribution and determinants of the disease in addition to inadequate investments in screening, diagnosis and treatment in these countries. Prevalence of human papillomavirus (HPV) infection among the general populations varies from 7-14% and the age-specific prevalence across age groups is constant with no clear peak in young women. This observation may be the result of a low clearance rate of incident infections, frequent re-infection/reactivation, limited or no data in target high-risk age groups (teenagers), and sexual behavioural patterns in the population. High-risk HPV types were found in 97% of cervical cancers, and HPV-16 and 18 were found in 80% of cancers in India. Beyond research studies, demonstration projects and provincial efforts in selected districts, there are no serious initiatives to introduce population-based screening by public health authorities in these countries. Cervical cancer is a relatively neglected disease in terms of advocacy, screening and prevention from professional or public health organizations. Cytology, HPV testing and visual screening with acetic acid (VIA) or Lugol's iodine (VILI) are known to be accurate and effective methods to detect cervical cancer and could contribute to the reduction of disease in these countries. While HPV vaccination provides hope for the future, several barriers prohibit the introduction of prophylactic vaccines in these countries such as high costs and low public awareness of cervical cancer. Efforts to implement screening based on the research experiences in the region offer the only currently viable means of rapidly reducing the heavy burden of disease.