Panel issues advice on early detection of oral, breast, and cervical cancers in IndiaBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3807 (Published 13 July 2015) Cite this as: BMJ 2015;351:h3807
Cancer experts in India have collaborated with colleagues in the United States to develop recommendations for the screening and early detection of oral, breast, and cervical cancers—the three most common cancers in India.
The Institute for Cytology and Preventive Oncology in Uttar Pradesh and the US National Cancer Institute Center for Global Health in Maryland convened an expert panel including clinicians, researchers, policy makers, and public health professionals and published their evidence based recommendations in the Lancet Oncology.1
For cervical cancer, the panel said that testing for DNA from human papilloma virus (HPV) was the most sensitive and reproducible primary screening method, even in a limited resource setting such as India. Better community awareness could encourage women to collect their own vaginal samples for DNA testing, while also reducing the labour resources needed, the panel said. Women who were positive for HPV DNA could be triaged using high quality cytological tests, if available, before a colposcopy was required.
Until DNA tests were introduced, national screening programmes in India would continue to use visual inspection with acetic acid, the panel said, emphasising the importance of following the World Health Organization guidelines to ensure the quality of these programmes. HPV testing, if affordable, was recommended for women over 30 and visual inspection with acetic acid for those between 30 and 49. Opportunistic screening of eligible women at healthcare centres would also improve awareness.
For oral cancers, the panel recommended a combination of counselling to reduce alcohol and tobacco use and oral visual examination by auxiliary health workers as the primary screening strategy. Health workers could be trained using the manuals and atlases developed by Thiruvananthapuram’s Regional Cancer Center and WHO’s International Agency for Cancer Research. Screening should particularly be offered to those who use alcohol, tobacco, or betel (areca) nut. Screening should be conducted every three years and targeted towards those aged between 30 and 60. Opportunistic screening could be carried out at select outreach clinics that serve remote populations. Trained clinicians could collect punch biopsies under local anaesthesia to link the screening programme and diagnosis. The panel also recommended that policies to control tobacco and alcohol be put in place.
For breast cancer, the panel said that early detection should be a public health priority but must be done cautiously to avoid false positive diagnoses. There should be better access to core needle biopsy and fine needle aspiration to improve diagnosis and treatment. Women between 40 and 60 should undergo early detection screening at least once every three years. Better awareness should be promoted from the age of 30, but there should also be better access to diagnostic tests and appropriate treatment, said the panel. Clinical breast examinations and cervical cancer screening could be integrated.
Preetha Rajaraman, of the US National Cancer Institute, said it was important that Indian policy makers implemented targeted early detection and screening programmes. She told The BMJ that it was essential to increase public awareness and highlight the issue of unnecessary deaths due to delayed detection and treatment of cancer. Strategic investment by the government in healthcare systems geared at building early detection programmes was cost effective and saved lives, she added.
Cite this as: BMJ 2015;351:h3807
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