Cervical cancer is the fourth most common cancer in women worldwide with a large majority (around 85%) of the global burden occurring in less developed countries. There were an estimated 266,000 deaths from cervical cancer worldwide in 2012. Almost nine out of ten (87%) of these cervical cancer deaths occur in the less developed regions of the world.
The rate of invasive cervical cancer has dropped by more than 50% in developed countries over the last few decades. It is now the twelfth most common cancer in women in the UK and fourteenth in the USA. This decline in the incidence of invasive cervical cancer as well as improvement in survival can be attributed to regular screening of women with the Pap smear and the availability of a vaccine in recent years.
The situation in developing countries such as India is different. Cervical cancer is still the most common type of cancer and the leading cause of death among genital cancers in rural India. The data that is available in India is based on hospital based cancer registries - actual community data about the incidence of cervical cancer is lacking. Availability of such community level data would give an accurate idea of the magnitude of the problem.
The realization that the majority of these cancer deaths can be prevented by early diagnosis and implementing an effective screening program prompted a group of committed people to set up the Mahati trust in October 2011. We, at Mahati trust, set out on a mission. We wanted to conduct a large scale community level screening of women in the rural areas of Karnataka state in South India. This would allow us to estimate the true incidence of cancer cervix in rural Indian women and also to extend life-saving preventive and early detection services.
We have worked incessantly in the villages of rural Karnataka (Chikkaballapur District to be precise) over the past 12 years. We completed screening in 13 PHCs (Muddenahalli, Nandi, Nayanahalli, Dibbur, Peresandra, Mandikal, Hampasandra, Beecheganahalli, Ellodu, Jangamakote, Hemarlahalli, Y Mudikadalli, Y Unisanahalli,) in 3 Taluks and covered 440 villages, have conducted 461 screening camps so far, screening 28757 women, collected 20450 pap smear samples; of these, 281 women tested pap test positive and were subsequently directed to receive the appropriate treatment. Also, 36 had invasive cervical cancer. Even if 10 - 15% of the pap test women are turned positive for CA cervix, then the overall numbers will be alarmingly higher than the WHO estimates of 21.99 cases per 100000 women!
Having worked at the grassroot level, we now realize the possible magnitude of the problem. We also have an idea of the hurdles that impede provision of screening services and treatment. This makes us believe that we need to double our efforts to keep the service going.
From the inception till end of 2023 (12 years), we were systematically conducting screening programs village by village in each PHC of Chikkaballapur district and were able to only cover 13 PHCs as on December 2023. Chikkaballapur district alone has 64 PHCs overall. In order to continue and increase the coverage of screening, it’s necessary to have parallel programs and parallel teams conducting the screening programs atleast twice a week. Mahati Trust is a self-funded trust and sustainability of these programs becomes next to impossible without constant flow of funds.
The overall expenses include:
- The transportation costs to travel to these PHCs which are approx 100 kms one way from Bangalore
- Remuneration to the teams (Parallel teams to conduct screening camps simultaneously at different places)
- Medical equipment expenses (recurring and non-recurring) and management, documentation expenses.
A. A local coordinator is employed from Chikkaballapur and it is her objective to give awareness door to door in the villages with the help of the pamphlets we have created.
A. Currently the camps are weekly (4/5 camps a month). But planning to increase them to twice a week.
A. The pap smear slides are sent to Cytology department at Sri Sai Sarala Memorial Hospital, Muddenhalli. The cytologists read the pap smears and provide classification as normal and abnormal. (LSIL, HSIL, Carcenoma)
A. The women are referred to Sri Sai Sarala Memorial hospital for further evaluation and treatment at no cost.