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Cancer Detection

The fact that early detection leads to higher chance of getting cured is well established and is also well known. But there is a great reluctance to get screened for cancer both in Urban & Rural Settings. Secondly it is presumed that screening done once is adequate.  Much like in other diseases, screening has to be done repeatedly and on a regular basis to pick up cancers early. And those with abnormal findings or with premalignant conditions have to be on a follow up at Cancer centres. Only if these steps are taken , the process is useful.

Unfortunately all these do not happen. Most people come for screening just once! Many of screened people do not come to collect their reports. This we have seen especially at Chennai where women have not bothered to collect their Pap smear reports. Thirdly our experience from the rural camps is that those with frank cancers are unwilling to take treatment even when offered free.

These factors have deterred us from holding screening camps especially in Chennai & Coimbatore Sector. In Mumbai the response is better comparatively. The Pap smear camps have drawn a large number of women and they have actually come & collected their reports.  It has been possible as our health workers are constantly contacting them over phone and in person. Secondly a small gift is being given to the women if they showed up to collect their reports.

By & large most of the screening camps have screened people only once. Even this one time screening has helped in some ways. We are happy that the fears associated with tests like Pap Smear & Mammography has been allayed.  Secondly at most camps very few or none had frank cancers among the screened individuals. This has emboldened the onlookers to enroll themselves for screening. Lastly Camps being goodwill gestures, a lot of organizations pitch in help to organize and / or sponsor these camps.

mum-chnThe first camp was held at Suriyur near Trichy on 23rd Oct 1994. This camp screened 82 women, 2 of them had frank cancer of uterine cervix and 8 of them had premalignant conditions. This was shocking! This alarmingly high incidence could have been to 4 factors seen here: Poverty, very high illiteracy, lack of potable water and lastly most of the men belonging here, were stationed at other cities to earn livelihood and the women here confessed that their husbands had multiple sexual partners.

This camp showed us in real the state of rural India with respect to cancer and urged us to more in villages. But the shift of base from Trichy to Coimbatore stalled further camps for the next 3 years. We got reactivated in March “97 with a camp at Muthalamadai , a village in Kerala close to Tamil Nadu Border.

For the next 3 years screening camps was on top of our minds and we had detection camps in several villages around Coimbatore. Of these the one at Melkaraipatti , near Palani, drew the largest number , 400 persons were screened on a single day. The camp in Komarlingam village in Udumalpet found a large numbers of persons with Frank cancer, 16 cases and all of them tobacco related , while in a village near Sathyamangalam ,the number of frank cancers were zero amongst the 313 people screened!

The First camp at Anamalai , near Pollachi , had very good response both in terms of numbers & interest. It seemed possible that Camps could be held here on a regular basis. Association for India’s Development consented to support the camps after seeing the this camp and sent in 3000 dollars for cancer screening to us.
We took up 3 villages with this support and planned to conduct detection camps every 3 months for the next 3 years. The first camps like the one in Anamalai, generated a good response, second a mild response & by the 3rd camp the villages lost interest. Secondly patients with frank cancers refused treatment even if we offered it free ! Thereafter the fund was used for the one off camps in the villages.

Over the years we have reduced camps to bare minimum and in Chennai they are held only on anniversaries. It is only this year, Aug 2016, the women actually came to collect their Pap smear reports. We are happy to the see this change and this may encourage to hold camps more frequently.

coimbatur-chennai-city    m-c-sector

ayiramAayiram in Tamil means a thousand and we envisaged to sponsor Mammograms in 1000 women from October 2012 to September 2013.  Women had to attend a session on Breast cancer awareness and learn breast self exam. After that women above 40 yrs were offered a free Mammogram. In the first month there was a good response but by the February of 2013 the number of women seeking the facility was near zero. Campaign was then taken up on a war footing beginning with the International women ‘s day.  Nearly 40,000 women were contacted but the turnout remained poor. In late April the campaign by Mrs. Uma Babusekar was the turning point .In groups of twenties & thirties women attended the classes and availed the facility.

In one year’s time 713 women were offered free mammograms of which it is sad that only 563 actually underwent mammography. This means 1 out of every 5 women chose to not to undergo the mammogram even though it was offered Free!

Of the 563 mammograms done, about 16 of them had abnormal findings. Six women required FNAC.  Three required Trucut biopsy.  2 of these turned out to be very early Breast cancer (DCIS) . These women underwent selective removal of the tumour and in one of them the remnant breast tissue did not reveal any disease. In effect one woman among the asymptomatic 563 was found to have breast cancer; it was in very early stage and she got cured with selective removal and nothing else.

Though the world today only advocates Breast consciousness, it is very useful to get one baseline mammogram done at 40yrs. Knowledge about breast cancer creates this ‘consciousness” which we successfully created but the latter couldn’t be accomplished successfully. The fear & perception about mammogram still persists.

mumbai-sectorThe first camp was held in April 2000 in Kalina where our office was situated then. It was in association with an organization that was welcoming the Shankaracharya of Kanchi. 35 men & 47 women were screened . A second camp was held at the venue 3 months later. Soon we got calls from several groups & organization to hold camps and in next few years this activity gained steam.

We got introduced to Western Railways and a series of camps were held at heir hospital in Bandra to screen women for cervix cancers. That was a sort of turning point for us, the screening camps got us more & more focused on women. Navi Mumbai Municipal Corporation roped us to conduct Pap smear camps in all their health centres.  After our awareness talks to the workers at Construction companies, the employers wanted us to conduct oral cancer detection camps. Thus the camps in the recent past have mainly been Pap smear camps or Oral cancer detection ones.

Since the time our own centre opened in 2011 and even before that  at the spaces provided to us , screening camps were held regularly. From September 2013 it is regular feature at the Centre, on Wednesdays & Fridays, Pap smear camps are held and on Sunday oral cancer detection is done.

The response to camps has been good at Mumbai and has encouraged us hold more and more. It has also taken us beyond Mumbai to Nashik , Dahanu & Belagavi , to name a few. Gynecologists have been particularly cooperative & so are the dental surgeons, they readily accept our invitation and spend quality time at our camps .Similarly our volunteers &paramedical staff show great enthusiasm and conduct camps smoothly & efficiently.

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The majority of camps done in and around Mumbai are for women. While both Breast examination & Pap smears are done, the latter takes predominance.  These camps were held at several venues and at times at the same venue many times.

The first such place was the Railway hospital at Bandra, where a series of camps were held in July & Aug 2004. The second place was the L& T Health Centre. 233 women were screened over 8 camps. Similarly a number of camps were held at Pragati Kendra, Godrej Colony, Vikhroli, Mumbai. Hospitals like Mukund hospital at Andheri called us several times and so did the residents of Jagdusha nagar . At the Municpal Hospital at Jogeshwari Pap Smear camps held for 3 weeks in row screening 15 women each time. But it is the Municipal Corporation of Navi Mumbai who did it in big fashion.

tabWhen we started this project there was great apprehension whether ladies would turn up for the camp, but at each post, the health workers posted there had gathered a healthy number. The women here weren’t aware of cancer screening though this place was merely a hour & half’s drive from Powai.  And carrying out detection such deprived women was gratifying.

The first camp was at karave on 9th March, 15 ladies had come and the response was similar in the next 4 camps. Dr. Vidya Kshirsagar, the Doctor incharge of these centres then made a personal visit and motivated the workers and the response improved. So much so at Mahape post we had to make a second visit. It was felt that including doctors practicing in the area would be good as many ladies needed follow ups. Half way through we included local practitioners in the screening

In 17 days we had screened 578 ladies and 423 of them underwent the Pap Smear test. This makes an average of 25 women per camp which is quite good.  The second stint was from 11th to 31st Dec 2009. During this period 228 women were screened over 7 camps and 168 Pap smears were taken.  We hope such drives are continued by this municipal corporation and other municipalities also join in.

The Women cancer clinic came into being on 25th September 2013 and screening camp was held once a week on Wednesdays. This camp was later added on Fridays too to benefit women who missed out on the Wednesday camp.

A lot of home work is done before the camps are actually held. Our health workers go on a house to house campaign in Vikhroli and also conduct awareness programs in the locality. Women are explained the importance of Pap smear and the availability of this free facility at our centre.

Once the women collect for the camp, a volunteer educates them on cancers with a power point presentation. Registration & relevant history is filled up in forms and then the Gynecologist take Pap smear and colposcopy is also done.  A fortnight later they are called & given their reports and those with abnormal findings are referred to Preventive oncology department of Tata Memorial Hospital.

Month camps Screened
13-Sep 1 12
13-Oct 4 57
13-Nov 4 40
13-Dec 4 60
14-Jan 4 29
14-Feb 3 29
14-Mar 4 60
14-Apr 5 69
14-May 4 30
14-Jun 4 49
14-Jul 5 98
14-Aug 4 85
14-Sep 4 86
14-Oct 3 37
14-Nov 7 93
14-Dec 7 80
15-Jan 8 108
15-Feb 7 44
15-Mar 7 74
Total 89 1140

In the period from Sept 2013 to March 2015 , 1140 women were screened in 89 camps .  Of these 80 women had abnormalities and 18 of them needed advanced colposcopies and 3 of them required cervical biopsy. 232 women did not bother to collect their reports despite several reminders. This was very sad and defeated the very purpose of conducting this screening. In a measure to overcome this, from Jan 2015 we started giving gifts to all women who came to collect their report. In the next few months the difference was obvious.

The success of our camps encouraged us to do it in a bigger fashion and an appeal was sent to Association for India‘s development (AID). Dr.Ravi kuchimanchi , the founder of the organization and representatives from Chicago chapter visited the centre and sanctioned a sponsorship for 960 women over one year’s time

The AID supported project took off on 3rd June 2015 and was completed on 27th Feb 2016. In this period of 9 months, 1000 women were screened for cervical cancer.  88 women had local infection 73 women needed detailed colposcopy and there were 2 ladies with frank cancers.  Both these women were sent to Tata Memorial Hospital and treatment has already begun. Of the 73women advised colposcopy , 14 have got it done and are on follow up , the remaining have been constantly reminded . From March to September 2016 another 198 women have been screened over 24 camps.

Month women screened Colposcopy   Advised Frank cases Treat&Repeat Smear
         
JUNE 147 6 0 14
JULY 176 9 0 12
AUG. 167 10 0 16
SEPT 108 6 0 4
OCT 70 5 0 6
NOV 34 5 0 8
DEC 51 11 0 5
JAN 125 12 2 15
FEB 122 9 0 8
 Total 1000 73 2 88

We are happy we competed 3 months in advance & also recruited 40 additional women. These camps also brought in other benefits. Firstly it kept the centre abuzz with activity. The pressure to reach a specific number in a specified amount time pushed us deeper into the community. More awareness programs & camps came into being. And lastly the efficient conduct of the camps roped in more volunteers and even donors. Overall it was a satisfying experience conducting these camps and we hope it attracts continued sponsorship & patronage.

oral-cancer-campThe awareness campaign in construction companies brought in added benefits. It resulted in detection camps for oral cancers. Marathon Realty & Wadhwa Constructions permitted us hold camps at several sites of theirs. In one of sites of Wadhwa constructions 450 men were screened at one go and therein 53 men were found to white patches in their mouth, which is a premalignant condition for oral cancers. At other sites too there was a sizeable number of number who had white patches or their mouths were narrowed ( Oral sub mucous Fibrosis, Gutka is particularly notorious for causing this within 2 years of usage). These men were advised follow up with Dental practitioners & some prescribed drugs.

These camps made beginning with World No tobacco day, 31st May 2014. The proximity to BEST bus depot to our centre got the conductors & drivers to the camp and slowly men in the neighborhood too trickled in . Doctors, interns & final year students visit the centre on alternate Sundays and on rest of the days dental surgeons practicing nearby pitch in help.

58 camps have been held so far screening 1099 persons. 5 men were found to have frank cancers & they were referred to TATA Memorial hospital or to their hospital of choice. 108 men were found to have premalignant conditions and they have been advised to quit smoking and take treatment. 11 men had severe narrowing of the mouth due to  Submucous fibrosis , they too have been advised similarly .Of these men 3 come to the centre for exercises to increase the size of mouth opening.

Like we said for awareness, screening camps have been the result of the coordinated efforts of several individuals, organization , medical & paramedical personnel , volunteers & donors. It has been popular in the Mumbai sector not elsewhere where the trust has its operations. It has helped in causing early detection to some extent and at the least removed the fear associated with the screening procedure. This activity needs to get bigger and has to screen the same persons year after year to be truly useful.