{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:20:38Z","timestamp":1791235238770,"version":"4.1.0"},"reference-count":55,"publisher":"BMJ","issue":"Suppl 1","license":[{"start":{"date-parts":[[2023,12,17]],"date-time":"2023-12-17T00:00:00Z","timestamp":1702771200000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Despite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for oral, breast and cervical cancer prevention in a rural community at the primary care level of Northern India and its policy implications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This was a camp-based project conducted for 1\u2009year, using oral visual examination, clinical breast examination and visual inspection of cervix by application of 5% acetic acid according to primary healthcare operational guidelines. During the project, screen-positive participants were followed through reverse navigation. Information about socio-demographic profile, clinical and behavioural history and screening were collected. Predictors for screen-positivity and follow-up compliance were identified through multivariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>Based on the aim of project, one of the remotely located and low socioeconomic rural blocks, having 148 villages (estimated population of 254 285) in Varanasi district, India was selected as the service site. There is an established healthcare delivery and referral system as per the National Health Mission of Government of India. Oral, breast, gallbladder and cervical cancers are the leading cancers in the district.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>We invited all men and women aged 30\u201365 years residing in the selected block for the last 6 months for the screening camps. Unmarried women, women with active vaginal bleeding, those currently pregnant and those who have undergone hysterectomy were excluded from cervical cancer screening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 14\u2009338 participants were screened through 190 camps and the majority (61.9%) were women. Hindu religion, tobacco use, intention to quit tobacco and presence of symptoms were significantly associated with screen-positivity. Nearly one-third (220; 30.1%) of the screened-positives complied with follow-up. Young age and illiteracy were significantly associated with lower compliance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Poor follow-up compliance, despite the availability of tertiary cancer care, patient navigation, free transportation and diagnostic services, calls for research to explore the role of contextual factors and develop pragmatic interventions to justify \u2018close the care gap\u2019. Community cancer screening needs strengthening through cancer awareness, establishing referral system and integration with the National Tobacco Control and Cancer Registry Programmes.<\/jats:p><\/jats:sec>","DOI":"10.1136\/fmch-2023-002397","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T03:15:12Z","timestamp":1702869312000},"page":"e002397","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention"],"prefix":"10.1136","volume":"11","author":[{"given":"Priyanka","family":"Sharma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-8059","authenticated-orcid":false,"given":"Divya","family":"Khanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyajit","family":"Pradhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Birur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,17]]},"reference":[{"key":"2023121719150596000_11.Suppl_1.e002397.1","unstructured":"World Health Organization . Cancer. Geneva, Switzerland World Health Organization; 2023. Available: https:\/\/www.who.int\/health-topics\/cancer#tab=tab_1 [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.2","unstructured":"International Agency for Research on Cancer . Cancer today. GLOBOCAN 2020. Geneva, Switzerland World Health Organization; 2020. Available: https:\/\/gco.iarc.fr\/today\/home [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.3","doi-asserted-by":"crossref","first-page":"598","DOI":"10.4103\/ijmr.ijmr_1821_22","article-title":"Cancer incidence estimates for 2022 & projection for 2025: result from National cancer registry programme, India","volume":"156","author":"Sathish Kumar","year":"2022","journal-title":"Indian J Med Res"},{"key":"2023121719150596000_11.Suppl_1.e002397.4","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1002\/ijc.33712","article-title":"Outcome of the randomized control screening trials on oral, cervix and breast cancer from India and way forward in COVID\u201019 pandemic situation","volume":"149","author":"Budukh","year":"2021","journal-title":"Int J Cancer"},{"key":"2023121719150596000_11.Suppl_1.e002397.5","unstructured":"Ministry of Health and Family Welfare, Government of India . Prevention, screening and control of non-communicable disease: hypertension, diabetes and common cancers (oral, breast, cervix) (part of comprehensive primary health care). 2016. Available: https:\/\/dghs.gov.in\/WriteReadData\/userfiles\/file\/Publication\/Operational%20Guidelines%20on%20Prevention,%20Screening%20and%20Control%20of%20Common%20NCDs_1.pdf [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.6","unstructured":"International Institute for Population Sciences (IIPS) and ICF . 2021 National family health survey-5 [Ministry of Health and Family Welfare, Government of India]. 2019\u201321. Available: http:\/\/rchiips.org\/nfhs\/factsheet_NFHS-5.shtml#:~:text=National%20Family%20Health%20Survey%20(NFHS,policies%20and%20programmes%20.%20.%20.%20 [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.7","doi-asserted-by":"crossref","unstructured":"Datta SS , Ghose S , Ghosh M , et al . Journeys: understanding access, affordability and disruptions to cancer care in India. Ecancermedicalscience 2022;16:1342. doi:10.3332\/ecancer.2022.1342","DOI":"10.3332\/ecancer.2022.1342"},{"key":"2023121719150596000_11.Suppl_1.e002397.8","unstructured":"World Health Organization . Comprehensive cervical cancer control. A guide to essential practice. Second ed. WHO press. World Health Organization Geneva, Switzerland, Available: https:\/\/www.who.int\/publications\/i\/item\/9789241548953 [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.9","unstructured":"Ministry of Health and Family Welfare, Government of India . Community based assessment checklist (CBAC) form for early detection of NCDs, tuberculosis (TB) and leprosy [Ministry of Health and Family Welfare, Government of India]. Available: https:\/\/dghs.gov.in\/WriteReadData\/userfiles\/file\/Leprosy\/LOCAL_REF_4964_1611895745717.pdf [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.10","unstructured":"Ministry of Health and Family Welfare . Not dated. National programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke. Module for ASHA on non-communicable diseases. Available: https:\/\/main.mohfw.gov.in\/sites\/default\/files\/Module%20for%20ASHA%20on%20Non-communicable%20Diseases_1.pdf [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.11","doi-asserted-by":"crossref","first-page":"3667","DOI":"10.4103\/jfmpc.jfmpc_2281_21","article-title":"Assessment of national program for prevention and control of cancer, diabetes, CVD and stroke (NPCDCS): an observational study in rural Jaipur, Rajasthan","volume":"11","author":"Meena","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"2023121719150596000_11.Suppl_1.e002397.12","unstructured":"National Academies of Sciences, Engineering, and Medicine . National cancer policy forum; board on health care services; Institute of medicine. Cancer care in low-resource areas: cancer prevention and early detection: workshop summary. Washington (DC) National Academies Press (US); 2016. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK395952\/ [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.13","doi-asserted-by":"crossref","first-page":"4041","DOI":"10.1002\/cncr.34486","article-title":"Cervical cancer elimination in Indian context: moving from barriers to facilitators","volume":"128","author":"Vikraman","year":"2022","journal-title":"Cancer"},{"key":"2023121719150596000_11.Suppl_1.e002397.14","doi-asserted-by":"crossref","unstructured":"Budukh AM , Pradhan S , Singh VB , et al . Cancer pattern in Varanasi district from Uttar Pradesh state of India, a foundation for cancer control based on the first report of the population-based cancer registry. Indian J Cancer 2023. doi:10.4103\/ijc.IJC_44_21","DOI":"10.4103\/ijc.IJC_44_21"},{"key":"2023121719150596000_11.Suppl_1.e002397.15","unstructured":"World Health Organization . International agency for research in cancer. Cancer screening at IARC. 2023. Available: https:\/\/screening.iarc.fr [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.16","doi-asserted-by":"crossref","unstructured":"Ribeiro AS , Salles PR , da Silva TA , et al . A review of the nonsurgical treatment of oral leukoplakia. Int J Dent 2010;2010:186018. doi:10.1155\/2010\/186018","DOI":"10.1155\/2010\/186018"},{"key":"2023121719150596000_11.Suppl_1.e002397.17","unstructured":"World Health Organization . WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. Geneva, Switzerland World Health Organization; 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240030824 [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.18","unstructured":"Tata Memorial Center, National Cancer Grid (NCG) of India . Consensus evidence based resource stratified guidelines on secondary prevention of cervical, breast & oral cancers. NCG working group. 2019. Available: https:\/\/tmc.gov.in\/ncg\/docs\/PDF\/DraftGuidelines\/Preventive\/3_%20NCG_INDIA_Rev_Preventive%20Oncology_Primary_Care.pdf [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.19","doi-asserted-by":"crossref","first-page":"442","DOI":"10.4103\/ijc.IJC_128_21","article-title":"Consensus guidelines on management of oral potentially malignant disorders","volume":"59","author":"Birur","year":"2022","journal-title":"Indian J Cancer"},{"key":"2023121719150596000_11.Suppl_1.e002397.20","unstructured":"World Health Organization . Improving data for decision-making: a toolkit for cervical cancer prevention and control programmes. Geneva, Switzerland World Health Organization; 2018. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/279420 [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.21","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.31557\/APJCP.2021.22.5.1393","article-title":"Community-based mobile cervical cancer screening program in rural India: successes and challenges for implementation","volume":"22","author":"Srinivas","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"2023121719150596000_11.Suppl_1.e002397.22","doi-asserted-by":"crossref","first-page":"28","DOI":"10.2991\/jegh.k.191111.001","article-title":"Cervical cancer care continuum in South India: evidence from a community-based screening program","volume":"10","author":"Vidhubala","year":"2020","journal-title":"J Epidemiol Glob Health"},{"key":"2023121719150596000_11.Suppl_1.e002397.23","doi-asserted-by":"crossref","unstructured":"Shruti T , Khanna D , Khan A , et al . Status and determinants of early detection of oral premalignant and malignant lesions in India. Cancer Control 2023;30:10732748231159556. doi:10.1177\/10732748231159556","DOI":"10.1177\/10732748231159556"},{"key":"2023121719150596000_11.Suppl_1.e002397.24","doi-asserted-by":"crossref","first-page":"318","DOI":"10.4103\/0973-1482.187279","article-title":"Awareness of Cervical cancer and willingness to participate in screening program: public health policy implications","volume":"13","author":"Patra","year":"2017","journal-title":"J Can Res Ther"},{"key":"2023121719150596000_11.Suppl_1.e002397.25","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.031195"},{"key":"2023121719150596000_11.Suppl_1.e002397.26","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0020-7292(00)00224-1","article-title":"Women and reproductive health in a graying world","volume":"70","author":"Senanayake","year":"2000","journal-title":"Intl J Gynecology & Obste"},{"key":"2023121719150596000_11.Suppl_1.e002397.27","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/jgs.15198","article-title":"Women\u2019s sexual health and aging","volume":"66","author":"Granville","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"2023121719150596000_11.Suppl_1.e002397.28","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.amepre.2017.02.024","article-title":"Cervical cancer screening and incidence by age: unmet needs near and after the stopping age for screening","volume":"53","author":"White","year":"2017","journal-title":"Am J Prev Med"},{"key":"2023121719150596000_11.Suppl_1.e002397.29","doi-asserted-by":"crossref","first-page":"308","DOI":"10.4103\/apjon.apjon_73_18","article-title":"Risk factors of cervical cancer: a case-control study","volume":"6","author":"Kashyap","year":"2019","journal-title":"Asia Pac J Oncol Nurs"},{"key":"2023121719150596000_11.Suppl_1.e002397.30","unstructured":"ICO\/IARC information centre on HPV and cancer [Human Papillomavirus and Related Cancers, India Fact Sheet]. 2023. Available: https:\/\/hpvcentre.net\/statistics\/reports\/IND_FS.pdf"},{"key":"2023121719150596000_11.Suppl_1.e002397.31","doi-asserted-by":"crossref","first-page":"278","DOI":"10.4103\/0971-5851.195751","article-title":"Burden of cervical cancer and role of screening in India","volume":"37","author":"Bobdey","year":"2016","journal-title":"Indian J Med Paediatr Oncol"},{"key":"2023121719150596000_11.Suppl_1.e002397.32","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_5_171ndianJMedRes_2018_148_6_687_252161"},{"key":"2023121719150596000_11.Suppl_1.e002397.33","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X681757"},{"key":"2023121719150596000_11.Suppl_1.e002397.34","unstructured":"Ministry of Petroleum and Natural Gas . Pradhan Mantri Ujjwala Yojana 2.0. Government of India. 2021. Available: https:\/\/www.pmuy.gov.in\/about.html [Accessed 21 Mar 2023]."},{"key":"2023121719150596000_11.Suppl_1.e002397.35","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4103\/ijcm.IJCM_536_20","article-title":"Compliance for community-based cervical cancer screening program among women of age 30\u201365 years residing in low socioeconomic settings of Mumbai, India","volume":"47","author":"Kulkarni","year":"2022","journal-title":"Indian J Community Med"},{"key":"2023121719150596000_11.Suppl_1.e002397.36","doi-asserted-by":"crossref","unstructured":"Mittra I , Mishra GA , Dikshit RP , et al . Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: prospective, cluster randomised controlled trial in Mumbai. BMJ 2021;372:n256. doi:10.1136\/bmj.n256","DOI":"10.1136\/bmj.n256"},{"key":"2023121719150596000_11.Suppl_1.e002397.37","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66658-5"},{"key":"2023121719150596000_11.Suppl_1.e002397.38","doi-asserted-by":"crossref","unstructured":"Shastri SS , Mittra I , Mishra GA , et al . Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014;106:dju009. doi:10.1093\/jnci\/dju009","DOI":"10.1093\/jnci\/dju009"},{"key":"2023121719150596000_11.Suppl_1.e002397.39","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/jog.14162","article-title":"Experience of a \u2018screen and treat\u2019 program for secondary prevention of cervical cancer in Uttar Pradesh","volume":"46","author":"Shikha","year":"2020","journal-title":"J Obstet Gynaecol Res"},{"key":"2023121719150596000_11.Suppl_1.e002397.40","doi-asserted-by":"crossref","first-page":"3703","DOI":"10.31557\/APJCP.2019.20.12.3703","article-title":"Call for systematic population-based cervical cancer screening: findings from community-based screening camps in Tamil Nadu, India","volume":"20","author":"Vidhubala","year":"2019","journal-title":"Asian Pac J Cancer Prev"},{"key":"2023121719150596000_11.Suppl_1.e002397.41","doi-asserted-by":"crossref","first-page":"413","DOI":"10.31557\/APJCP.2021.22.2.413","article-title":"Mobile screening unit (MSU) for the implementation of the 'screen and treat' programme for cervical cancer prevention in Pune, India","volume":"22","author":"Joshi","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"2023121719150596000_11.Suppl_1.e002397.42","doi-asserted-by":"crossref","unstructured":"Kumar A , Tiwari A , Gadiyar A , et al . Assessment of readiness to quit tobacco among patients with oral potentially malignant disorders using transtheoretical model. J Educ Health Promot 2018;7:9. doi:10.4103\/jehp.jehp_75_17","DOI":"10.4103\/jehp.jehp_75_17"},{"key":"2023121719150596000_11.Suppl_1.e002397.43","first-page":"547","article-title":"Tobacco cessation: are oral cancer patients ready for it","volume":"40","author":"Sujatha","year":"2019","journal-title":"IJMPO"},{"key":"2023121719150596000_11.Suppl_1.e002397.44","doi-asserted-by":"crossref","first-page":"OR5","DOI":"10.26440\/IHRJ\/0504.07440","article-title":"Tobacco habits, oral mucosal lesions and counselling provided to support staff of educational institutions situated in greater Noida, Uttar Pradesh, India: a cross-sectional study","volume":"5","author":"Nagar","year":"2021","journal-title":"IHRJ"},{"key":"2023121719150596000_11.Suppl_1.e002397.45","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2003.007153"},{"key":"2023121719150596000_11.Suppl_1.e002397.46","doi-asserted-by":"publisher","DOI":"10.2147\/OAJC.S135439"},{"key":"2023121719150596000_11.Suppl_1.e002397.47","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/0973-1482.73369","article-title":"Cancer care in the rural areas of India: a firsthand experience of a clinical oncologist and review of literatures","volume":"6","author":"Das","year":"2010","journal-title":"J Cancer Res Ther"},{"key":"2023121719150596000_11.Suppl_1.e002397.48","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.31557\/APJCP.2020.21.6.1673","article-title":"Diagnostic delay for head and neck cancer in South India: a mixed-methods study","volume":"21","author":"Ganesan","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"2023121719150596000_11.Suppl_1.e002397.49","doi-asserted-by":"publisher","DOI":"10.4103\/ijc.IJC_232_18"},{"key":"2023121719150596000_11.Suppl_1.e002397.50","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(18)30003-2"},{"key":"2023121719150596000_11.Suppl_1.e002397.51","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.4103\/2141-9248.121227","article-title":"Reasons for non-compliance of patients to attend referral hospital after screening for oral pre-cancer lesions through camp approach in rural population of India","volume":"3","author":"Singh","year":"2013","journal-title":"Ann Med Health Sci Res"},{"key":"2023121719150596000_11.Suppl_1.e002397.52","doi-asserted-by":"crossref","unstructured":"Bhatt S , Isaac R , Finkel M , et al . Mobile technology and cancer screening: lessons from rural India. J Glob Health 2018;8:020421. doi:10.7189\/jogh.08.020421","DOI":"10.7189\/jogh.08.020421"},{"key":"2023121719150596000_11.Suppl_1.e002397.53","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/0971-5851.158848","article-title":"Delivery of cancer care in rural India: experiences of establishing a rural comprehensive cancer care facility","volume":"36","author":"Banavali","year":"2015","journal-title":"Indian J Med Paediatr Oncol"},{"key":"2023121719150596000_11.Suppl_1.e002397.54","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.31557\/APJCP.2020.21.9.2569","article-title":"Opportunities and barriers to breast cancer screening in a rural community in Coastal Karnataka, India: a qualitative analysis","volume":"21","author":"Kathrikolly","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"2023121719150596000_11.Suppl_1.e002397.55","doi-asserted-by":"crossref","first-page":"4052","DOI":"10.1002\/cncr.34488","article-title":"Overcoming disparities to improve cancer care: the story of cervical cancer","volume":"128","author":"Duska","year":"2022","journal-title":"Cancer"}],"container-title":["Family Medicine and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/fmch-2023-002397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T06:02:44Z","timestamp":1730872964000},"score":1,"resource":{"primary":{"URL":"https:\/\/fmch.bmj.com\/lookup\/doi\/10.1136\/fmch-2023-002397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":55,"journal-issue":{"issue":"Suppl 1","published-online":{"date-parts":[[2023,12,17]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/fmch-2023-002397"],"URL":"https:\/\/doi.org\/10.1136\/fmch-2023-002397","relation":{},"ISSN":["2305-6983","2009-8774"],"issn-type":[{"value":"2305-6983","type":"print"},{"value":"2009-8774","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}