INCTR/NNCTR Screening and Prevention Program
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Program: Clinical Studies
Coordinators: Dr Surendra Bade Shrestha,
Other INCTR Participants:
Collaborators: The Australian Cervical Cancer Foundation
Branch(es): INCTR/NNCTR
Location: Single Country
Country(s): Nepal
Institutions: The Nepal Australian Cervical Cancer Foundation
Other Nepalese NGOs
Background Information: The Nepal Australian Cervical Cancer Foundation (NACCF / ACCF) is a non-profit organisation which has been working for reducing the mortality and morbidity of cervical and breast cancer in Nepali women. In 2015 the Australian Embassy Direct Aid Program (DAP) kindly accepted our project proposal entitled ‘Cervical and Breast Cancer Screening and Prevention Program’.

Among cancers in women, cervical cancer ranks as the first and breast cancer as the second affecting women of Nepal. The reason behind the high incidence rate are, a lack of awareness and education about the cancer, as well as lack of available and affordable preventative services in the country. The best method of reducing these cancers is early detection and preventive treatments.
Objectives: The project aimed to provide Cervical Cancer Screening and follow-up treatment for 2,800 healthy women aged between 30 and 60 years in Kathmandu Valley, Palpa, Rupandehi and Makawanpur Districts.

In addition, the project also provided Breast Cancer Screening of 2,800 women.

Secondary goals were to screen and treat the women for related diseases of STI Infection, prolapse of the uterus and to provide the women with cancer education.
Methods: At first, for the information of participating women, they have to fill up necessary form provided by the project. These forms will give necessary information of the women receiving cervical and breast cancer screening. The Breast Cancer orientation session details the technique of self examination. This serves to empower the women to be aware of changes in their breast in the future and provides a method of sustainable breast cancer prevention. For the practical demonstration trained nurses perform systematic methods of breast examination and women presenting with breast abnormality are referred to an appropriate hospital for specialist examination and necessary treatment.

In the camp, participating women are then directed to undergo cervical cancer screening. The visual screening methods known as VIA and VILI provide result on the spot itself of the presence of any pre-cancerous lesions. Women having STI (Sexual Transmitted Infection) Infection are provided medication. And uterus prolapse are graded. The cases of first degree prolapse are given treatment by ring pressury on the spot. Women, presenting second and third degree prolapse, needs further test and if necessary treatment by surgical methods. And those women having second and third degree prolapse are refers to appropriate hospitals. Women having positive cases are given appropriate treatment such as Cryotherapy, Thermocoagulation, and LEEP. Biopsy is also taken for those positive cases. Women having positive cases are to receive follow-up treatment free of cost in our centre at Banepa or at affiliated Hospitals.
Progress: We hope that this final report will clearly indicate the achievement of our project goals of preventing, treating and researching Cervical and Breast Cancer in Nepal. As well as forming successful relationships with organisations and communities that has similar objectives. In fact, we have exceeded our original targets of women to be screened for cervical (2,800) and breast (2,800) cancer with 2,843 and 2,843 women. Furthermore, we provided Cervical and Breast Cancer Education to more than three thousand members of the participating communities.

The program has been valuable and successful. NACCF is very pleased to help the women from various locations and feel good to give women this indispensible opportunity of Cervical and Breast Cancer Screening and Prevention services. And we hope such supports and helps will continue in the years to come.

Activities and Achievements

The NACCF/ACCF has organised full day screening camps in communities within Kathmandu Valley, Palpa, Rupandehi, and Makawanpur Districts. For the purpose of camping we formed networks between the communities in coordination with related District Health Offices, Local Hospitals, Health Posts, Village development committee
and other stakeholders. Local NGOs and community team leaders are responsible for mobilizing local adult women and inform them about the program and identifying appropriate camp sites. NACCF/ACCF has orientated the local community members by providing an education relating to cancer awareness as well as Cervical and Breast Cancer Screening practices.

We have a team of about 18 trained fields volunteer, 27 nurses, 6 doctors and 50 community volunteers.

NACCF/ACCF staff used to mobilise each district to assist the screening camp program.

Work Plan and Achievements from Sep. 2016 – April 2017

Completed organisational tasks:

a. Appointed and orientated staff
b. Surveyed target villages

Training Activities
Date (2016/2017)
Activity: Cx and breast cancer screening, technical skills
Districts:Kathmandu Valley;Palpa; Rupandehl;Makawanpur
Participants: A total of 42 nurses trainedand 63 volunteers
in 4 days between 19th Oct and 19th February
26th Aug 2016
19th Oct. 2016

Orientation and Educational Activities

Orientation and Educational Activities
(Sep. 2016- March 2017)

Community orientation; cancer education; Cervical cancer screening practices.
12 communities and 2,886 individuals participated

Breast cancer awarenesss and self examination: techniques:
2,886 individuals and 12 communities participated

Community orientation: Cancer education; Cervical cancer screening practices

12 communities and 2886 individuals participated


Breast cancer awareness and self examination techniques 2,886 individuals and 12 communities participated

Cervical and Breast Cancer Screening Camps
Activity Sep. 2016 - March 2017
Target Individuals Communities
Cervical Cancer Screening 2,800 2,843 12
Breast Cancer Screening 2,800 2,843 12

Monitoring/Evaluation and Reports

This component of the project is ongoing and will be completed before April 2017.

Social Audit/Review meeting
This component of the project is ongoing and will be completed before April 2017.

Summary of Achievements

The NACCF/ACCF was successful in providing Cervical and Breast Screening to 2,843 women between the months of Sep. 2016 to April 2017. In addition, NACCF/ACCF organised 4 groups for technical skills transfer training for doctors and nurses with specialist training in Cervical and Breast Cancer screening. This helps the field nurses working in the screening camps to gain the necessary skills for the detection practices, increasing the sensitivity and specificity of the screening technique.

63 community Volunteers received specialist training in screening practices of Cervical and Breast Cancer education as well as camp management work.

A total of 2,886 women from 12 communities participated in the NACCF/ACCF community orientation program.
Community orientation deals the importance of early detection and treatment of Cervical and Breast Cancer.

Screening camps are organised in 12 communities, in which 2,843 eligible women participated. Among them, 96 (3.37%) were found to be positive. They were given free treatment with Thermocoagulation/ Cryotherapy and medication. 1,045 (36.75%) of participating women had an STI infection. They were provided free medication on the camp day. 102 (3.58%) of women were found to have uterine prolapse and they were referred to an appropriate hospital for treatment.

2,843 women participating in the Breast cancer screening were given breast cancer education and self breast examination. Among them, 249 (8.75%) were treated by medication. Those who needed additional tests and treatment were referred to TU Teaching Hospital and BPKMC Hospital, Bharatpur for specialist follow-up treatment.

Treatment services and Follow-up tests:

For follow up test and treatment cases, the referring clinics and hospitals are, Banepa clinic, BPKMC Hospital Bharatpur, Maternity Hospital Thapathali (Kathmandu) and TU. Teaching Hospital (Kathmandu). The cost of these treatments is provided by the project. In this program the follow up services are continuing:

Observations/Findings

Number of women screened for cervical cancer: 2,843 Number of women with cervical –VIA/VILI positive: 96
Number of women with cervical infection: 1,045
Number of women presenting with uterine prolapse: 102
Number of positive cases treated for potential pre-cancerous lesions of the cervix: 96
Total number of women screened for breast cancer: 2,843
Number of women referred for medication for breast abnormality: 249

Outcomes/Impact of the Project

Cervical cancer screening program:

• 12 Cervical Screening and 108 Cervical Cancer orientation programs were held in 4 districts.
• 2,886 women attended cervical cancer orientation programs.
• 2,843 women aged 30 – 60 years received cervical cancer screening.
• 1,599 women had a normal cervix.
• 1,045 women had a cervical infection, all of whom were provided free medication.
• 102 women were found with uterine prolapse; follow-up treatment for these women is ongoing.

Follow up Tests and treatment:

• 96 women had a positive VIA/VILI and were treated by Thermocoagulation/ Cryotherapy.
• Biopsies of 6 women were taken for laboratory test from 96 for the confirmation of cancer.

Cervical pre-cancer treatment machine and other necessary equipment donations included:

A Cold Coagulation machine was donated by PHASE World Wide UK to NNCTR/ NACCF. Cold Coagulation treatment was provided for first time in Nepal for pre Cancer positive cases.

Breast cancer screening program:

• 12 Breast Cancer screening and 108 Breast Cancer orientation programs were held in all 4 districts
• A total of 2,886 women benefited from cancer orientation programs.
• A total of 2,843 women aged 30 – 60 years received breast cancer screening
• A total of 249 of these women were found with breast abnormalities on clinical test.
• Follow-up treatment for these women is on-going.
Training
• 42 nurses were trained to perform VIA/VILI screening.
• 43 Community Volunteers were trained to assist with screening camps.
• 16 nurses were trained to perform clinical breast examinations and to provide education on self - breast examination.

Remarks

The NACCF /ACCF has successfully accomplished the program on Cervical and Breast Cancer Screening and Prevention in four districts of Nepal in collaboration with six local NGOs. It has achieved its goal to screen 2,800 healthy women aged between 30-60 years. This year a NACCF/ACCF team has organized a camp at Rayapur Primary Health Post Amuwa-a, Rupandehi. Rupandehi DHO has given special importance to this site. The site is near Bhairahawa Municipality. Most of the women were illiterate there. They are ignorant about infrastructure or facilities that could enable development. They are totally dependent upon their husbands. The camp was a new thing for the women of Amuwa. For the development of these women, the camp on Cervical and Breast Cancer Screening is very important. Women had difficulty in learning about cervical and breast cancer. However, they readily participated in the camp. We have screened 283 women. Among them 7(2.47%) women had abnormal findings. These included: 87(30.74%) with STI and 21(7.42%) with uterine prolapse. 67(590.1%) had a normal cervix. In comparison with other three districts, Rupandehi has the highest incidence of positive findings with 32.29 %, STI infection 35.88% and uterine prolapse 41.17%.

Orientation programs were held in all districts with the help of local volunteers and the co-organiser's team of related district. The awareness program on Cervical and Breast Cancer Screening was disseminated on to local people through orientation program, pamphlets, local FM radio and field visits of local volunteers in the area. The flow of women for Cervical and Breast Cancer Screening was remarkable.

External relationships

We formed good relationships with community groups enabling us to successfully organise and facilitate the cancer screening camps in all four districts.
Future Plans: It is important to continue the activities described here - there are clearly many women in need and non-cancerous lesions are frequent. This initial phase has shown what can be achieved - even the poorest women were willing to go to the camps - in many cases, doubtless, due to symptoms. Of the total of 2,848 women screened by visual inspection of the cervix 96 had CIN lesions. for which they were treated. Almost half of the 2,848 (1,045) had overt infection of the uterine cervix and 102 had symptomatic uterine prolapse. Although 249 of these women had breast abnormalities, the types of abnormalities are not described.

The training of medical and nursing staff and other health oriented personnel has strengthened the ability of 4 districts to screening for cervical cancer and these trained
Duration: 10/2016-02/2017
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Year: 2017
Last Update: 02/2017
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