A community health worker-led, population-based cancer education and screening strategy in a high-burden, resource-constrained setting in India: A retrospective cohort study

Background: The uptake of screening for three common cancers at the population level remains very low despite the implementation of nationwide screening for noncommunicable diseases in India. Objectives: The primary objective was to assess the cancer care cascade of a community health worker (CHW)-led population-based cancer education and screening strategy (PBES for oral, cervical, breast, and other cancers) in Assam, India, under a programmatic setting. The secondary objective was to identify the factors associated with the cancer care cascade of this initiative. Materials and Methods: In this cohort study, trained CHWs delivered PBES to all individuals aged ≥30 years during household visits. Symptom-positive individuals were referred to the health subcenter (HSC) for cancer screening by trained staff supervised by a medical officer. Individuals suspected of having cancer were referred from HSC to the tertiary cancer center (TCC) for diagnosis and treatment initiation. Results: Of the 48,233 individuals assessed, 24,915 (51.7%) were female, 33,287 (69.0%) were aged <50 years and 4,466 (9.3%) had at least one cancer-related symptom. Oral, cervical, breast, and other cancer site-related symptoms were observed in 2,790 (5.8%), 864 (3.5%), 151 (0.6%), and 953 (2.0%) individuals, respectively. A total of 96 individuals were diagnosed with cancer. The median durations between PBES and cancer diagnosis, and between diagnosis and treatment initiation, were 47 days and 56 days, respectively. Conclusion: The CHW-led PBES strategy is feasible in resource-limited settings. Future interventions must address dropouts and delays at the HSC and TCC levels.