Cancer screening: Individual decisions or Population approaches?

http://screening.iarc.fr/

R. Sankaranarayanan MD

Special Advisor on Cancer Control Head, Early Detection and Prevention Section (EDP)

Head, Screening Group (SCR)

•  Population approaches are complimentary to and facilitate individual approaches

•  They are not competitors to individual approaches!

•  Both approaches are needed!

Cancer Screening: population approaches

•  Involves population-based mass communication activities aimed at changing or maintaining people’s behaviour for the benefit of individuals and society as a whole

•  Predominantly uses “ Social marketing” principles and methods

Cancer Screening: population approaches

•  In the context of screening programmes, they aim to increase awareness, to encourage health care seeking behaviour, to empower individuals, to increase participation and to improve coverage in all aspects of screening.

•  Facilitate informed consent processes.

Cancer Screening: population approaches

•  Facilitates uniform messaging

•  Allow messages to be reviewed and revised

•  More feasible in low- and medium-resource settings

•  Intuitively cost effective and efficient

•  Offers equitable access to messaging

•  Facilitates an organized screening programme

Cancer Screening: population approaches

•  Politically more attractive and acceptable

•  Contents are uniform

•  Allows contents to be scrutinised and reviewed by range of stake holders

•  Allows contents to be revised

Cancer Screening: population approaches

•  Seeks to develop and integrate marketing concepts

•  With other approaches to influence behaviours that benefit individuals and communities

•  For the greater social good

Cancer Screening: population approaches

based on social marketing

Scaling up of breast (CBE) and cervix (VIA) screening in Tamil Nadu State, India, 2012-2013

Tamil Nadu state

Phasing of districts

Phase I (16 districts)

Phase II (16 districts)

The Nilgiris

Coimbatore

Tirunelveli

Kanniyakumari

Thoothukkudi

Ramanathapuram

Vellore

Tiruvan-namalai

Krishnagiri

Erode

Dharmapuri

Solem

Narnakkal

Karur

Thiruvallur

Kancheepuram

Viluppuram

Cuddalore

Pudukkottai Nagapattinam

Thiruvarur

Tiruchirappalli

Thanjavur

Perambular

Dindigul

Theni Madurai

Virudhunagar

Sivaganga

Karaikal

Based on the evidence from a randomized trial and lessons learnt from a pilot project, a population based screening program was introduced supported by population based awareness campaign in the entire state of Tamil Nadu, targeting 4 NCDs, namely • Cancer cervix • Cancer breast • Hypertension • Diabetes

Mellitus

IEC Hoardings – Cancer Breast

IEC Hoardings – Cancer Breast

IEC – Bus boards

Tamil Nadu: Scaling up of cervical screening (July 2012-December 2013) Target population 7

million women aged 30-59 years Number (%)

Women screened with VIA and VILI 2,249,617

VIA/VILI positive 84,545 (3.8)

Women detected with Cervical Cancer 6137 (0.3)

Women who had CBE 3,281,411

Women positive on CBE 43,195 (1.3)

•  Population approaches are complimentary to and facilitate individual approaches

•  They are not competitors to individual approaches!

•  Both approaches are needed!

Cancer Screening: population approaches