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Breast cancer (BC) remains a global health challenge, devastatingly impacting women's lives. Low‐and‐middle‐income countries (LMIC), such as India, experience a concerning upward trend in BC incidence, necessitating the implementation of cost‐effective screening methods. While mammography, ultrasonography, and magnetic resonance imaging are preferred screening modalities in resource‐rich settings, limited resources in LMICs make clinical breast examination (CBE) the method of choice. This review explores the merits of CBE, its coverage, barriers, and facilitators in the Indian context for developing strategies in resource‐constrained settings. CBE has shown significant down‐staging and cost‐effectiveness. Performed by trained health workers in minutes, CBE offers an opportunity for education about BC. Various individual and health system barriers, such as stigma, financial constraints, and the absence of opportunistic screening hinder CBE coverage. Promising facilitators include awareness programs, capacity building, and integrating CBE through universal health care. No healthcare provider must miss any screening opportunity through CBE. [ABSTRACT FROM AUTHOR]

The Government of India (GOI) has launched a nationwide cervical, breast and oral cancer prevention and control program. However, the fifth round of the National Family Health Survey (NFHS-5), a nationwide survey conducted by the Ministry of Health and Family Welfare (MoHFW), GOI, has shown concerning results on screening uptake by both men and women across India. This study was conducted to describe the uptake of cancer screening by women residing in Uttar Pradesh (UP), the largest state of India. We analyzed NFHS-5 data available in public domain to determine the number of women (aged 30-49 years) participating in cancer screening across the 71 districts in UP state. We utilized population projections for the year 2021 provided by the population projections for India and states for calculating the number of women. The district-wise estimation was done using a projection of district-level annual population. Although the GOI has made screening available for common cancers, NFHS-5 results indicated that the screening uptake among women aged 30-49 years is a cause for concern. The data revealed less than 1% of women underwent screening, and some of the districts showed no screening uptake. GOI has laid down a framework for cancer screening; however, poor participation among women calls for research to understand the barriers to cancer screening and to develop interventions to address these barriers. [ABSTRACT FROM AUTHOR]

The data suggest that of the total population of 186 015 000 women aged 30 to 49 years, only 3 534 285 (1.9%) women reported to uptake cervix cancer screening test whereas 1 674 135 (0.9%) women reported taking screening test for breast and oral cancers. Several center and state government-funded health schemes are available that assist patients in avoiding financial hardship.3-5 The data on screening uptake for cervix, breast and oral cancers are given for the first time in NFHS-5 series. [Extracted from the article]

Abstract Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes — either organized or opportunistic — have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and... [ABSTRACT FROM AUTHOR]

Globally, cervical cancer is the fourth most common cancer among females and a major public health problem in low- and middle-income countries (LMICs). There are several screening tests available for cervical cancer screening; however, due to a lack of organised screening facilities as well as factors such as low participation rates in screening programmes, many women die due to cervical cancer. To reach out to a large number of women, an easy, non-invasive and time-saving screening method is required. Evidence supports that cervical cancer screening with human papillomavirus deoxyribonucleic acid (HPV DNA) testing is the most effective technique for lowering the incidence and mortality associated with cervical cancer when compared to other screening methods. Furthermore, a small number of studies have reported that menstrual blood can be used as an alternative sample for HPV detection for cervical cancer screening. We have done a systematic review of the studies that have reported the diagnostic accuracy of menstrual blood to detect HPV. We found five studies in our literature search. The studies showed the diagnostic accuracy of menstrual blood in terms of sensitivity ranging from 82.8% to 97.7% and specificity ranging from 50.0% to 98.0% in cervical intraepithelial neoplasia or HPV infection detection. This review supports the use of menstrual blood as a screening tool for cervical cancer especially in LMICs where women are reluctant to participate in cervical cancer screening due to issues such as embarrassment and discomfort to test procedures as well as busy schedules. However, further studies are required to compare the diagnostic accuracy of menstrual blood in detecting HPV compared to other self-sampled HPV detection methods. This is one of the methods that can be explored further for use as a cervical cancer screening test. [ABSTRACT FROM AUTHOR]

Background: In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix with acetic acid (VIA) on the incidence of cervical cancer and the associated rates of death in the Osmanabad district in India. Methods: In this cluster-randomized trial, 52 clusters of villages, with a total of 131,746 healthy women between the ages of 30 and 59 years, were randomly assigned to four groups of 13 clusters each. The groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or VIA (34,074) or to receive standard care (31,488, control group). Women who had positive results on screening underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment. Results: In the HPV-testing group, cervical cancer was diagnosed in 127 subjects (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced disease) in the control group (hazard ratio for the detection of advanced cancer in the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were 34 deaths from cancer in the HPV-testing group, as compared with 64 in the control group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). No significant reductions in the numbers of advanced cancers or deaths were observed in the cytologic-testing group or in the VIA group, as compared with the control group. Mild adverse events were reported in 0.1% of screened women. Conclusions: In a low-resource setting, a single round of HPV testing was associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer. N Engl J Med 2009;360:1385-94. [ABSTRACT FROM AUTHOR]