Indiana University Health Ball Memorial Hospital, Muncie, IN
Background: Currently, screening in rural India is done in most instances by utilizing mobile detection units that the government of India sets up to reduce the barrier of accessibility. These screening camps infrequently occur and manage to screen around 100-150 people a day. Screening even with a positive result is ultimately useless without follow-up care. Breast cancer, which is often diagnosed late in presentation, is widely screened for by utilizing mobile mammography screening units. The authors propose that instead of recruiting patients randomly, patients should be chosen prior to the set-up of camps by using accredited social health workers (ASHAs), community health leaders (CHL), and other allied health professionals (AHP) based on risk factors. Methods: Mobile health screening camps were deployed in rural Andhra Pradesh, India, where for 2 screening sessions, females were recruited either a day before or just before set up. These results were compared to another 2 screening sessions where females were recruited for 2 weeks prior to being set up by ASHAs, CHLs, and other AHPs. They recruited patients at risk of breast cancer, including those with a family history, who were smokers, who felt a lump on self-examination, who had a prior history of cancer, and those with a BMI over 25. They explained about mammography, the need for them to be screened, and the need for follow-up care. Both data sets were compared to check for positivity rates on mammography and establishment of the initial follow-up appointment. Results: It was found that the screening camps where recruitment took place on the same day or the day before had a more significant number of patients who were recruited to get screened. In total, 267 people were screened that day. Out of those 267, mammography was positive in 21 patients; however, only 1 of those 21 patients established care at a follow-up visit. In the screening camps where ASHAs, CHL, and other AHPs were recruited to recruit patients based on high-risk factors, a total of 138 people were screened. Of those 138 people, 37 people had positive findings on mammography. Out of the 37 people, 29 patients established follow-up care. It was found that due to the decreased number of mammograms performed, the overall cost went down even with the need to allocate funding for recruitment. Conclusions: This study showed that it is beneficial to establish the recruitment process before setting up mammography camps by utilizing ASHAs, CHLs, and other AHPs to screen for high-risk individuals. Despite a more significant number of patients screened using the current widely utilized method of randomly recruiting patients in India, the follow-up rates were poor. By targeting high-risk women for mammography, the follow-up rates improve, and the overall cost of the screening camp decreases.
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