Success story in Kannapuram model of cancer control

A community-based cancer-control initiative which focused on sustained awareness campaigns, culturally sensitive communication and formation of a women volunteers’ squad to help patients navigate the rigmarole of cancer treatment has evolved as a successful model for encouraging more women towards screening and early detection of breast cancer.

The “Kannapuram model”, named after the Kannapuram grama panchayat in Kannur district, where the community-based initiative was tested out, is a success story writ by the grama panchayat in association with the Malabar Cancer Centre.

The successful experiment has now found a place in the latest issue of WHO South-East Asia Journal of Public Health.

Following sustained, planned community-level cancer awareness activities, 96% of the women above 30 years in the panchayat underwent breast cancer screening. Of the 6.2% referred for follow-up, 66.5% underwent further investigations. Breast cancer detection rate was 0.96 per 1,000, all in the early stages, who have all been treated and are now cancer-free.

In women, the breast cancer incidence has gone up 300 fold in Kerala in the last 25 years and accounts for 34% of all cancers in women. It is a sad reality that two-thirds of breast cancer cases are reported to hospitals at Stages 3 and 4.

Lack of awareness or misconceptions about risk factors and symptoms, fear of cancer diagnosis, social stigma, fear of catastrophic health expenditure are some of the reasons that affect women’s participation in early screening programmes, making late-stage presentations and high mortality, the face of breast cancer in Kerala

“We first did a baseline house-to-house study in 3,800 houses to understand the general health aspects of the people in the gramapanchayat. But the response from the people was lukewarm. We understood then that we had to first engage with the community, win over their trust and rid them of their fear before we could actually get them to participate in any screening programme,” says Neethu A.P., Department of Preventive and Community Oncology, MCC, who led the project

In phase 1, the effort was to sensitise all stakeholders on the importance of screening, early detection and lifestyle modification for cancer prevention by doctors from MCC, following which, a phased plan of community engagement over three years (2017-19) was drawn up

In phase 2, sustained multifaceted public awareness programs were planned under the guidance of MCC, in collaboration with other social service organizations, and the Health department. Every social, religious, cultural gathering was used as opportunities to push health messages on how early cancer screening and detection can save lives. Cancer survivors’ meet was organised to reduce the fear about cancer treatment. Food festivals were organised to encourage people to include seasonal, locally available and pesticide-free fruits and leafy vegetables in the diet

In phase 3, the Kannapuram gramapanchayat organised a mega 10-day breast cancer screening programme for women above 30 years. The programme gained publicity as a women’s health empowerment movement.

Trained female technicians screened 200–500 women daily, with a handheld, noninvasive medical device with piezoelectric sensors to differentiate varying tissue elasticity, along with Clinical Breast Examination (CBE). Women with positive test results were counselled and referred to MCC for detailed investigations using mammogram or ultrasound scanning.

“ Women tend to back out of follow-up investigations out of fear. So we formed a dedicated women’s squad of Kudumbasree leaders, who kept track of all these women, fixed appointments, organised travel and also accompanied the women to MCC to ensure that they did not drop out. We are so happy that our grama panchayat’s name today figures in WHO’s journal,” says K. Rethi, Kannapuram grama panchayat president

Of the 3,247 women above 30 years, 3,118 participated in the screening camp. Out of them, 203 women (6.2%) required further investigations. The majority (84%) had no symptoms. Of these, 135 (66.5%) underwent mammography. Fifteen women with BI-RADS (Breast Imaging Reporting and Data System, a scoring system of 0-6 for classifying breast imaging results) score 4 and 5 underwent wire-guided biopsy, of which three were confirmed to have early-stage carcinoma (Ductal carcinoma in situ, Stage 1A, and Stage 2A, respectively).

Despite all efforts, 33% of referred women failed to undergo further investigation and prevented 100% successful completion of the project.

The strength of the Kannapuram model was the strong community engagement, which helped people overcome their fear of cancer and encouraged their participation in the screening programme.

The efficiency of the patient navigation strategy in the Kannapuram model was what perhaps made all the difference in this community-led cancer control initiative. The women squad of navigators acted as the bridge between the health system and community, motivated women to attend screening camps and the much-needed hand-holding and emotional support to the referred women, to manage the complexities of the healthcare system, undergo investigations and complete cancer treatment