Advocacy to action for cervical cancer elimination in the state of Assam: a narrative review of the government policies and the latest report of NCDIR survey.

Background: Assam is the state of north-eastern region of India and is called the 'cancer capital' of the country. There have been accelerated developments in the field of cancer care in the state of Assam in recent times. Though the highest burden of cervical cancer is found in the northeast region, no government- initiated specific programme for cervical cancer elimination has been developed. The strategies implemented at various health care level is mostly derived from the 'umbrella' initiatives of NPCDCS. Due to unique cervical cancer profile of the state, there is a need to fill in the data gaps that needs to be investigated and reported and possible solutions should be outlined to optimise the continuum of care.

Aims and objectives: In this article, we have reviewed the government policies related to cervical cancer and their implementation at various level of health care system of Assam. Primary objective was to report the gap existing for implementation of cervical cancer prevention and treatment strategies in the state of Assam and secondary objective was to outline possible interventions to optimize the delivery of cervical cancer screening.

Methodology: The relevant articles related to government policies were searched on electronic database including Pubmed, national and state-level government websites on health welfare programmes and reports of NCDIR. The data for quantification of gap in cervical cancer services and awareness was extracted from the NCDIR survey conducted as a part of cancer research in the North East Region (CaRes NER), a multidisciplinary programme for preventing and controlling cancer in the north-eastern states run by ICMR-NCDIR, Bengaluru.

Results: Timeline of development in the field of cancer care has been summarised in this review under the headings of government initiatives so far for cancer care and its reflection in Assam, call for cervical cancer elimination and its implications in Assam, the current situation in the state of Assam, recent developments in cancer care field in Assam. The quantification of the gaps in cervical cancer care in the state of Assam is based on data from NCDIR survey. Among 2,817 respondents, fewer than a quarter were aware of cancer screening for major cancers, with no specific data available on awareness of cervical cancer. The majority of respondents reported learning about cancer through media or friends and family, while health awareness camps contributed minimally. Only 0.8% were aware of the HPV vaccine, and 0.2% expressed hesitation in discussing cancer. Notably, none of the respondents had undergone cervical cancer screening by any method. In terms of healthcare infrastructure, less than 10% of surveyed Primary Health Centers (PHCs) and none of the Community Health Centers (CHCs) or District Hospitals provided cancer screening services. Fewer than a quarter of PHCs had counseling services for risk behavior, provided by counselors or specialized personnel. Among the medical officers at PHCs, 38.5% had received training under NPCDCS, NHM, or other state-level non-communicable disease (NCD) programs. Gynecologists were available in approximately half of the CHCs and over 80% of district hospitals. However, over 90% of PHCs reported a shortage of laboratory facilities for cancer detection. Regarding HPV vaccination, none of the CHCs offered the service, while it was available in 14.3% of district hospitals and 20.0% of private health facilities CONCLUSION: The key findings of this review and the proposed corrective steps in this paper can be implemented in systematic manner to optimise the delivery of cancer care services and improve the outcomes.