Non-Communicable diseases

1. A PROJECT PROPOSAL TO SCREEN
AND CONTROL BREAST AND
CERVICAL CANCER IN RAJSHAHI
DISTRICT
SUBMITTED TO :
PROFFESOR. MALAY KANTI
MRIDHA
MBBS, MSc (Nut), MSc (HE), MPH,
PhD
PBH644: NCD Epidemiology
SUBMITTED BY:
DR. MD. ROKEBUL HASSAN (2035017680)
DR. IPSHITA JAHAN SHAANTA (203518568
DR. MD. ROBEUS SUNY (2035134680)
DR. AFRIN ANWAR LINDA (2035189680)
DR. NUR TASMIA TAHRAT (2025175680)
DR. UMMA SALMA (2035443680)

2.  Women’s cancers, including breast, cervical and ovarian cancer, lead to hundreds of
thousands of premature deaths among women.
 Breast cancer is a disease in which cells in the breast grow out of control. There are
different kinds of breast cancer.
 The most common type of breast cancer is ductal carcinoma, which begins in the
lining of the milk ducts. Another type of breast cancer is lobular carcinoma, which
begins in the lobules of the breast.

3.  Cervical cancer is caused by sexually-acquired infection with Human papillomavirus
(HPV). Most people are infected with HPV shortly after onset of sexual activity.
 Cervical cancer is the second most common cancer in women worldwide. Yet, because
of poor access to screening and treatment services, the vast majority of deaths occur
in women living in low- and middle-income countries.

4.  The goal of screening is to catch cancers early. Early-stage cancers are easier to treat
than later-stage cancers, and the chance of survival is higher. Routine screening for
breast cancer lowers one's risk of dying of breast cancer. Screening for breast cancer
is done by mammography.
 Screening tests offer the best chance to have cervical cancer found early when
treatment can be most successful. Screening can also actually prevent most cervical
cancers by finding abnormal cervical cell changes (pre-cancers) so that they can be
treated before they have a chance to turn into a cervical cancer.

5. Objectives should be- S M A R T
 Specific: Objective should be clear, precise and unambiguous.
 Measurable: Objective should be successful and measured in terms of quality and
quantity.
 Actionable/Attainable: Objective should be realistically achievable, taking into
account the time- frame, availability of resources and support.
 Relevant: Objective should be supportive to achieve the overall goals.
 Time bound: Objective should be completed within a specific date and time.

6. For breast cancer:
 Limit alcohol, Maintain a healthy weight, Breast-feed, Limit postmenopausal
hormone therapy.
For cervical cancer:
 Radiation therapy with chemotherapy given at the same time.
 Radical hysterectomy and removal of pelvic lymph nodes with or without radiation
therapy to the pelvis, plus chemotherapy. Radical trachelectomy.
POPULATION:
 Target population is uninsured or underinsured women who are at or below the
poverty level, aged 40 to 64 years for breast cancer services, and aged 21-64 years for
cervical cancer services. Screening done over 342 women for breast cancer and
cervical cancer.

7. Strategies as "specific, discrete activities designed to achieve the objectives stated in the
plan. These strategies should be evidence-based. That is, the strategy has been evaluated
and found to be effective at decreasing the burden of cancer
Specific:
For Breast cancer:
 To find out the proportion of breast cancer patients with delay presentation.
 To identify health seeking pattern of breast cancer patients.
 To describe the factors influencing health seeking behaviours of breast cancer patients.
 To explore the experiences and challenges in seeking health care for breast cancer.
For Cervical cancer:
 To determine awareness , knowledge & UPTAKE of cervical cancer screening, barriers to
cervical cancer screening uptake.
 To determine factors influencing mother’s practice of cervical cancers screening.
 To determine cervical cancer screening technology called “VIA”.
 HPV Vaccination targets 9-13 years old girls.

8. Measurable:
For breast cancer:
 Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly
used to screen for breast cancer.
For cervical cancer:
 The most common screening test to detect cervical cancer or precancerous cells
(dysplasia) is the Pap test. During a Pap test, the doctor takes a sample of cells from
the surface of the cervix inside the vagina, and then sends the sample to be reviewed
by pathologists in a lab.

9. Actionable/ Attainable:
For breast cancer:
 Breast cancer prevention starts with healthy habits, such as-
 Limit alcohol, Maintain a healthy weight, Be physically active, Breast-feed, Limit
postmenopausal hormone therapy.
For cervical cancer:
 Cervical cancer can often be prevented by having regular screenings with Pap tests
and HPV tests to find any precancers and treat them. It can also be prevented by
receiving the HPV vaccine.

10. Relevant:
For breast cancer:
 The goal of cancer treatment is to achieve a cure for our cancer, allowing us to live a
normal life span. This may or may not be possible, depending on our specific
situation.
 There are four main goals for chemotherapy: Curative therapy to kill all cancer
cells. Adjuvant therapy which targets cells left after surgery to prevent recurrences.
Neoadjuvant therapy to shrink tumours before surgery.
For cervical cancer:
 The three main treatments for cervical cancer are radiation, chemotherapy and
surgery. Some people may have a combination of treatments. Radiation or
chemotherapy may be used to treat cancer that has spread beyond the pelvis (Stage
IV) or cancer that has recurred.

11. Time bound:
For breast cancer:
 Breast cancer has to divide 30 times before it can be felt. Up to the 28th cell division,
neither we nor our doctor can detect it by hand. With most breast cancers, each
division takes one to two months, so by the time we can feel a cancerous lump, the
cancer has been in our body for two to five years.
For cervical cancer:
 It takes 15 to 20 years for cervical cancer to develop in women with normal immune
systems. It can take only 5 to 10 years in women with weakened immune systems,
such as those with untreated HIV infection.

12.  Director
 Program Manger
 Deputy Program Manager
 Technical Consultant
 Surveillance Medical Officer
 Nurses
 Account Officer
 Field Monitoring Officer

13. Project duration: 06 months
Work Plan:
 Establish an advisory board.
 Establish a team of trainers to train health workers and volunteers.
 Cancer Awareness Camp: With the help of health workers and volunteers, we will motivate
parents to send their 9-13 years aged girls for vaccine against HPV. Women aged 40-64 years are
encouraged to go through cervical cancer screening program. We will educate young female adults
and women to perform breast self examination technique. We will also give them leaflets
containing cancer warning signs.
 Cervical cancer screening: We will build temporary camp in 11 upazilla of Rajshahi district to
conduct Cervical cancer screening program. Visual Inspection with acetic acid (VIA) based
screening is followed in Bangladesh for cervical cancer screening. We will run the test under
trained physician and nurses. The positive cases will be counseled and referred to tertiary
hospital.
 Breast cancer screening: Along with the cervical cancer screening camp we will also have place for
breast cancer screening. Bangladesh has adopted the clinical breast examination method for
breast cancer screening. Here, clinical breast examination will be done by physician. We will also
collect data on family history of breast cancer.

14. The purpose of this project will be to educate, motivate, create awareness and screening and of
women who are in the early stage of developing breast and cervical cancer. Evaluation will prove the
viability of the project and to learn what and why it works.
For the above mentioned purposes, the assessment will--
 Observe if the plan is in right direction or not.
 The plan is following the achievement of the project goals or not.
 What is working and what is not.
 Is the plan useful for the project users.
 Proper documentation of project activity.
 Observe how project activity has met proposed target.
 Systematic and continuous collection, assessment and use of information on the key elements of
the project.
Need to ensure that the project is running with efficiency and dedication.

15. Estimated Budget:
 Estimated total Budget 15,00,000 BDT
 Direct cost 10,00,000 BDT
 Indirect cost 5,00,000 BDT

16. 1. Community consulted on joint screening messages
2. Adapted joint screening messages documented
3. Identify and develop local resources. This could include:
 Information resource for community members on cancer screening e.g. brochure,
poster, postcards, etc.
 Information for community members on location of cancer screening services.
 Pictograph of how to use the cervical screening kit.

17. For breast cancer:
 These can cause unnecessary and unwanted side effects. Other potential harms from breast
cancer screening include pain during the procedure and radiation exposure from the
mammogram test itself. While the amount of radiation in a mammogram is small, there may
be risks with having repeated X-rays.
 This can lead to more tests, which can be expensive, invasive, time-consuming, and may
cause anxiety. Tests also can lead to overdiagnosis.
For cervical cancer:
 Cervical cancer screening will inevitably lead to unintentional harmful effects e.g. detection
of indolent pathological conditions defined as over detection or overdiagnosis. Overdiagnosis
often leads to overutilisation, overtreatment, labelling and thereby negative psychosocial
consequences.
 Most common consequences are: changes in sex life (67%), fatigue (64%), menopause (56%),
bowel difficulties (54%) and bladder difficulties (54%).