Screening for cervical and breast cancer among community health care workers (ASHAs) of Puri district, Odisha

Background:Breast cancer and cervical cancer are the leading causes of cancer-related mortality in Indian women. As part of the Indian national guidelines for population-based cancer screening, village-level accredited social health activists (ASHAs) are the key mobilizers for encouraging women to undergo cervical and breast cancer screening. Assessing screening rates in these health workers themselves, can improve implementation of the national program by identifying some of the facilitators and barriers for screening.Methods:A cross-sectional study was conducted among ASHAs in Puri, Odisha, in eight primary health centers (PHCs) randomly selected from 10 blocks. Of all 291 ASHAs in these PHCs, 242 (83.2%) who consented, were given a self-administered questionnaire to assess screening and its associated factors.Results:The screening rates for cervical and breast screening in ASHA workers were 9.1% (95% CI: 5.4%-12.8%, 22/242) and 14.9% (95% CI: 10.3%-19.5%, 36/242), respectively. Having undergone screening themselves, was associated with referring others for screening (83.3% of those screened for breast cancer had referred others vs 37.4% of those never screened; 86.4% of those screened for cervical cancer had referred others vs 34.1% of those never screened).Conclusions:ASHAs reported low rates of screening for breast and cervical cancer. History of screening significantly influenced the referral of others for screening. ASHAs need to be empowered with both educational exposure as well as motivation for health-promoting activities for themselves, in order to increase population-wide screening coverage.