Journal of Cancer Policy 3 (2015) 3–4
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Journal of Cancer Policy
journal homepage: www.elsevier.com/locate/jcpo
Letter to the Editor
Missing cervical cancer patients in India: Time to
rejuvenate follow up strategy through mhealth
Dear Sir,
Intent of the letter
Cervical cancer is the one of the most common cancer in women
worldwide and a major health menace among women in low and
middle income countries like India. In an elaborate study conducted in India it was found that mounting number of cervical
cancer patients are missing after their first hospital visit due to
inappropriate screening and follow up strategy [1]. The patients
who have undergone Pap test were advised to return back to
the collection centre on day seventh to collect the reports from
cytopathology centre. But this second visit acts as rate limiting
step leading to a high loss to follow up as several women never
reported back to collect their reports due to resistive affordability and logistic barrier. Since many of them among these missing
patients are also diagnosed as preneoplastic lesions such losses
met with heavy price turning to even frank carcinoma cervix in
near future. This is not only thwarting patients for treatment but
even worsening the cervical cancer status in India. This has had
press hard to find an effective overhauling solution to this failing
strategy.
Global perspective of mhealth
In the backdrop of this grave situation mhealth or mobile
health seems to be an effective remedial mechanism. The unprecedented spread of mobile technologies as well as advancements
in their innovative applications to address health priorities has
evolved into a new field of eHealth, known as mHealth. The
field’s potential had been recognised by the United Nations (UN)
and World Health Organization (WHO). The Global Observatory
for eHealth (GOe) defined mHealth or mobile health as medical and public health practice supported by mobile devices, such
as mobile phones, patient monitoring devices, personal digital
assistants (PDAs), and other wireless devices. According to the
International Telecommunication Union there are now close to
5 billion mobile phone subscriptions in the world. The penetration of mobile phone networks in many low and middle income
countries surpasses other infrastructure such as paved roads
and electricity and dwarfs fixed Internet deployment [2]. With
increased accessibility comes the possibility of greater personalisation and citizen-focused public health and medical care. It is thus
utmost essential to reap the multiplier effect of mhealth in tandem with various government programmes such as Digital India
to effectively mobilise telecommunication resources in healthcare
services.
Proposal for resolving loss to follow up
There are number of factors influencing the cervical cancer
screening in India such as multiple visits to screening facility which
increases loss to follow up. It can be owed due to financial losses
of the screened women and her attendants where income source
is majorly rested upon their daily wages [1,3]. Therefore it is proposed that during their Pap smear test all women and their relatives
contact mobile number should be taken to create Health directory.
After cytopathology report creation, it will be send to concerned
mobile number via SMS with attached Pap report copy and the
physician’s advice about normality or abnormality in the local language and guidance for further line of action. If their report is
abnormal they will be specifically rang with advice and guided to
follow visit to the concerned treatment facility. If they fail to follow
advice then nearest responsible health professional can be asked to
seek these women in regular terms for specialise treatment. Proposed theory can be exemplified further through the contact tracing
system followed in diagnosing and following sexually transmitted
infection in India. This will lead into translating current doctor centric health care approach into patient centric approach along with
use of ICT. Furthermore these women can be followed in future
on regular occasions for materialising targeted healthcare. Usually
large number of women has negative Pap test with no abnormality
detected (NAD), thus this approach will decrease even the unnecessary visit to the heath facility reducing both the burden on health
care facility and the unnecessary financial losses of the patients
undergoing screening. Furthermore it will be amazing to investigate further the role of ASHA (Accredited Social Health Activist, a
recruited cadre of zealous female health worker more than 8 lakhs
in number) participating in its realisation [4].
Global success stories of mhealth
Few examples for utilisation of mhealth are, the Ministry of
Bangladesh in 2007, started a project to increase awareness of
its health campaigns by broadcasting SMS to all mobile numbers
in the country to mobilise citizens for raising awareness such as
National Immunisation, National Breastfeeding Week, and National
Safe Motherhood Day. Similarly Mobile communications between
doctors in Ghana improved medical practice, Cam e-WARN; monitoring disease outbreaks in Cambodia via SMS, Be Healthy, Be
Mobile initiative of ITU and WHO’s mhealth for Tobacco control
remained success stories [2].
Thus mobile technology infrastructure has enormous potential for community mobilisation in developing countries such as
India in disseminating government health programmes and news,
improving timely access to emergency and general health services, geriatric care, adapting social-health linkages, reducing drug
shortages at health clinics, enhancing clinical diagnosis and treatment adherence. Remedy as described for the missing patients in
http://dx.doi.org/10.1016/j.jcpo.2015.02.001
2213-5383/© 2015 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
4
Letter to the Editor / Journal of Cancer Policy 3 (2015) 3–4
cervical cancer screening is one of the optimistic example. This can
supplement and even replace the overburdened brick and mortar
healthcare system in providing unprecedented healthcare diffusion
deep in society, realising universal concept of ‘Affordable Health for
All’.
Funding
None declared.
Conflict of interest
None declared.
References
[1] Singh S, Badaya S. Factors influencing uptake of cervical cancer screening
among women in India: a hospital based pilot study. J Community
Med Health Educ 2012;2:157, http://dx.doi.org/10.4172/2161-0711.1000157
http://omicsonline.org/2161-0711/2161-0711-2-157.php
[2] World Health Organization (WHO). mhealth: New horizons for health
through mobile technologies; 2015. http://www.who.int/goe/publications/
goe mhealth web.pdf [accessed 26.01.15].
[3] Singh S, Badaya S. Health care in rural India: a lack between need and
feed. South Asian J Cancer 2014;3:143–4 http://journal.sajc.org/text.asp?2014/
3/2/143/130483
[4] Singh S, Badaya S, Multani MK. Is existing cervical cancer screening proven
productive in developing nations: time to move from the laboratory to community. South Asian J Cancer 2013;2(4):242 http://journal.sajc.org/article.asp?issn=
2278-330X;year=2013volume=2;issue=4;spage=242;epage=242;aulast=Singh
Sorabh Badaya ∗
Sandeep Singh
Gajra Raja Medical College, Gwalior, Madhya
Pradesh 474001, India
∗ Corresponding
author at: 219, Shanti Nagar, Near
Durgapura Rly. Stn., Jaipur, Rajasthan 302018,
India. Tel.: +91 7597583774/141 2761078;
fax: +91 141 2761078.
E-mail address: [email protected]
(S. Badaya)
26 January 2015
Available online 18 February 2015