Greetings from India. I'll be presenting my study, are we running late to catch the WHO call for elimination of cervical cancer? Every seven minutes we lose a woman due to cervical cancer. By 2030, the WHO has given an ambitious goal to eliminate cervical cancer. In this regard, we devised a study to determine the factors responsible for delay in presentation, diagnosis, initiation and completion of treatment of cervical cancer in a tertiary cancer center in Northeast India. It was a prospective observational study conducted over a period of one year. At the start of the study, we have issued a KAP questionnaire to the patients to assess the baseline status of patients. We divide the delay into five types, D1 being the patient delay from time of onset of symptoms to presentation to the doctor, D2 the diagnostic delay from time of presentation to doctor to diagnosis of cancer, D3 from diagnosis of cancer to start of treatment, D4 from the time of start of treatment to completion of treatment, D5 was the total delay. A total of 101 patients were included in the study. This is my country India and the state of Assam. The red dot represents the cancer institute I work in and blue represents the referral center. The majority of the patients were from the state of Assam. The median distance from the institution was 178 kilometers and the median time to reach the institution was four hours. Mean age of patients was 51 years, 53% of the patients were illiterate, 82% of the patients were unemployed, 51% of the patients belonged to the middle socioeconomic scale, 22% were widowed and 62% availed the government insurance schemes. Majority of the patients belonged to the stage 2B, 38% of the patients. Of the 101 patients, 91% of the patients underwent concurrent chemo radiation, 9% of the patients underwent surgery. In the KAP questionnaire, we observed that 78% of the patients did not know abnormal bleeding as a danger sign for cancer. Sadly, none of the patients had ever taken HPV vaccination or a screening test for cervical cancer. Majority of the patients did not have a gyne checkup or medical camp checkup in the preceding years. 17 patients had consulted QACS. When we divided the delay based on type of treatment, we observed that chemo radiation was associated with an increased D1 of 30, 60 days compared to 25 days. D2 was equivalent in both groups. It took an average of 30 days to start chemo radiation in D3 and 56 days for completion of chemo radiation. Overall, delay in chemo radiation was 169 days and 30 days in surgery group. When you divide it into long and short delay as shown on the left side, we observed that 50% of the patients had a delay, a long delay in D1, 68% of the patients had long delay in D2, 91% of the patients had long delay in D3 and 50% of the patients had long delay in D4. When we observed what were the significant factors responsible for delay, we observed that age greater than 50 years, no prior gyne checkup and involvement of QACS to be significant factors for D1. Involvement of QACS and lack of finances to be significant factors for D2. Fear of cancer, lack of finances, referral for advanced diagnostic outset to be significant factors for D3 and fear of cancer and lack of finances to be significant factors for D4. Our study showed an overall delay of 52% which is higher than other studies. This is due to lower socio-economic and cultural difference in northeastern India. The rugged terrain as shown in the map prior showed is difficult to access region. Illiteracy and poverty led to a vicious cycle of poor access to screening facilities and vaccination which meant women presented in advanced stage of disease further worsening their economic condition. Few factors which are responsible for longer patient and physician delay are 40% of the patients hit the symptoms from caregivers due to fear of abandonment or nuclear family. 35% of primary care physicians missed out on doing a perspeculum examination. So how did we correct these faults? First thing, for addressing D1 we increased awareness camps and secondly northeastern part of the country is having improvement in the transport facilities nowadays. To combat D2, a new PET scan was installed in the institution and thus capacity building both in laboratories and training of doctors. To combat D3, the government insurance Daeshman scheme caters to patients below the poverty line and two new radiotherapy machines were installed in the institution and to cater to D4, an institutional fund, the Women and Child Welfare Fund took care of patients who did not fall under the insurance schemes. It was a, the novelty of the study was extensive prospective study. It's a region based study and the physician has administered the questionnaire where the drawbacks of the smaller sample size, it is single institution and the recall bias that was present. So it is 2024. We have six years left to 2030 until each cancer center takes an effort to find out what problems ails its patient and addresses those by corrective measures. We are definitely bound to miss the train for cervical cancer elimination.

cervical cancer

treatment delays

awareness campaigns

socio-economic factors

WHO elimination goal