Burden of the problem
Cervical cancer is the second most common cause of cancer in women worldwide .Nearly half a million of cases are diagnosed each year and half of them die annually due to the disease .It is the leading cause of cancer related deaths of women even in developed countries and more than 80% of deaths occurin developing countries of Africa and Asia.
The National Cancer registry programme (NRCP) estimates cervical cancer as the number one among cancers among women. According to the recent report NRCP 2005 it constitutes 21.4% of all cancers in women and at a time 10000-20,000 new cases of invasive cervical cancer occur and 26000-45000 cases of precancerous lesions occur every year in Nepal.
Rationale for screening
Deaths due to cervical cancer has been decreased significantly in recent years in developed countries due to organized population based screening strategies using PAP test , Cytology , HPV Dna testing and HPV vaccination programmmes. Understanding the natural history of HPV infection, identifying the long pre invasive period of cervical cancer has helped us put effective screening programmes to reduce the disease burden.
Although PAP test has been recommended as the gold standards for cervical cancer screening but in country like Nepal due to lack of facilities for collecting PAP samples, lack of laboratory facility for processing the samples, lack of adequate pathologists for reporting and the cost involved has hindered it to be used as a screening test and more over visual tests like VIA has been recommended by the WHO and Nepal government as the screening test for cervical cancer in Nepal. It is a simple test where women will be examined using speculum and 5% acetic acid applied to the cervix , negative test implies counseling and return for retesting in 5 years and positive test implies counseling and treatment with cryotherapy or colposcopy and cryotherapy at the same setting using SVA (single visit approach) .
Inspite of the development of the screening programme in Nepal the coverage is very poor and the programme has been effective due to inadequate trained man power to do the tests, provide treatment with crotherapy or LEEP, and perform colposcopy if required and womens health awareness about the screening tests itself, the importance of the tests and need to do the tests.
This project will be operated for 2 years and 5000 women and girls will be screened. Screened and positive cases of cervical cancer will be given free treatment at BPKIHS.
Single time expenditure including Colposcopy digital, Cryotherapy machine and other machine and equipment $12000
25 Camps of 200 screening @ $750*25 = $18750
Project Director (Gynaecologist) Cost (Collaborating Organization Contribution) @100*25 = $2500
Training and demonstration
Laptop 1 PC @ $750
Projector 1 PC @ $900
Projector Screen @ $450
Program manager 24 mo @ 250 = $6000
Free treatment for cases with cancer (contribution from project)100* @100 = $10000
Certified Nurses 2@$50*25= $2500
FCHV (female community health volunteer) 10*25*$10= 2500
Publication of posters booklets 3000 @$5= 15000
Porter. For carrying material to very remote places: 10*2way*$100= $2000
Total cost= $ 70850
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