A Report from a Community-Centric Cancer Control Approach in the Post-Conflict Northern Province of Sri Lanka
Abstract
1. Introduction
2. Materials and Methods
2.1. Project Overview
2.2. Stage 1: Planning and Stakeholder Engagement
2.3. Stage 2: Training of Community Cancer Educators (CCEs)
2.4. Stage 3a: Health Camp Delivery—Community Education
2.5. Stage 3b: Health Camp Delivery—Screening
- Oral-related cancer screening included a visual inspection with handheld lights and palpation of the head, neck, and cervical lymph nodes. Intraoral examinations were conducted with white light, and findings were recorded as normal or abnormal. Abnormalities checked during oral screening included visible lesions, non-healing ulcers lasting more than two weeks, palpable lumps, or swelling in the jaw or neck. This method has demonstrated 87% sensitivity and 50% specificity in detecting potentially malignant oral disorders [28]. It is also effective in reducing oral cancer mortality when used in population-based screening in LMICs [28,29,30].
- Breast cancer screening was conducted using a clinical breast examination (CBE) performed by trained female cancer nurses. CBE is an inexpensive screening method particularly suitable for LMICs [31]. Evidence shows that it can improve chances of successful treatment and survival by enabling earlier diagnosis [32]. Abnormalities checked included palpable lumps with irregular borders, asymmetry between breasts, skin dimpling, and nipple retraction.
2.6. Data Collection
3. Results
4. Discussion
4.1. Limitation
4.2. Future Work
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CCEs | Community Cancer Educators |
NCCP | National Cancer Control Program |
WWC | Well Woman Clinic |
CCMB | CancerCare Manitoba |
LMICs | Low- and Middle-Income Countries |
MOH | Medical Officers of Health |
CEDC Jaffna | Centre for Early Detection of Cancer Jaffna |
CANE | Cancer Aid North East |
References
- Gunasekera, S.; Seneviratne, S.; Wijeratne, T.; Booth, C.M. Delivery of cancer care in Sri Lanka. J. Cancer Policy 2018, 18, 20–24. [Google Scholar] [CrossRef]
- Jayarajah, U.; Abeygunasekera, A.M. Cancer services in Sri Lanka: Current status and future directions. J. Egypt. Natl. Cancer Inst. 2021, 33, 13. [Google Scholar] [CrossRef]
- Perera, I.; Amarasinghe, H.; Jayasinghe, R.D.; Udayamalee, I.; Jayasuriya, N.; Warnakulasuriya, S.; Johnson, N.W. An overview of the burden of oral cancer in Sri Lanka and its inequalities in the face of contemporary economic and social malaise. Community Dent. Oral Epidemiol. 2023, 51, 680–696. [Google Scholar] [CrossRef]
- Perera, C.; Mapitigama, N.; Abeysena, C. Perception of Cervical Cancer Screening Program among Healthcare Workers in a District of Sri Lanka: A Qualitative Study. Eur. Mod. Stud. J. 2021, 5. [Google Scholar]
- Vithana, P.V.; Hemachandra, N.N.; Ariyaratne, Y.; Jayawardana, P.L. Qualitative assessment of breast cancer early detection services provided through well woman clinics in the district of Gampaha in Sri Lanka. Asian Pac. J. Cancer Prev. 2013, 14, 7639–7644. [Google Scholar] [CrossRef]
- NCCP. National Cancer Incidence and Mortality Data Sri Lanka 2019; National Cancer Control Program: Colombo, Sri Lanka, 2019.
- NCCP. Cancer Incidence Data; National Cancer Control Program: Colombo, Sri Lanka, 2024.
- Sankaranarayanan, R. Screening for cancer in low- and middle-income countries. Ann. Glob. Health 2014, 80, 412–417. [Google Scholar] [CrossRef]
- Chidyaonga-Maseko, F.; Chirwa, M.L.; Muula, A.S. Underutilization of cervical cancer prevention services in low and middle income countries: A review of contributing factors. Pan Afr. Med. J. 2015, 21. [Google Scholar] [CrossRef] [PubMed]
- Glasziou, P.; Straus, S.; Brownlee, S.; Trevena, L.; Dans, L.; Guyatt, G.; Saini, V. Evidence for underuse of effective medical services around the world. Lancet 2017, 390, 169–177. [Google Scholar] [CrossRef] [PubMed]
- Jacobs, B.; Ir, P.; Bigdeli, M.; Annear, P.L.; Van Damme, W. Addressing access barriers to health services: An analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan. 2012, 27, 288–300. [Google Scholar] [CrossRef] [PubMed]
- Huq, M.S.; Acharya, S.C.; Sharma, S.; Poudyal, S.; Sapkota, S.; Shrestha, S.; Wijesooriya, K. Cancer care and outreach in South Asian Association for Regional Cooperation (SAARC) countries: From epidemiology and the National Cancer Control Programme to screening, diagnosis, and treatment. Lancet Oncol. 2024, 25, e639–e649. [Google Scholar] [CrossRef]
- Garg, P.; Krishnamoorthy, Y.; Halder, P.; Rajaa, S.; Verma, M.; Kankaria, A.; Kakkar, R. Urban-rural disparities in cervical cancer screening among Indian women between 30–49 years: A geospatial and decomposition analysis using a nationally representative survey. BMC Cancer 2025, 25, 67. [Google Scholar] [CrossRef] [PubMed]
- Bhatia, S.; Landier, W.; Paskett, E.D.; Peters, K.B.; Merrill, J.K.; Phillips, J.; Osarogiagbon, R.U. Rural-Urban Disparities in Cancer Outcomes: Opportunities for Future Research. J. Natl. Cancer Inst. 2022, 114, 940–952. [Google Scholar] [CrossRef] [PubMed]
- UNICEF. Northern Provincial Council–Citizens Budget 2022 June 2023. Available online: https://www.unicef.org/srilanka/reports/citizens-budget-2022 (accessed on 15 September 2024).
- Balawardena, J.; Skandarajah, T.; Rathnayake, W.; Joseph, N. Breast cancer survival in Sri Lanka. JCO Glob. Oncol. 2020, 6, 589–599. [Google Scholar] [CrossRef]
- Hewage, S.A.; Samaraweera, S.; Joseph, N.; Kularatna, S.; Gunawardena, N. Presentation, diagnosis and treatment delays in breast cancer care and their associations in Sri Lanka, a low-resourced country. Clin. Oncol. 2022, 34, 598–607. [Google Scholar] [CrossRef]
- Wijeratne, D.T.; Gunasekara, S.; Booth, C.M.; Berry, S.; Jalink, M.; Carson, L.M.; Gyawali, B.; Promod, H.; Jayarajah, U.; Seneviratne, S. Colorectal Cancer Treatment Characteristics and Concordance with Guidelines in Sri Lanka: Results from a Hospital-Based Cancer Registry. JCO Glob. Oncol. 2022, 8, e2200004. [Google Scholar] [CrossRef]
- Nagai, M.; Abraham, S.; Okamoto, M.; Kita, E.; Aoyama, A. Reconstruction of health service systems in the post-conflict Northern Province in Sri Lanka. Health Policy 2007, 83, 84–93. [Google Scholar] [CrossRef]
- Kale, S.; Hirani, S.; Vardhan, S.; Mishra, A.; Ghode, D.B.; Prasad, R.; Wanjari, M. Addressing cancer disparities through community engagement: Lessons and best practices. Cureus 2023, 15, e43445. [Google Scholar] [CrossRef]
- Carethers, J.M.; Doubeni, C.A. Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies. Gastroenterology 2020, 158, 354–367. [Google Scholar] [CrossRef]
- Habila, M.A.; Kimaru, L.J.; Mantina, N.; Valencia, D.Y.; McClelland, D.J.; Musa, J.; Jacobs, E.T. Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review. Front. Glob. Women’s Health 2021, 2, 697607. [Google Scholar] [CrossRef]
- Philip, P.M.; Nayak, P.; Philip, S.; Parambil, N.A.; Duraisamy, K.; Balasubramanian, S. Population-based cancer screening through community participation: Outcome of a district wide oral cancer screening program from rural Kannur, Kerala, India. South Asian J. Cancer 2018, 7, 244–248. [Google Scholar] [CrossRef] [PubMed]
- Dangal, G.; Dhital, R.; Dwa, Y.P.; Poudel, S.; Pariyar, J.; Subedi, K. Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study. PLoS Glob. Public Health 2024, 4, e0002832. [Google Scholar] [CrossRef] [PubMed]
- Sabeena, S.; Ravishankar, N.; Kalpana, M.M. Implementation strategies of cervical cancer screening in South Asia: A systematic review. Int. J. Gynaecol. Obstet. 2024, 166, 483–493. [Google Scholar] [CrossRef] [PubMed]
- Sivakumar, S.S. Water Resources and Agriculture Potential in Northern Sri Lanka. Northern River Basins Yield Study for Operational Policy of Irrigation. 2021. Available online: http://www.opac.lib.esn.ac.lk/cgi-bin/koha/opac-detail.pl?biblionumber=90928 (accessed on 21 September 2025).
- Adikari, P.S.; Pathirathna, K.; Kumarawansa, W.; Koggalage, P.D. Role of MOH as a grassroots public health manager in preparedness and response for COVID-19 pandemic in Sri Lanka. AIMS Public Health 2020, 7, 606–619. [Google Scholar] [CrossRef]
- Haj-Hosseini, N.; Lindblad, J.; Hasséus, B.; Kumar, V.V.; Subramaniam, N.; Hirsch, J.M. Early Detection of Oral Potentially Malignant Disorders: A Review on Prospective Screening Methods with Regard to Global Challenges. J. Maxillofac. Oral Surg. 2024, 23, 23–32. [Google Scholar] [CrossRef]
- Walsh, T.; Liu, J.L.; Brocklehurst, P.; Glenny, A.M.; Lingen, M.; Kerr, A.R.; Scully, C. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst. Rev. 2013, 2013, Cd010173. [Google Scholar] [CrossRef]
- Brocklehurst, P.; Kujan, O.; O’Malley, L.A.; Ogden, G.; Shepherd, S.; Glenny, A.M. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst. Rev. 2013, 2013, Cd004150. [Google Scholar]
- Khanna, D.; Sharma, P.; Budukh, A.; Khanna, A.K. Clinical breast examination: A screening tool for lower- and middle-income countries. Asia-Pac. J. Clin. Oncol. 2024, 20, 690–699. [Google Scholar] [CrossRef]
- Sayed, S.; Ngugi, A.K.; Nwosu, N.; Mutebi, M.C.; Ochieng, P.; Mwenda, A.S.; Salam, R.A. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Cochrane Database Syst. Rev. 2023, 4, Cd012515. [Google Scholar] [CrossRef] [PubMed]
- Ko, A.M.-S.; Lee, C.-H.; Ko, Y.-C. Betel quid–associated cancer: Prevention strategies and targeted treatment. Cancer Lett. 2020, 477, 60–69. [Google Scholar] [CrossRef]
- Senevirathna, K.; Jayasinghe, Y.A.; Jayawickrama, S.M.; Amarasinghe, H.; Jayasinghe, R.D. Oral Cancer Disease among the Poor: A Sri Lankan Context. Oral 2023, 3, 420–436. [Google Scholar] [CrossRef]
- Sumithrarachchi, S.; Athukorala, I.; Rumy, F.; Jayasinghe, R. Prevalence of tobacco and areca-nut use among patients attending dental teaching hospital in the central province of Sri Lanka and its association with oral mucosal lesions; a cross sectional study. J. Oral Biol. Craniofacial Res. 2024, 14, 39–43. [Google Scholar] [CrossRef]
- Lopez, A.M.; Hudson, L.; Vanderford, N.L.; Vanderpool, R.; Griggs, J.; Schonberg, M. Epidemiology and Implementation of Cancer Prevention in Disparate Populations and Settings. Am. Soc. Clin. Oncol. Educ. Book 2019, 39, 50–60. [Google Scholar] [CrossRef]
- Hood, S.; Campbell, B.; Baker, K. Culturally Informed Community Engagement: Implications for Inclusive Science and Health Equity; RTI Press: Triangle Park, NC, USA, 2023. [Google Scholar]
- Wu, S.; Chalela, P.; Ramirez, A.G. Changes in knowledge and awareness for a community-based cancer screening educational program. Arch. Public Health 2023, 81, 130. [Google Scholar] [CrossRef] [PubMed]
- Huchko, M.J.; Olwanda, E.; Choi, Y.; Kahn, J.G. HPV-based cervical cancer screening in low-resource settings: Maximizing the efficiency of community-based strategies in rural Kenya. Int. J. Gynaecol. Obstet. 2020, 148, 386–391. [Google Scholar] [CrossRef]
- Shah, S.K.; Nakagawa, M.; Lieblong, B.J. Examining aspects of successful community-based programs promoting cancer screening uptake to reduce cancer health disparity: A systematic review. Prev. Med. 2020, 141, 106242. [Google Scholar] [CrossRef] [PubMed]
- Kline, K.N.; Rangel, M.L.; Bulsara, S.; Chenier, R.; Escobar, B.; Montealegre, J.; Weiss, M.J. Using Culturally Adapted Theater Outreach to Promote Cancer Screening Among Medically Underserved Minority Communities. J. Racial Ethn. Health Disparities 2025, 12, 273–284. [Google Scholar] [CrossRef] [PubMed]
- Mallawaarachchi, D.V.; Wickremasinghe, S.C.; Somatunga, L.C.; Siriwardena, V.T.; Gunawardena, N.S. Healthy Lifestyle Centres: A service for screening noncommunicable diseases through primary health-care institutions in Sri Lanka. WHO South-East Asia J. Public Health 2016, 5, 89–95. [Google Scholar] [CrossRef]
- Warnasekara, J.; Gamakumbura, M.K.; Konthota, S.D.; Liyanage, L.S.K.; Lakpriya, B.A.D.; Agampodi, S. Is Cancer Screening a Priority among Adult Females in Sri Lanka? Anuradhapura Med. J. 2018, 11, 11. [Google Scholar] [CrossRef]
- Devotta, K.; O’Campo, P.; Bender, J.; Lofters, A.K. Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers. Curr. Oncol. 2024, 31, 4038–4051. [Google Scholar] [CrossRef]
- Tikkanen, R.S.; Closser, S.; Prince, J.; Chand, P.; Justice, J. An anthropological history of Nepal’s Female Community Health Volunteer program: Gender, policy, and social change. Int. J. Equity Health 2024, 23, 70. [Google Scholar] [CrossRef]
- Hilmianà, H.; Iskandar, Y. The role of women in improving the welfare of their families to improve their conditions during the COVID-19 pandemic in Indonesia. Cogent Bus. Manag. 2024, 11, 2373465. [Google Scholar] [CrossRef]
- IARC. International Agency for Research on Cancer. Preamble to the IARC Monographs; IARC: Lyon, France, 2019; Available online: https://monographs.iarc.who.int/iarc-monographs-preamble-preamble-to-the-iarc-monographs/ (accessed on 15 September 2024).
- Rajapaksa, S.W.; Vidanapathirana, J.; Nawaratne, S.; Suranga, M.A. Tobacco control strategies enrich the National Strategic Plan on prevention and control of cancer in Sri Lanka. Asian Pac. J. Cancer Prev. 2021, 22 (Suppl. S2), 45–50. [Google Scholar] [CrossRef] [PubMed]
- Amarasinghe, H.; Warnakulasuriya, S.; Johnson, N.W. Evaluation of a social marketing campaign for the early detection of oral potentially malignant disorders and oral cancer: Sri Lankan experience. J. Oral Biol. Craniofacial Res. 2021, 11, 204–208. [Google Scholar] [CrossRef]
- Palaniraja, S.; Taghavi, K.; Kataria, I.; Oswal, K.; Vani, N.V.; Liji, A.A.; Chandran, A. Barriers and contributions of rural community health workers in enabling cancer early detection and subsequent care in India: A qualitative study. BMC Public Health 2025, 25, 1527. [Google Scholar] [CrossRef]
- Thampi, V.; Hariprasad, R.; John, A.; Nethan, S.; Dhanasekaran, K.; Kumar, V.; Gill, P. Feasibility of Training Community Health Workers in the Detection of Oral Cancer. JAMA Netw. Open 2022, 5, e2144022. [Google Scholar] [CrossRef] [PubMed]
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Dosumu, A.N.; Thanenthiran, A.J.; Sritharan, G.; Mahendran, T.; Surenthirakumaran, R.; Sithamparanathan, K.; Asence, S.; Decker, K.M.; Navaratnam, S. A Report from a Community-Centric Cancer Control Approach in the Post-Conflict Northern Province of Sri Lanka. Int. J. Environ. Res. Public Health 2025, 22, 1492. https://doi.org/10.3390/ijerph22101492
Dosumu AN, Thanenthiran AJ, Sritharan G, Mahendran T, Surenthirakumaran R, Sithamparanathan K, Asence S, Decker KM, Navaratnam S. A Report from a Community-Centric Cancer Control Approach in the Post-Conflict Northern Province of Sri Lanka. International Journal of Environmental Research and Public Health. 2025; 22(10):1492. https://doi.org/10.3390/ijerph22101492
Chicago/Turabian StyleDosumu, Abiola N., Antony J. Thanenthiran, Ganeshamoorthy Sritharan, Thanuja Mahendran, Rajendra Surenthirakumaran, Kandasamy Sithamparanathan, Stephanie Asence, Kathleen M. Decker, and Sri Navaratnam. 2025. "A Report from a Community-Centric Cancer Control Approach in the Post-Conflict Northern Province of Sri Lanka" International Journal of Environmental Research and Public Health 22, no. 10: 1492. https://doi.org/10.3390/ijerph22101492
APA StyleDosumu, A. N., Thanenthiran, A. J., Sritharan, G., Mahendran, T., Surenthirakumaran, R., Sithamparanathan, K., Asence, S., Decker, K. M., & Navaratnam, S. (2025). A Report from a Community-Centric Cancer Control Approach in the Post-Conflict Northern Province of Sri Lanka. International Journal of Environmental Research and Public Health, 22(10), 1492. https://doi.org/10.3390/ijerph22101492