Overview of Ten Years (2007-2016) Cervical and Breast Cancer Screening Program in Indonesia

Abstract

Background: Cervical and breast cancer screening have been national program in Indonesia since 2007. The Ministry of Health of Indonesia in collaboration with provincial and district government developed and implemented the program. Method of cervical cancer screening was visual inspection with acetic acid (VIA) or Papanicolaou test and early treatment with cryotherapy for VIA positive. Meanwhile, method of breast cancer screening was clinical breast examination (CBE). After 10 years of implementation, it need to know how the program was conducted and what the results are. Aim: The study was aimed to know activities and results of cervical and breast cancer screening in 10 years (2007-2016). Methods: Design of the study was descriptive study through literature and data review from related data and information sources. Secondary data were collected from Directorate of Non Communicable Disease Control, Ministry of Health, Directorate of Primary Health Service, and professionals. The study was conducted in November-December 2017. Results: Program of cervical and breast cancer screening was started by pilot project in 2007 by 6 districts of 6 provinces in Indonesia: Jakarta, West Java, Central Java, Jogjakarta, North Sumatera, and South Sulawesi. By April 21, 2008 the program was launched as national program by Indonesian First Lady. Then, the program was developed in all province in Indonesia. Activities conducted to develop the program were training of trainers at national level, trainings at district level, socialization to community, providing services of the screening, monitoring, and evaluation. The screening was provided by trained health care provider (general practitioner and midwife) in primary health centers with referral system to district/municipality hospitals. Target of the program was women aged 30-50 years. Since 2007 till 2016, the program was running in all 34 (100%) provinces, 393 out of 514 districts/municipalities (76%), 3706 out of 9813 primary health centers (38%). Clinical trainers of the program were 366 persons consists of OB/GYN oncologist, OB/GYN surgeon oncologist, surgeon, general practitioners, and midwives. Providers of screening were 8526 persons consists of 2783 general practitioners, and 5743 midwives (2.3 providers per primary health center). There were 375 cryotherapy set for early treatment of VIA positive. The result of ten years cervical and breast cancer screening showed that 1,925,943 women have been screened or 5.15% of target 37.4 million women. It was still lower than target of 20% in 2016. VIA positive 73,453 women (3.8%), suspect of cervical cancer 1739 (1 per 1000), lump/tumor in the breast 4030 women (2.1 per 1000). Conclusion: Cervical and breast cancer screening program was running in all provinces and majority of district/municipalities in Indonesia with adequate human resources, but the coverage of the screening was still low.