Mehra Golshan, MD, MBA

Improving screening and treatment uptake in rural India.

Impact

Cancer is one of the leading causes of death in both developed and developing countries. The most common cancers in India are breast, cervix, lung, and oral cancers and most deaths occur in individuals younger than 70 years old. This is because the overall population of India is younger and has high cancer rates. Additionally, there are unique local patterns of tobacco use as well as the use of betel nuts and leaves, which have been shown to be carcinogenic. Poor access to screening, delayed diagnoses, and inadequate, incorrect, or suboptimal treatment (including patient inability to access or complete appropriate therapies) are the chief factors that contribute to poor cancer survival in India. Dr. Golshan is working to build a program to improve access to screening and treatment in rural India.

Progress Thus Far

Dr. Golshan has set up a three-tier model for community-based screening of breast, cervical, and oral cancers in Assam, India. The objectives of the DESH (Detect Early Save Her/Him) program are to reduce the proportion of late-stage diagnosis and mortality from breast, cervical, and oral cancers through a community-based screening and referral program. The model for cancer prevention implemented under DESH includes the following four components: 1) Community-based education regarding cancers and their risk factors and about the importance of screening; 2) Screening for cancer of the breast, cervix, and oral cavity; 3) Referral to a cancer center; and 4) Supportive care of cancer patients. Dr. Golshan and his team set up two fully functional, mobile cancer screening units that are equipped to carry out digital mammography, clinical breast examinations, visual inspections of the cervix, and visual inspections of the oral cavity. Dr. Golshan’s initial screening project, DESH 1.0, screened 16,404 people from 105 villages. The team identified 251 screen-positive patients who were diagnosed and treated for cancer. The second phase of DESH that started in 2019 has screened and triaged over 25,000 people for breast, cervical, and oral cancer. This has been the largest breast, cervical, and oral cancer combination screening trial in India’s history.

What’s next

Dr. Golshan is now working to combine the data of nearly 30,000 screened patients from the first two phases of DESH. The team is now actively launching programs in urban areas as well as continuing in rural Assam. The team is analyzing the data for outcomes and next steps in terms of rolling out a larger state and national screening trial.