Quality of Breast Cancer Early Detection Services Conducted by Well Woman Clinics in the District of Gampaha, Sri Lanka

Background: Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detectioncan lead to reduction in morbidity and mortality. Aim: To evaluate selected aspects of breast cancer earlydetection services implemented through well woman clinics (WWCs) in the Gampaha District.
Methods: Thestudy consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE)coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003-2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services.The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values,which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilitiesand clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCsusing an interviewer-administered questionnaire.
Results: CBE coverage in the Gampaha district increasedonly from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were ratedsubstandard varied between 7-18 (35- 90%). The items that were lacking included dust bins, notice boards,stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities,punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breastself-examination (BSE) were substandard in 7- 20 clinics (35-100%). Client satisfaction for WWC services was45.2% (IQR: 38.7-54.8%) and only 11% had a score of ≥70%, the cut off set for satisfaction.
Conclusions: Breastcancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years aftercommencing WWCs. All 20 clinics were substandard for overall CBE and BSE.