Cancers of cervix and breast account for 50% of cancers and 42% of all deaths respectively from cancers among women in India. A research project entitled "Early Detection of Common Cancers in Women in India" was set up in 1998 by the Tata Memorial Hospital to investigate the efficacy of simple low cost tests such as Visual Inspection of the cervix with Acetic Acid (VIA) for the early detection of cervical cancers and Clinical Breast Examination (CBE) for the early detection of breast cancers. In this project around 75,000 women were enrolled in the Screening Arm. These women were invited for health education on cancer awareness and screening for breast and cervical cancers four times at an interval of two years. The last time they received health education was around a decade back. Another group of approximately 76,000 women were enrolled in the Control Arm of the trial. These women were invited for one single round of cancer related health education at the time of enrollment, which was nearly 15 years ago. The current sub-study is planned according to the instructions from the present External Data Safety Monitoring Committee (DSMC) after their review of the study in March 2016 and March 2017. It was advised by the DSMC to conduct a companion nested case control study to the main trial to evaluate the long-term retention of the given cancer awareness education.

The Primary Objectives of the trial are to evaluate the long term retention of cancer awareness education among the trial participants.

Methodology: Study Area: Twenty slum-clusters of Mumbai, which were already selected by simple random sampling and randomized into 10 Screening-Clusters and 10 Control-Clusters, from the ongoing study and one nearby slum cluster with similar socio – economic background, which was not included in the prior intervention.

Study Population:

1) Arm 1: Randomly selected participants from one of the randomly selected clusters of the screening arm, from among the 10 screening clusters of the ongoing study

2) Arm 2: Randomly selected participants from one of the randomly selected clusters of the control arm, from among the 10 control clusters of the ongoing study

3) Arm 3: Socio-economically and age wise similar women from one new cluster which is randomly selected from the three slum clusters in Mumbai (wherein women have not been exposed to such cancer awareness programme before).

The women will be enrolled in the study only after obtaining the informed consent . Personal interviews using a pre-designed questionnaire will be conducted for each of these enrolled women to evaluate the retention of health education among participants in Arm 1 and Arm 2. The women from Arm 3 will also be interviewed using the same questionnaire to assess their knowledge regarding various aspects of cancer. The questionnaire will mainly cover the risk factors, signs and symptoms, methods of early detection, prevention and basic modality of management of breast, cervical and oral cavity cancers, since these topics were covered in the health education delivered in the main study.

Sample size: Around 400 randomly selected participants from each arm will be listed.

Benefits:

a) The information gained by conducting personal interviews will help us understand the duration and content retention of health education about common cancers in women when delivered once and when delivered up to four times, as compared to the similar general population of women who have never been exposed to structured, organized cancer related health education. b) The results of this study would be beneficial to guide the public health professionals and policy makers to understand better the modality, frequency and impact of community based health education.