title: Quality of breast cancer early detection services conducted by well woman clinics in the district of Gampaha, Sri Lanka.
abstract: BACKGROUND
  Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District.
  
  
  METHODS
  The study 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 facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire.
  
  
  RESULTS
  CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard 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 breast self-examination (BSE) were substandard in 7- 20 clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ≥70%, the cut off set for satisfaction.
  
  
  CONCLUSIONS
  Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSE.
authors.affiliation: National Cancer Control Programme, Ministry of Health, Maharagama, Sri Lanka. cvithana1@gmail.com
authors.forename: Palatiyana Vithanage Sajeewanie Chiranthika
authors.initials: PV
authors.lastname: Vithana
authors.forename: May
authors.initials: M
authors.lastname: Ariyaratne
authors.forename: Pl
authors.initials: P
authors.lastname: Jayawardana
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D001071:Appointments and Schedules; D001943:Breast Neoplasms / Q000175:diagnosis*; D016504:Breast Self-Examination / Q000592:standards; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006796:Household Work / Q000592:standards; D006801:Humans; D007374:Interior Design and Furnishings / Q000592:standards; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013188:Sri Lanka; D011795:Surveys and Questionnaires; D014932:Women's Health Services / Q000592:standards*