As per the National Program for Prevention and Control of Non-Communicable Diseases (NP-NCD), which of the following screening activities are not done at the Sub-Centre (SC) or Primary Health Centre (PHC) level?

1. A

   VIA for cervical cancer screening

2. B

   Visual inspection for oral cancer

3. C

   Mammography for screening at primary level

4. D

   Screening starts beyond 30 years

Appeared in: INI-CET EXAM -2025

Explanation

• Mammography is a specialized diagnostic imaging procedure used for breast cancer screening.
• It requires sophisticated X-ray equipment and trained radiologists to perform and interpret the results.
• These resources are not available at the primary healthcare level, such as Sub-Centres (SCs) and Primary Health Centres (PHCs).
• Under the NPCDCS, suspected cases of breast cancer identified through Clinical Breast Examination (CBE) at the primary level are referred to higher centers (like District Hospitals) for further investigation, which may include mammography.

Why Other Options Were Wrong

• Option A: Visual Inspection with Acetic Acid (VIA) is a key screening method for cervical cancer that is specifically designed for and performed at the PHC level by trained healthcare personnel.
• Option B: Visual inspection for oral cancer (Oral Visual Examination - OVE) is a fundamental component of the NPCDCS screening program conducted by frontline health workers at the SC and PHC levels.
• Option D: This statement is a correct description of the program's guidelines. The NPCDCS targets individuals aged 30 years and above for opportunistic screening for NCDs, including common cancers. The question asks what activity is not done, and this guideline is followed.

Related Visual

• Visual 1: Flowchart: 'Cancer Screening Pathway in Indian Public Health System'. This visual would illustrate the process from initial screening at the Sub-Centre/PHC level (using methods like CBE, VIA, OVE) to referral and confirmatory diagnosis (including mammography) at higher-level facilities like the District Hospital.
• Visual 2: Infographic: 'Levels of Healthcare in India'. This would show the three-tier system (Primary, Secondary, Tertiary) and list the typical services and resources available at each level, highlighting why mammography is not a primary care service.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Screening activities under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD/NPCDCS) at the primary healthcare level as background academic context rather than a clinical decision trigger.
• Nurses and Community Health Officers (CHOs) at Health and Wellness Centres (HWCs) are pivotal in implementing the NPCDCS. Their role includes conducting opportunistic screening, identifying high-risk individuals, providing health education, and ensuring timely referrals.
• Understanding the referral pathway is crucial for patient safety and effective management. A nurse at a PHC must know that a patient with a suspected breast lump (found via CBE) needs to be referred to a District Hospital for mammography and further evaluation, not managed at the PHC itself.
• What if? If a patient insists on having a mammogram at the PHC, the nurse's role is to educate the patient about the healthcare system's structure, explain why the test is not available at the PHC, and facilitate the referral process to the appropriate facility to ensure the patient receives the necessary diagnostic services without delay.

How to Approach the Question

• First, identify the core elements of the question: the specific program (NP-NCD/NPCDCS), the level of healthcare (SC/PHC), and the action (screening activities not done).
• Next, analyze each option in the context of primary healthcare resources in India. Consider the complexity, cost, and required expertise for each activity.
• Evaluate 'VIA for cervical cancer'. This is a simple visual test, suitable for the PHC level.
• Evaluate 'Visual inspection for oral cancer'. This is also a simple examination, suitable for the SC/PHC level.
• Evaluate 'Mammography'. This is a radiological test requiring an X-ray machine and a specialist. This is not a primary care resource.
• Evaluate 'Screening starts beyond 30 years'. This is a policy guideline, not an activity. The guideline itself is a core part of the program at the primary level. The question asks which activity is not done.

Concept Tested & Keywords

• Concept Tested: Screening activities under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD/NPCDCS) at the primary healthcare level.
• Stem keywords: National Program for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening activities, Sub-Centre (SC), Primary Health Centre (PHC)
• Lead-in keywords: not done
• Negative lead-in flag: NOT

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QzlzcJD8ETMpikUCgsUfyi

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