WOMEN’S EMPOWERMENT, CADRE TRAINING, AND MASS EXAMINATION FOR CERVICAL CANCER DETECTION

Cervical cancer is the most commnon type of cancer in women and the main reason people die from cancer in poor countries like Indonesia. Cervical cancer is a type of cancer that is caused by the Human Papillomavirus (HPV) and can be dangerous to a woman’s health. Cervical cancer has the second most cases and deaths in the world, after breast cancer. The East Java Provincial Health Office’s Health Profile for 2021 says that Trenggalek is an area with a low rate of cervical cancer screening. So, we started doing community service projects to make more people aware of cervical cancer and how to find it early. Some ot the things that are done are health education about cervical cancer and ways to find it early. During this practice, women of reproductive age (WRA) were also asked to take part in a free Visual Acetate Acid (VIA) test done by the team. The next event was a free VIA test, which 21 WUS students took part in. The results of the VIA test showed that 20 people had bad VIA and one person had good VIA. The team then sent people who had a good VIA to get more care. Women, cadres, and other important people in the community can learn more about cervical cancer through community service. However, community service in other areas is needer in the coming year so that this issue can be brought up and the community can benefit from it, especially since cervical cancer is on the rise. People also think that is would change how women with cervical cancer get their treatments and improve their quality of life.


INTRODUCTION
According to the World Health Organization (WHO), cancer is one of the noncommunicable diseases that pose a threat to global health.Cancer, also known as neoplasms or malignant tumors, is a disease characterized by the presence of abnormal cells that can grow uncontrollably and have the ability to attack and spread throughout the body's cells and tissues (WHO, 2021).
Cervical cancer is a gynecological malignancy caused by the Human Papillomavirus (HPV) that can lead to health issues for women, particularly in developing nations.The incidence and mortality rate of cervical cancer is second only to breast cancer worldwide.In developing countries, it remains the leading cause of cancer-related deaths among those of reproductive age.Nearly 80 percent of instances occur in developing nations.In addition to the HPV virus, the American Cancer Society (2019) lists sexual history, a weakened immune system, long-term use of oral contraceptives, an elevated gravida, an early age at first pregnancy, and a family history of cervical cancer as additional causes of cervical cancer.The incidence of this malignancy begins between the ages of 25 and 34 and peaks between 45 and 54.
Due to the prolonged precancerous phase, cervical cancer is a preventable disease.From the onset of HPV infection to the development of cervical cancer, there is a three-to twenty-year period of time.In its precancerous and early stages, cervical cancer is a silent disease because it does not cause symptoms or complaints.Therefore, routine screening is required for the early detection of cervical cancer.Screening or early detection is the examination of women without symptoms for precancer and cancer.When screening is performed as early as possible and precancerous lesions are identified, cancer is more treatable and has a greater chance of being cured.Screening is prescribed for all women aged 30-49 at least once in their lifetime, and preferably more frequently (Mastutik et al., 2015;Zuliyanti, 2018).
Screening tests can identify cervical cancer in its precancerous stage.IVA and Pap smear are frequent screening methods.Pap examination is the standard diagnostic for cervical cancer screening.The Pap test has not been effective to reduce cervical cancer mortality and morbidity in Indonesia.This is due to a number of factors, including human resource factors, funds, facilities/infrastructure, implementing organizations, geographical conditions, and the reality that screening should be performed by women.One of the additional causes is that health personnel' awareness of cervical cancer remains low.Due to these issues, the Pap test screening rate in Indonesia remains low.Consequently, IVA is presently used as an alternative screening method for cervical cancer detection.IVA screening has not been extensively implemented, however, due to the novelty of the technique.
According to the Health Profile of the East Java Provincial Health Office for the year 2020, Trenggalek is a district with a low IVA examination rate, specifically 0 out of 1087 WUS.In order to improve the early detection of cervical cancer in Trenggalek Regency, it is necessary to implement integrated actions involving the community, health cadres, and health professionals.

COMMUNITY SERVICE METHOD
The method of activity in the implementation of community service consists of 4 parts: d.Follow up on the target of counseling by asking their wish to participate in IVA examination activities that will be carried out by the UNAIR community service team and making a list of IVA examination participants.

Part 3 : Free IVA Examination
A free IVA examination will be carried out after activities 1 and 2. This examination is to facilitate WUS in early detection of cervical cancer.Participants in this activity were health cadres who had been trained, participants in counseling on early detection of cervical cancer, and WUS who were aware of the importance of early detection of cervical cancer.

Section 4 : Program Evaluation
Program evaluation is carried out by looking at the success of cadres in advocating for WUS to conduct early detection of cervical cancer.This activity was carried out through a Focus Group Discussion (FGD) which involved all village cadres and midwives.From the evaluation activities, the midwifery study program team will analyze the obstacles found and discuss follow-up plans.

RESULTS AND DISCUSSIONS
Community service is an effort to disseminate science, technology and art to the community.These activities must be able to provide added value to the community, both in health (medical), economic, policy, and behavior change (social) activities.Describe that community service activities have been able to make changes to individuals/communities and institutions, both short and long term.This community service activity has been completed in September 2022 with the following details:

Refresher/training of cadres
The training for health cadres was delivered by the UNAIR community service team which contained material on cervical cancer, signs and symptoms, factors that influence cervical cancer, early detection examinations and the role of cadres in early detection of cervical cancer.This training was attended by 30 health cadres in the Karanganyar Health Center area.Held on September 27 2022 at the Krandegan village hall, Gandusari Trenggalek sub-district.

Health Education to Women of Reproductive Age
Counseling for Women of Reproductive Age was delivered by the UNAIR community service team which contained material on cervical cancer, signs and symptoms, factors that influence cervical cancer, early detection examinations and the role of cadres in early detection of cervical cancer.This counseling was attended by 80 health cadres in the Karanganyar Health Center area.Held on September 27 2022 at the Krandegan village hall, Gandusari Trenggalek sub-district.

Free IVA Examination
This examination is to facilitate WUS in early detection of cervical cancer.Participants in this activity were health cadres and participants in early detection of cervical cancer counseling.This activity was attended by 21 WUS with the results of 20 people with negative IVA and 1 person with positive IVA.The team then referred patients with positive IVA for further management.In this IVA examination activity, the UNAIR community service team also provided guidance to Karanganyar health center midwives to carry out IVA examinations and motivated them to activate IVA examinations for WUS.
Following the conclusion of the implementation, a post-test was administered to assess the knowledge level of public health cadres.From the calculation results of the pre-and post-tests, it can be concluded that the knowledge level of community cadres has increased by 26% after community service.This is consistent with Fitriyani's (2020) research, which indicates that providing health education has an effect on increasing knowledge of early detection of cervical cancer during the Covid19 pandemic (Fitriyani, 2020).Knowledge and attitudes facilitate cervical cancer detection at an early stage.Participation in cervical cancer screening examinations is influenced by women's level of knowledge.This is also consistent with the majority of one's knowledge being acquired through hearing (ears) and sight.(eyes).A person's knowledge of objects also varies in intensity or level, so mass media can be used to provide counseling or information in an effort to increase public awareness of VIA early detection (Notoatmodjo, 2012).
It should also be noted that the intensity of a person's knowledge of the subject varies, so counseling or information can be disseminated through the media in an effort to increase public knowledge about early detection of IVA (Izza, 2020).Therefore, we must continue to conduct community service activities in other areas in the coming year so that this issue can be raised and disseminated more broadly, public knowledge about cervical cancer increases, and women of childbearing age become more aware of and empowered to conduct cancer screenings.cervix.In addition, increased awareness and high coverage of screening for early detection of cervical cancer can influence the optimization of treatment in order to enhance women's quality of life.
1. Part 1 : Refresher/Training of Cadres Cadre training to increase cadre knowledge about cervical cancer, signs and symptoms, factors that influence the occurrence of cervical cancer, early detection examinations and the role of cadres in efforts to detect cervical cancer early.This training was attended by all health cadres in the Karanganyar Health Center area.2. Part 2 : Health Education to Women of Reproductive Age: a. Education about cervical cancer and early detection of cervical cancer by the Midwifery Study Program team, Faculty of Medicine, Airlangga University.b. Questions and answers and discussion about the education that has been given.c.Filling out the questionnaire for pretest and posttest.