10 October 2025
Anonymous Writer
A research team from the Faculty of Medicine, Universitas Sumatera Utara (FK USU), in collaboration with the SingHealth Duke-NUS Global Health Institute (SDGHI), Singapore, is conducting a collaborative study titled “Strengthening Health Systems to Improve Early Breast Cancer Diagnosis in Medan, North Sumatra.”
The study is led by dr. Ivana Alona, MPH, Sp.KKLP (FK USU) and Prof. Tan Hiang Khoon, MBBS FRCS(Ed) FAMS PhD (CEO of Singapore General Hospital – SDGHI), with support from FK USU researchers including Dr. dr. Isti Ilmiati Fujiati, M.Sc, CM-FM; Prof. Dr. Dr. Dedy Hermansyah, Sp.B (K-Onk); dr. Denny Rifsal Siregar, Sp.B (K) Onk; and dr. Endi Taris Pasaribu, M.Si., Sp.B (K-Onk). The team also includes Dr. Dra. Erni Asneli Asbi, M.Si from the Faculty of Social and Political Sciences (FISIP) USU, as well as two SDGHI researchers, Kaisin Yee, MPH and Sarah Suprat, M.Soc.Sci.
FK USU hosted the SDGHI team for three days, during which activities included guest lectures, visits to hospitals and community health centers (Puskesmas) in Medan, and discussions with policymakers, professional organizations, and the Chair of the Family Welfare Empowerment Team (TP PKK) of North Sumatra.
Background and Urgency
Breast cancer remains the most common cancer among women in Indonesia and the leading cause of cancer-related deaths. GLOBOCAN 2022 data show that breast cancer constituted 16.2% of all new cancer cases in 2022, totaling 66,271 cases.
Early detection programs through SADARI (breast self-examination) and SADANIS (clinical breast examination) have been promoted since 2007 and reinforced by the 2008 national declaration “Save Indonesian Women from Cancer.” However, screening coverage remains low—surveys indicate that around 90% of women have not undergone SADANIS in the past three years, and most patients present at advanced stages (60–70%).
In line with Minister of Health Regulation No. 29 of 2017, breast and cervical cancer control is a national priority. Nevertheless, significant challenges persist in practice. Systematic reviews conducted by the research team identified multiple contributing factors, including psychological barriers, low health literacy, inefficiencies in the healthcare system, and socio-economic and cultural constraints. These challenges form the basis of the FK USU–SDGHI collaboration to identify systemic and social barriers and develop community-based strategies to enable earlier and more equitable breast cancer diagnosis in Medan.
Research Objectives and Approach
This study aims to provide practical solutions to delayed breast cancer diagnosis by strengthening community-based health systems. The primary focus is to validate barriers faced by women in accessing early diagnosis—ranging from limited access and low symptom awareness to communication challenges between patients and healthcare providers.
Using a participatory approach, the research team engages diverse stakeholders—doctors, primary healthcare workers, policymakers, community organizations, and women’s health cadres—to formulate contextual and implementable strategies.
The 18-month study is divided into three phases:
Phase One: Qualitative and quantitative methods, including focus group discussions (FGDs) and in-depth interviews with patients, healthcare providers, and community leaders to understand real-world barriers.
Phase Two: Strategy formulation and intervention design, translating field findings into actionable recommendations through collaborative workshops. Interventions include improving community health literacy, enhancing doctor–patient communication training, and strengthening digital referral mechanisms.
Phase Three: Pilot implementation, assessing the effectiveness of developed strategies—such as cadre training, improved clinical screening services, and technology-based patient tracking—to evaluate their impact on accelerating diagnosis and increasing public awareness.
Audience with the Chair of TP PKK North Sumatra
As part of the research activities, a delegation comprising dr. Ivana Alona, MPH, Sp.KKLP (Principal Investigator, FK USU); Kaisin Yee and Nursarah Suprat (SDGHI); Prof. Dr. dr. Arlinda Sari Wahyuni, M.Kes, FISPH, FISCM, Sp.KKLP (Head of the Department of Community and Preventive Medicine FK USU); dr. Putri C. Eyanoer, Ms.Epi Ph.D, FISPH, FISCM, Sp.KKLP (Head of the Sp.KKLP Program); Dr. Dra. Erni Asneli Asbi, M.Si (FISIP USU); and dr. Fernando Silalahi, Sp.B (K-Onk) (PERABOI), held an audience with Mrs. Kahiyang Ayu, Chair of TP PKK North Sumatra. The meeting was also attended by the Head of the North Sumatra Provincial Health Office, H. Muhammad Faisal Hasrimy, A.P., M.A.P., and his team.
Mrs. Kahiyang emphasized the critical role of PKK as a grassroots women’s movement in raising awareness of early breast cancer detection. She expressed support for regular seminars and cadre training every 3–6 months to ensure sustained competence. PKK’s involvement is expected to expand outreach for SADARI and SADANIS education to the smallest community units and strengthen referral networks from communities to health facilities. She also suggested expanding implementation areas to other regions in North Sumatra, such as Binjai, Deli Serdang, and Serdang Bedagai.
Discussions with Adam Malik Hospital, Medan Health Office, and PERABOI
The research team also engaged in discussions with various stakeholders to gain deeper insights into barriers to early breast cancer detection from psychological, social, and health system perspectives.
At RSUP H. Adam Malik, Prof. Dr. dr. Kamal Basri Siregar, Sp.B (K) Onk, FICS, MHKes, noted that 70% of patients present at advanced stages. Key barriers include delayed tiered referrals (Puskesmas–Type B/C hospitals–Type A hospitals), limited BPJS coverage for early screening, insufficient training and empathy among healthcare providers, and low awareness of SADARI/SADANIS. The team highlighted the need for referral policy reforms, financial incentives, and enhanced communication training for doctors. Integration of digital systems (iCare, ASIK) and utilization of the Adam Malik cancer registry were also proposed for spatial analysis and data-driven policymaking.
From the Medan City Health Office, represented by dr. Pocut Fatimah Fitri, MARS, it was emphasized that although SADARI campaigns have been conducted since 2023, behavioral change remains limited due to fear of treatment and distrust in doctors. Direct, empathetic education by cadres and physicians was deemed essential. The Health Office estimates that only 10% of women are familiar with SADARI, and achieving 50% coverage is considered a success. Regular training and modest incentives for cadres and doctors were strongly recommended to sustain motivation.
Discussions with PERABOI and the Oncology Subspecialty Program FK USU, represented by Prof. Dr. Dr. Dedy Hermansyah, Sp.B (K-Onk) and dr. Endi Taris Pasaribu, M.Si., Sp.B (K-Onk), emphasized USU’s potential role as a coordinating body for education, research, governance, and integrated health policy pilots—such as establishing a “Breast Cancer Research Board.” Plans include service assessments aligned with FK USU’s oncology strengths, expanded SADARI/SADANIS training, integrated community–Puskesmas–hospital data systems, and a paradigm shift positioning doctors as patient companions rather than mere service providers.
Toward a Responsive and Inclusive Health System
These engagements mark a significant milestone in strengthening synergy among academia, government, civil society, and healthcare providers to build community-based early detection systems. The next phase will involve pilot implementation in Medan, engaging PKK cadres, healthcare workers, and digital referral systems. The outcomes are expected to serve as a national model replicable across regions and provinces.
As stated by dr. Ivana Alona,
“Early detection is not merely a medical issue—it is social and systemic. Only through cross-sector collaboration can we save more women from breast cancer.”
News of this audience has also been published on the official North Sumatra Provincial Government portal:
👉 PKK North Sumatra Ready to Collaborate with Multiple Parties to Address Breast Cancer
Contact:
dr. Ivana Alona, MPH, Sp.KKLP
Principal Investigator & Lecturer, FK USU
📧 ivana@usu.ac.id
Signing of a Cooperation Agreement Between the Faculty of Medicine, USU and the Faculty of Medicine and Health Sciences, Universitas Jambi for the Development of the Pulmonology and Respiratory Medicine Specialist Training Program
NewsIntegrated Laboratory of the Faculty of Medicine, USU Undergoes KAN Accreditation Surveillance
NewsUSU Faculty of Medicine Receives Visit from Chief Assessor of the National Accreditation Committee to Strengthen Laboratory Quality Standards
