Context

• Recently, Lancet published a report titled ‘Women, Power and Cancer’- on gender inequity in cancer care.
• The report highlights how societal apathy towards women’s health, lack of knowledge, awareness, and absence of quality expertise at the primary care level delayed their access to cancer prevention, detection, and care.

Key Findings of the Lancet Report

• High Incidence and Mortality Among Women
  • The report highlighted that even though men are at a higher risk of cancers that affect both genders, cancer incidence and mortality in women remains high.
  • Globally, women account for 48% of the new cancer cases and 44% of cancer deaths.
  • This happens even though some of the cancers in women, such as breast and cervical cancers, are highly preventable and treatable.
• Deaths Among Women Were Preventable
  • The report said around 6.9 million cancer deaths among women in India were preventable and 4.03 million were treatable.
  • Around 63% of premature deaths due to cancers in Indian women could have been prevented by reducing risk factors, screening, and diagnosis, while 37% could have been averted with timely and optimal treatment.

Reasons Behind the Poorer Outcomes for Women

• Lack of Knowledge and Financial Constraints
  • The report said women face challenges in accessing timely and appropriate care in the absence of knowledge, decision-making and financial powers, and availability of services at the primary level closer to home.
  • Irrespective of which part of the world they live in and which sections of the society they belong to, women are more likely than men to lack the knowledge and power to make informed decisions.
  • It added that they are also much more likely to experience financial catastrophe due to cancer.
• Underrepresentation of Women in Leadership Positions
  • When it comes to providing cancer care, the report said, women are under-represented as leaders, are likely to face gender-based discrimination and sexual harassment.
  • According to the report, the value of unpaid cancer caregiving by women amounts to around 3.66% of India's national health spending.
• Less Health-Seeking Behaviour
  • The healthcare-seeking behaviour is very less among women, especially in the poor sections of the society.
  • While the risk of certain cancers, such as the ones related to exposure to smoke or tobacco, may be similar in men and women, treatment of women is not the priority.
  • This is the reason women are likely to be more affected than men.
• Societal Stigma
  • The most common cancers in women are breast and cervical cancer.
  • However, women hesitate to approach male doctors with these problems or even let a female doctor check the genital area, leading to delays in diagnosis and treatment.
• Unavailability of Health Care Facilities Near Home: The need for travel to district hospitals, state capitals, or to big tertiary hospitals in other states for screening, diagnostic tests, and treatment also leads to delays in treatment, resulting in poorer outcomes.

The Importance of Screening

• When it comes to the two most common cancers in women– breast and cervical – they are highly preventable and treatable.
• Doctors say that women come in at late stages of the disease when both cancers can be caught very early through screening.
• Doctors advise that self-examination of breasts every month, with a clinical examination by a doctor every year.
• Women over the age of 40 should also get a mammography once a year to check for breast cancer.
• Women who detect any lumps during self-examination must consult a doctor immediately.
• For cervical cancer, women between the ages of 25 and 65 years should get a pap smear test to check for pre-cancerous growth on their cervix.
• An HPV test, a test to detect the human papilloma virus that causes most cervical cancers can also be done every five or ten years. 

What Should be the Government’s Role?

• Conduct Large Scale Awareness Programmes
  • One of the most important interventions needed is to create awareness among people, especially women, so they come forward for screening and seek care.
  • When the government carried out an information campaign to tell people that Covid-19 vaccines can prevent deaths due to the infection, people turned up in large numbers to get the shot.
  • The same is needed for cancer prevention.
• HPV Vaccination Programme
  • HPV vaccination programme by the government, which is in the works, is likely to reduce the incidence of the common cancer in women.
  • The vaccine for HPV that causes cervical cancer is already available in the country and an indigenous one has also been developed.
  • The government is working to include the vaccine in the universal immunisation programme for young girls.
  • The vaccine has to be administered in women below the age of 25 years before sexual activity. It prevents the virus from entering the body.
• Make Screening Available at PHC (Primary Health Cantre) Level
  • Screening programme of the government at the level of PHCs and sub-centres can also help in early diagnosis.
  • One of the challenges is that the patients are then lost for follow-up, because they have to go to higher centres for biopsy and then treatment.
• Provide Training to Nursing Staff at PHCs for Simple Procedures
  • For cervical cancer, treatment can be provided by the nursing staff at the PHCs itself, as is done in Bangladesh.
  • Removing precancerous or cancerous lesions in the cervix can be quite easy.
  • Acetic acid which is a dilute form of vinegar can be put on the cervix of the women and the cancerous regions get highlighted in white.
  • A small probe can then be used to either freeze or burn and destroy the tissue. It is not a complex procedure and can be done by trained nurses.

Some Recommendations Made by the Lancet Report

• Regular Collection and Monitoring of Data: The report said there is a need to regularly collect data on gender and social demographics for cancer health statistics.
• Policies to Reduce Exposures: The report called for developing, strengthening, and enforcing laws and policies that reduce exposures to known cancer risks.
• Promote Equal Participation of Women in Cancer Research: The report highlighted that cancer care and research is dominated by men who decide what is prioritised, funded, or studied.
  • The report suggested equitable access to cancer research resources, leadership, and funding opportunities for women.

Conclusion

• There are millions of women who fail to seek early treatment due to multiple reasons, be it family responsibilities or not taking their condition seriously enough.
• Awareness is important among women who are educationally and financially less empowered to arrest the incidence and high mortality among women.