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Journalism of Courage
Thirty six-year old Rama Devi from Mumbai’s Nala Sopara area did not know that her headaches stemmed from a developing brain cancer as her alcoholic husband never thought it merited a basic consultation. “If you die, then die. If you live, then live,” he told her as she went through physical abuse. The local doctor dismissed her condition as an eye problem. It was because of her father-in-law, a small-time vendor, who ensured she got medical attention and diagnosis. Her story is a representative case of women living with cancer, domestic violence and poverty, who cannot access treatment and quickly degenerate into advanced stages. She features among many others in a new Lancet Commission report on gender inequity in cancer care.
The report, titled “Women, Power and Cancer,” 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. The study authors found that nearly two-thirds of the cancer deaths in Indian women were preventable and 37 per cent were treatable if only they had been diagnosed on time and accessed optimal care. Around 6.9 million cancer deaths in women were preventable and 4.03 million were treatable.
Dr Ishu Kataria, Commissioner, Lancet, pointed out that women in India diagnosed with cancer died because of family apathy, their own indifference to their condition, lack of access and finance. Emphasising the need for a feminist approach to cancer, she says, “We need cancer to be seen as a priority issue in women’s health. Women interact with cancer in various ways, not only as people living with the disease but also as unpaid caregivers, individuals participating in cancer prevention and screening at the national level, healthcare providers, researchers and policy makers. In this context they face gender bias and discrimination on multiple fronts, be it due to their age, ethnicity, socio-economic status, gender identity or sexual orientation. This hinders their ability to seek good quality care for both diagnosis and treatment.”
In terms of cancer deaths among women, the official data shows that top three cancers in India — breast, cervical, ovarian — were the leading causes in 2020. Infection continues to be the biggest risk factor for cancer in Indian women, contributing to 23 per cent of deaths. Infections that increase the risk of cancers include the HPV virus, which causes cervical cancer, and Hepatitis B and C infections that increase the risk of liver cancer. Tobacco was the second important risk factor for cancer, contributing to six per cent of the cancer deaths, the report said. Alcohol consumption and obesity each contributed to one per cent of cancer mortality in India.
Rama’s case is representative of many dispossessed women in India. Married at the age of 16 to a man 15 years older, she birthed two daughters, now aged 18 and 13, and a son, currently aged five. Rama’s husband drives an auto-rickshaw in the day and drinks at night, too self-involved to bother about her headaches and vomitting, which began in 2015. For two years, Rama consulted a local doctor, who dismissed it as an eye problem, recommending glasses that she got made for Rs 1,000. But her headaches and the vomiting continued and she was admitted to a hospital and diagnosed with brain cancer. With an apathetic husband, the family ran into financial problems forcing the children to drop out of school. Her elder daughter took up a factory job while Rama sold her family jewellery.
The trend in Lancet is also echoed by patients at Tata Memorial Centre’s Homi Bhabha Cancer Hospital and Research Centre at Muzaffarpur, Bihar. Thirty nine-year-old Ranidevi (name changed) from the nearby Kanhara village developed a small ulcer on the right side of her tongue last December. Her salesman-husband took her to a local doctor, who assured them that it would heal with pills and ointments. The doctor failed to gauge the seriousness of the situation and it was only seven months later, when she had difficulty in eating and swallowing, that she came to the centre and was diagnosed with Stage IV tongue cancer. Here access was not the problem but the local doctor’s lack of knowledge was. Ranidevi is now struggling to speak as 80 per cent of her tongue has been removed. “Had she come in early, only 20 per cent of her tongue would have been removed. She would not have required a tracheostomy to breathe and her quality of life would have been better,” says Dr Burhanuddin Qayyumi, Assistant Professor, Homi Bhabha Cancer Hospital and Research Centre, Muzaffarpur.
Ranidevi’s story is like many others in the Lancet study 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,” says Dr Pankaj Chaturvedi, Deputy Director, Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai.
