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Journalism of Courage
Several years ago, Reshma (name changed), then in her early 30s, was desperately searching for the drug Herceptin (trastuzumab), a game-changer for treating human epidermal growth receptor 2 (HER2) positive breast cancer. This is more aggressive than other breast cancers as cells over-produce a protein that in turn prods cancer cells to grow and divide faster. However, targeted therapies can block the HER2 protein. Survival rates are high when cases are diagnosed and treated early.
Despite her readiness for dealing with her cancer, which was diagnosed at stage 2, the prohibitive cost of the drug at that point of time delayed her treatment further. Her search took her from Mahabaleshwar to Pune, where a contact led her to the Prashanti Cancer Care Mission, an NGO which was set up by patient families and doctors. Fortunately, she was treated in time. “We had set up a fund for patients unable to afford treatments. In fact, it was called the Herceptin fund, which has now benefitted around 150 patients,” says Dr C B Koppiker, mission founder and breast onco-surgeon at Orchids Breast Health Centre, Pune. With timely care and treatment, Reshma recovered quickly. Supportive therapies and counselling at the centre meant that she did not have to deal with her cancer in isolation.
“Early diagnosis and timely access to treatment are critical for achieving positive outcomes in cancer patients. Cure rates can go up from 50 to 80 per cent,” says Dr Koppiker. “The socio-economic status of women, limited education, low awareness and the distances to screening centres in rural areas are some of the challenges that prevent early detection of symptoms. However, latest campaigns and efforts across the country have stepped up and breast conservation rates have improved to 30 per cent across the country,” he adds.
This is the gap that has been flagged by the latest Lancet study, which shows that compared to high income countries, where breast and cervical cancers were diagnosed early in 40 per cent of women patients, the number fell to 20 per cent in low and middle-income countries.
New research findings have found that one in five women with breast or cervical cancer in low and middle income countries are diagnosed at an early stage as compared to more than one in three in high income countries. “The situation in India is similar to that of other low and middle income countries(LMICs), where the proportion of early-stage tumours is far too low, leading to lower survival. Early detection is key but should not be limited to screening programmes,” says Prof Claudia Allemani, lead author and professor of Global Health at London School of Hygiene and Tropical Medicine(LSHTM) in an email response to The Indian Express. This means that access to care and therapy should be just as easy. She feels in India, universal health coverage would be essential to address social, economic, and geographic inequities in cancer care.
Findings from the VENUSCANCER project, led by LSHTM, provide the first global picture of pathways to care. Data from more than 2,75,000 women in 39 countries between 2015 and 2018 (India was not part of the study then) show that the proportion of women, whose cancer was detected at an early stage, was 40 per cent or higher in high income countries for cervical or breast cancers but much lower in low and middle-income countries at below 20 per cent.
Ovarian cancer is least likely to be diagnosed early across the world, at less than 20 per cent. This means that women in low and middle-income countries have it worse as they are not being diagnosed until the disease advances.
For all three cancers (breast, cervical and ovarian), women in LMICs experienced longer waits to receive surgery after diagnosis.
Cancers of the breast, cervix and ovary, comprising 34 per cent of all cancers in women in 2018, are a major public health problem worldwide. More than 3.2 million diagnoses of breast, cervical and ovarian cancers were predicted for 2022, with over 1.2 million deaths attributable to these cancers, as per the Lancet report. In India, the Global Cancer Observatory (GLOBOCAN) 2022 estimates for breast cancer in the female population include 1,92,020 new cases. The figure was 1,27,526 for cervical cancer and 47,333 for ovarian cancer.
The network of population-based cancer registries has been strengthened in the past decade. Prof Allemani hopes to include data from India in future projects. Population-based cancer registries collect data on every person diagnosed with cancer in their territory (province, state, region, or the whole country) over time.
In India, the National Programme for Prevention and Control of Non-Communicable Diseases includes the population-based screening of oral, breast and cervical cancers. Participation in the screening programme is low, with only one to two per cent of women, aged between 30 and 49 years, showing up.
Given this scenario, Prof Allemani suggests that non-specialised doctors should be trained to recognise early symptoms promptly. “Mobile screening units may also help increase participation,” she says. “With India recently introducing the HPV vaccine as part of the National Immunisation Programme to prevent cervical cancer, it will be important to educate girls and raise awareness in families about the importance of early detection and prevention,” Prof Allemani adds.
