LANCET COMMISSION REPORT ON GENDER INEQUITY IN CANCER CARE

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Context: The Lancet report titled 'Women, Power and Cancer' sheds light on the gender disparities in cancer diagnosis, treatment, and outcomes in India.

Key points from the report and expert opinions:

Preventable and Treatable Deaths

• The report highlights that a significant number of cancer deaths among women in India are preventable (6.9 million) and treatable (4.03 million). This suggests that many women are not receiving timely and adequate care.

Global Gender Disparities

• Despite women being at a lower overall risk of cancer compared to men, cancer incidence and mortality rates among women are still high globally. Women make up 48% of new cancer cases and 44% of cancer deaths worldwide. Some cancers that primarily affect women, such as breast and cervical cancers, are highly preventable and treatable.

Barriers Faced by Women

• Women face various challenges in accessing cancer care, including a lack of knowledge, decision-making power, and financial resources. They also often lack access to primary healthcare services closer to their homes. Additionally, they are more likely to experience financial hardships due to cancer.

Underrepresentation and Discrimination

• Women are underrepresented in leadership roles in cancer care, face gender-based discrimination, and may experience sexual harassment. They also constitute a significant unpaid workforce in cancer care, with their contribution estimated at 3.66% of India's national health expenditure.

Societal Changes Needed

• Experts emphasize the need for societal changes, such as promoting healthcare-seeking behaviour among women, addressing cultural taboos related to certain cancers, and encouraging early diagnosis and treatment.

Importance of Screening

• Early screening for common cancers in women, such as breast and cervical cancers, is crucial. Self-examination of breasts, clinical examinations by doctors, mammography for women over 40, and regular pap smear tests for cervical cancer are recommended.

Government Interventions

• The government can play a significant role in raising awareness about cancer prevention and screening. Expert opinions suggest that campaigns similar to COVID-19 vaccination drives can help increase participation in screening programs. Additionally, the introduction of an HPV vaccination program can reduce cervical cancer incidence.

Primary Health Centers

• To improve early diagnosis and treatment, primary health centres and sub-centres should be equipped to provide cancer care, particularly for cervical cancer. Trained nursing staff can play a crucial role in performing simple procedures to remove precancerous or cancerous lesions.

Data Collection and Research

• The report emphasizes the importance of collecting gender and social demographic data in cancer health statistics. It calls for the development and enforcement of policies to reduce known cancer risks and for greater equity in access to cancer research resources, leadership positions, and funding opportunities for women.

Cancer

• Cancer originates from genetic mutations that disrupt the normal regulation of cell growth and division. These mutations can be caused by various factors, including exposure to carcinogens such as tobacco smoke, radiation, certain chemicals, and genetic predisposition. These genetic changes lead to the uncontrolled growth of cells, resulting in the formation of a tumour.

Transmission of Cancer

• Cancer is not a contagious disease and cannot be transmitted from person to person like infectious diseases. It is a result of internal cellular changes and external factors that cause genetic mutations. However, some cancers may have a hereditary component, meaning that certain genetic mutations can be passed down from one generation to another, increasing the risk of developing cancer within a family.

Symptoms of Cancer

• Sudden and unexplained weight loss can be a sign of several types of cancer.
• Persistent and unrelenting fatigue that doesn't improve with rest.
• Ongoing pain that is not attributed to a specific injury or condition.
• Skin changes such as darkening, yellowing, or changes in moles.
• Persistent changes in bowel or bladder habits, such as blood in the stool or frequent urination.
• The presence of lumps, bumps, or masses that can be felt or seen.
• A chronic cough, hoarseness, or persistent respiratory symptoms.
• Difficulty swallowing or persistent indigestion.
• Changes in the menstrual cycle in women, including heavy bleeding or irregular periods.
• Neurological symptoms such as headaches, seizures, or changes in vision.

Cure for Cancer varies depending on the type, stage, and location of the cancer

• Surgery: Removal of the tumour or affected tissue.
• Chemotherapy: Use of drugs to kill cancer cells or stop their growth.
• Radiation Therapy: Use of high-energy radiation to target and destroy cancer cells.
• Immunotherapy: Boosting the body's immune system to fight cancer.
• Targeted Therapy: Medications that specifically target cancer cells.
• Hormone Therapy: Used for hormone-related cancers to block or alter hormone production.
• Stem Cell Transplant: Replacement of damaged bone marrow with healthy stem cells.

Gender Disparities in Cancer Diagnosis, Treatment, and Outcomes in India

• Gender disparities in cancer care in India can be traced back to deeply entrenched social and cultural norms. These norms have historically limited women's access to education, decision-making power, and economic independence. Additionally, traditional gender roles often place women in caregiving roles, leaving them with less time and resources for their healthcare.

Reasons for Gender Disparities in cancer care

Limited Healthcare Access

• Geographical Barriers: In India, a significant portion of the population resides in rural areas where healthcare facilities are often scarce and distant. Women in rural areas face challenges reaching healthcare centres, especially if they lack reliable transportation.
• Financial Constraints: Many women in India, particularly those from lower-income households, struggle to afford healthcare expenses. The cost of medical consultations, diagnostic tests, and treatment can be a significant burden.

Lack of Awareness

• Limited Health Education: A lack of comprehensive health education and awareness programs leaves many women uninformed about cancer risk factors, symptoms, and the importance of early screening. This knowledge gap can lead to delays in seeking medical attention.
• Stigma and Myths: Cultural and societal stigmas surrounding cancer can perpetuate misconceptions and myths. Women may avoid healthcare facilities due to fear, shame, or misinformation about cancer and its treatment.

Cultural Taboos

• Reproductive Health Taboos: Cultural norms often discourage open discussions about reproductive health and organs. This taboo can hinder women from openly discussing or seeking medical help for conditions such as breast or cervical cancer.
• Gender Roles: Traditional gender roles in India often place women in caregiving roles and prioritize their family's health over their own. This can lead to a delay in seeking healthcare for themselves.

Gender Bias

• Unequal Treatment: Gender bias within the healthcare system can result in unequal treatment. Women may receive less attention, fewer diagnostic tests, or less aggressive treatment compared to men, particularly for certain types of cancer.
• Provider Bias: Healthcare providers may unconsciously hold biases that affect their clinical decisions. These biases can influence diagnoses and treatment recommendations, potentially leading to disparities.

Economic Disparities

• Financial Dependence: Women in India may be financially dependent on male family members, making it challenging for them to make independent healthcare decisions. Economic disparities can restrict their access to healthcare.

Education Disparities

• Limited Education: Lower levels of education among women can contribute to a lack of awareness about health issues, including cancer. Educated women are more likely to seek healthcare and engage in preventive measures.

Inadequate Healthcare Infrastructure

• Underfunded Healthcare: Insufficient funding and resources in the healthcare system can lead to overcrowded and understaffed facilities, resulting in longer wait times and reduced quality of care.

Rural-Urban Divide

• Urban-Rural Disparities: Urban areas typically have better healthcare infrastructure and access to specialized cancer care facilities compared to rural areas, exacerbating disparities for rural women.

Language Barriers and Health Literacy

• Language Diversity: India's linguistic diversity can pose a barrier to effective healthcare communication, particularly for women who do not speak the dominant local language.

Caste and Social Hierarchies

• Caste-based Discrimination: Discrimination based on caste or social hierarchies can affect healthcare access and treatment options for marginalized women.

Impact of Gender Disparities in cancer care

Delayed Diagnosis

• Gender disparities often result in delayed cancer diagnoses for women in India.
• Delayed diagnosis means that cancer is often detected at more advanced stages, reducing the chances of successful treatment and survival.
• Late-stage diagnoses may require more aggressive treatments with increased risks and side effects.

Limited Treatment Options

• Women with late-stage cancer diagnoses typically have limited treatment options available to them.
• Some advanced cancers may be considered incurable, and treatment options may be primarily focused on palliative care to manage symptoms and improve quality of life.

Higher Mortality Rates

• Gender disparities contribute to higher mortality rates among women with cancer in India.
• Women with late-stage cancer diagnoses have a lower chance of survival compared to those diagnosed at earlier stages.

Economic Consequences

• Cancer can lead to severe financial burdens for families, particularly when women are the primary caregivers and income earners.
• The high costs associated with cancer treatment, including medical expenses, travel to healthcare facilities, and potential loss of income due to illness, can push families into financial hardship.

Psychosocial Impact

• Beyond the physical and financial aspects, gender disparities in cancer care can have a profound psychosocial impact on women.
• Women facing late-stage cancer diagnoses may experience heightened emotional distress, anxiety, and depression.
• Their mental well-being and overall quality of life may be significantly affected.

Caregiver Strain

• When women are the primary caregivers in their families, their illness places an additional burden on their loved ones.
• Caregivers, often family members, may struggle to provide care and support while managing their emotional stress and responsibilities.

Reduced Healthcare Utilization

• Gender disparities can discourage women from seeking healthcare due to cultural norms, stigma, and limited access.
• Women may avoid routine screenings and medical check-ups, leading to missed opportunities for early detection and prevention of cancer.

Societal Impact

• Gender disparities in cancer care perpetuate and reinforce broader gender inequalities in society.
• They can contribute to the overall marginalization of women, limiting their opportunities for education, employment, and participation in decision-making processes.

Steps Taken to Address Gender Disparities

Awareness Campaigns

• India has launched government-led awareness campaigns that target women to educate them about cancer prevention, early screening, and the significance of seeking timely healthcare.
• These campaigns aim to dispel myths and taboos associated with cancer, encourage health-seeking behaviours, and promote the importance of regular check-ups and screenings.

HPV Vaccination

• India has initiated programs to vaccinate young girls against the human papillomavirus (HPV), a major risk factor for cervical cancer.
• These vaccination initiatives are designed to prevent cervical cancer, which is one of the leading causes of cancer-related deaths among Indian women.

Strengthening Primary Healthcare

• Efforts are underway to expand and strengthen primary healthcare centres, especially in rural and underserved areas.
• The goal is to improve access to early diagnosis and treatment by bringing healthcare services closer to communities and reducing geographical barriers.

Promoting Gender Equity

• Initiatives have been launched to encourage women's participation in healthcare leadership roles and research.
• Promoting gender equity within the healthcare system can help address biases and ensure that women receive equitable care and attention.

Data Collection

• The collection of gender-disaggregated data for cancer health statistics is crucial for understanding the extent of disparities and tailoring interventions.
• Data collection helps in identifying areas where gender disparities persist and tracking progress in reducing them.

Challenges in addressing gender disparities in cancer care

Cultural Resistance

• India, like many other countries, has deeply rooted cultural norms and taboos surrounding health, especially women's health. Discussing issues related to reproductive health and certain cancers can be considered taboo. Overcoming these cultural barriers requires extensive public health campaigns, education, and awareness programs that aim to normalize conversations about health and promote gender-sensitive healthcare.

Access Barriers

• India's healthcare system faces significant challenges in terms of accessibility, especially in rural and remote areas. Women in such regions may have limited access to cancer screening, diagnostic facilities, and treatment centres. Addressing these disparities requires investments in healthcare infrastructure, mobile clinics, and telemedicine services to reach underserved populations.

Follow-up Care

• Ensuring that patients, especially women, receive timely and appropriate follow-up care is essential for improving cancer outcomes. Many factors can hinder follow-up care, including lack of awareness, transportation issues, and financial constraints. Implementing patient navigation programs, providing financial support for transportation, and enhancing patient education can help mitigate these challenges.

Resource Allocation

• Adequate resource allocation is crucial for reducing gender disparities in cancer care. This includes funding for cancer screening programs, treatment facilities, medical staff, and research. Advocacy efforts, both at the grassroots and policy levels, are necessary to ensure that gender disparities in cancer care receive the attention and resources they deserve.

Way forward for addressing gender disparities in cancer care

Continued Education

• Targeted Awareness Campaigns: Develop and implement awareness campaigns specifically tailored to different communities and regions within India. These campaigns should focus on the importance of cancer screening, early detection, and healthy lifestyle choices.
• Health Literacy Programs: Introduce health literacy programs in schools, community centres, and workplaces to educate women and families about cancer risk factors, symptoms, and available healthcare services.
• Access to Information: Ensure that cancer-related information is available in multiple languages and accessible through various mediums, including pamphlets, websites, and mobile apps.

Community Engagement

• Local Champions: Identify and empower local leaders, influencers, and healthcare workers within communities to serve as champions for healthcare-seeking behaviour and advocate for gender-sensitive healthcare.
• Community Workshops: Organize community workshops and forums to openly discuss cancer-related topics, dispel myths, and address cultural taboos. Encourage community members to share their stories and experiences.
• Support Groups: Establish support groups for individuals and families affected by cancer, providing a safe space for emotional support and information sharing.

Healthcare Infrastructure

• Rural Health Centers: Establish and upgrade rural healthcare centres with a focus on cancer care, ensuring they have the necessary equipment and trained personnel to provide basic cancer screenings and referrals.
• Mobile Clinics: Implement mobile healthcare units equipped with cancer screening tools to reach remote areas and underserved populations.
• Telemedicine: Expand telemedicine services to connect patients in remote areas with oncologists and specialists, reducing the need for long-distance travel.

Gender Equity

• Leadership Opportunities: Encourage women to pursue leadership roles in healthcare organizations, medical institutions, and research institutions. Implement policies that promote gender diversity and equity in these sectors.
• Research Funding: Allocate research funding specifically for studies related to gender disparities in cancer incidence, treatment outcomes, and healthcare access.
• Training and Sensitization: Provide training for healthcare providers on gender-sensitive care, addressing biases, and understanding the unique healthcare needs of women.

Policy Implementation

• Enforce Existing Policies: Ensure that existing policies related to gender equity and healthcare access are effectively enforced. This includes laws that protect women's rights and access to healthcare services.
• Monitoring and Evaluation: Establish mechanisms for monitoring and evaluating the impact of policies aimed at reducing gender disparities in cancer care. Regular assessments can help identify gaps and areas for improvement.
• Advocacy and Awareness: Collaborate with advocacy groups, NGOs, and civil society organizations to raise awareness about the importance of policy implementation and hold decision-makers accountable.

Conclusion

• The Lancet report highlights the urgent need to address gender disparities in cancer care, with a focus on raising awareness, improving access to screening and treatment, and promoting gender equity in healthcare leadership and research.

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REPORT ON CANCER:  https://www.iasgyan.in/daily-current-affairs/report-on-cancer

PRACTICE QUESTION Q. What are the key strategies and initiatives that have been implemented or suggested to address gender disparities in cancer care in India, as outlined in 'The Lancet report titled 'Women, Power and Cancer'? How do these strategies aim to overcome cultural resistance, improve access to healthcare, and promote gender equity in the context of cancer diagnosis, treatment, and outcomes?