NATIONAL

Creating a cancer-free world for women

Harmala Gupta

India has more cervical cancer cases than any other country



New vaccines, highly accurate tests available

Indian government and civil society must take a stand



When I reflect on all the women I’ve known who have passed away from cervical cancer, I am humbled by their courage but saddened by the thought that it need not have been this way. As the founder of a home-based palliative care programme in Delhi, I can no longer count the number of cases we have encountered of women who have died in great suffering from this devastating but preventable disease. India has more cervical cancer cases than any other country in the world (130,000 new cases are reported every year) and cervical cancer is the number one cause of cancer-related death among women in India.

Faces of sorrow

I remember vividly the faces of women I’ve met who have suffered from cervical cancer. They are faces of sorrow, ravaged by physical and emotional pain. Several years ago I visited Sunita, a striking young woman in the prime of her life, who was now losing her struggle against this disease. A mother of four and the former owner of a prosperous embroidery shop, she came to us emaciated, bald, and in excruciating pain.

Her anguish extended beyond the cancer that was destroying her body. It was rooted in her concern for her husband, her children, and her entire extended family. The devastation of cervical cancer is hard to express in words. But seeing the millions of strong women whose lives it claims, hearing their stories, and comforting them in their final hours, has reinforced my conviction that India must do everything possible to end this human tragedy.

This crisis does not end with the death of multitudes of exhausted women who appear at clinics doubled over in pain, learning tragically late of the cancer destroying them. It continues to be embodied in the motherless small child begging on the streets of Delhi forced to fend for himself, the work-weary father compelled to rear his five young children alone. Throughout India, the damage of cervical cancer is real. When women suffer from cervical cancer, India suffers. For every woman lost there is a family left in pain.

What upsets me when I watch these women die is the knowledge that nearly all these deaths could have been prevented. Thanks to screening programmes widely available there, cervical cancer has declined dramatically in industrialised nations. Rates in developing countries, however, continue to soar and India alone has one quarter of the world’s newly diagnosed cases of cervical cancer.

We already have all the tools and technology to save these lives. New vaccines and highly accurate tests developed in the last few years have the power to eliminate cervical cancer. Unlike most other cancers, scientists have identified the primary cause of cervical cancer: a common virus known as the human papilloma virus, or HPV. These new HPV vaccines can protect women against the two most common high-risk types of HPV, responsible for about 70 per cent of cervical cancers. The vaccines are now widely available in North America and Europe, but not India. It is true they are expensive, but surely when it comes to saving lives this should not stand in the way. The government has an obligation to find ways to subsidise the cost to make it more affordable.

While these new vaccines can protect girls and young women who have not yet been exposed to HPV, they will do little to help more mature women. In addition, even women who are vaccinated need cervical cancer screening. That is why ongoing screening for cervical cancer risk is critical. In fact, some experts warn that cervical cancer rates could actually increase, despite the introduction of immunisation if the two do not go hand in hand.

Most women in India lack access to quality screening. For the past 60 years, the main test for the disease in industrialised countries has been the pap smear, in which laboratory personnel visually examine cervical cells under a microscope. Although this test has saved many lives, it is only about 50 percent accurate in identifying women with serious cervical disease. And because this test requires highly trained professionals, the vast majority of women in India do not have access to it, especially poor women living in rural areas who are at the greatest risk of contracting it.

Recently, however, scientists have developed a test that can directly detect the presence of HPV. This HPV test is far more sensitive than the pap smear and has the potential to save many more lives. Scientists are producing a version specially designed for use in remote areas of developing countries. New tools such as the HPV vaccines and screening tests have enormous lifesaving potential, but they will not reach the women who need them unless the Indian government and civil society take a stand on this issue. Our national and state governments and NGOs must work together to ensure that access to the HPV vaccines and to basic screening tests are accessible to all women who might benefit, no matter what their socioeconomic status.

I’ve watched in anguish as women diagnosed with cervical cancer who come under our care gradually lose their appetite and vigour and waste away under the steady onslaught of nausea, swelling, and intractable pain. Once self-sustaining, proud women who managed entire households and provided for their families, they now suffer from disgrace and marginalisation in the wake of this disease. For those with access to healthcare facilities, chemotherapy and radiation leave many bedridden and unable even to feed or clean themselves, let alone care for their loved ones. They feel humiliated by their lack of control over simple bodily functions. But they are not the ones who should suffer shame. That burden should be borne by all of us who could have acted to prevent these women’s agony.

I take heart in the recent efforts of international leaders to respond to the toll that cervical cancer exacts on the world. At the Global Summit of Women held this week in Vietnam, business executives and government officials from 70 countries proclaimed the elimination of cervical cancer to be one of their top priorities. We need Indian business leaders and governments to also commit themselves to play an active role in addressing cervical cancer, by promoting the prevention tools that we know can work.

Access to clinics needed

If we’re going to address cervical cancer, we must transform our public health system. All women, no matter where they live and how rich or poor they are, need access to clinics and preventative care. Simultaneously we also must consider the changes that we can make to society as a whole. Women’s rights are intimately related to cervical cancer. Many Indian women currently marry young, have multiple pregnancies, and often have little control over the sexual habits of their husbands, all of which put their reproductive health at risk. We must reassure poor women who are disproportionately stricken by cervical cancer that they are not invisible, and that their wellbeing is critical to our country’s development. India can never truly claim to be a global power as long as its people die of preventable diseases. Women are the glue that holds Indian society together. They are the centre of the family unit. If we focus on addressing cervical cancer, we will undoubtedly improve the overall standard of health for all Indians, besides saving precious lives.

We must not let the courageous struggles of the thousands of Indian women who have died from cervical cancer go ignored. It is time for us to unite in a public movement against cervical cancer and make sure all women have access to the tools necessary to eliminate this disease once and for all.

(Harmala Gupta is President and founder of CanSupport, a pioneering home-based palliative care programme supporting people with advanced cancer in Delhi and its National Capital Region.)

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