Kavita Bai used to routinely seek the advice of the government-accredited social health worker on issues such as nutrition, contraception and overall good health practices. As per the doctors’ advice, she visited the government hospital in Pune for ante- and post-natal check-ups when she was pregnant. Yet, she died at the age of 36, leaving behind two daughters.
The housewife had been suffering from cervical cancer for years, which the hospital staff failed to diagnose. After complaining about the same symptoms — vaginal discharge and irregular periods — for months, a doctor finally tested her for cervical cancer. By the time Kavita found that she had cancer, the disease had spread throughout her body. She died within four months.
Kavita was one of the more than 70,000 women who lose their lives to cervical cancer every year — one woman dies every seven minutes in India.
Cervical cancer, which can be easily tested and treated if diagnosed early, has become the leading cause of cancer deaths among Indian women. According to the Cervical Cancer-Free Coalition, more women die of the disease in India than anywhere else in the world, accounting for one-third of the deaths.
Experts suggest that the numbers are grossly underestimated as a large number of cervical cancer cases remain undiagnosed.
According to Dr Homa Mansoor, who specialises in infectious diseases and volunteers for the international non-profit Doctors Without Borders, cervical cancer is one of the diseases that can be detected early and treated easily. “Even in the most resource-poor setting, diluted acetic acid can be used to conduct a basic test for diagnosing abnormal cell growth. The damaged tissue turns white,” she explains. “If the cancer is caught early through the test, the treatment is as simple as freezing the abnormal tissue using cryotherapy.”
Cryotherapy is a procedure that destroys abnormal tissue on the cervix by freezing it. During cryotherapy, cold liquid carbon dioxide is made to circulate through a probe placed next to the abnormal tissue.
Cryotherapy can be performed at a doctor’s office, clinic or a hospital as an outpatient procedure, which means the patient does not have to stay the night. It is an adequate treatment if the abnormal cells are small in number. The treatment becomes complex if the cancer has spread.
Similarly, research published by The Lancet notes that one of the most cost-effective tests for cervical cancer was visual inspection with acetic acid screening for those below the age of 40.
However, the test is not available at a majority of primary, secondary or tertiary health centres. “Even though clinical assessment would be the most affordable and most doable as part of the national programme, this remains a blind spot in policy,” says Dr Mira Shiva of the All-India Drug Action Network.
Some of the risk factors that may lead to cervical cancer are lack of hygiene, unsafe sex with multiple partners, early sexually active behaviour and repeated reproductive tract infections. These have made the cancer more common among poorer women, especially sex workers.
“The practice of early marriage, lack of toilets and general unhygienic living conditions put poorer women at the risk of developing cervical cancer,” says Leena Menghaney, a researcher and campaigner with Doctors Without Borders.
In a study conducted on cervical abnormalities and cancer in HIV-infected women by researchers at Tata Memorial Hospital, Mumbai, in 2010, it was found that cervical lesions were highly prevalent among HIV-positive women. The study concluded that there was a need for routine screening among such women.
In response, the National aids Control Organisation framed guidelines to test HIV-positive women for cervical cancer. However, the guidelines exist only on paper. Health workers at the non-profit Delhi Network of Positive People confirm that the test is neither available nor conducted, even on people living with HIV.
According to Dr Shiva, apart from screening, it is important for the government to invest in awareness. “Unlike tobacco-related oral cancer, which is the most common cancer among men, for which substantial sums are spent on creating awareness, nothing is spent on spreading awareness on cervical cancer, the most prevalent cancer among women,” she says.
She recommends that screening for early detection should be the starting point for policy in India, which is currently absent in the National Health Mission, because by the time the symptoms appear, the damage is done. “The key for policy should be to train medical personnel who can diagnose and provide tools for treatment if the cancer is detected early and finally cancer management,” she says.