Embracing equity in women's healthcare

Women's health entails a variety of gender-specific issues that contribute to the occurrence, management and outcomes of health conditions. Cancer is raising as one of the major women's health concerns. Each year, millions of women are diagnosed with cancer around the world. Hence it is important to reduce stigma and raise awareness about myths and misinformation regarding cancer. Though the term "cancer" is known for its fatality, nearly 40% of cancer deaths are preventable and at least two-thirds of common cancers are curable with timely diagnosis. Comprehensive awareness programs, preventive measures, regular screening programs, early detection and appropriate treatment can save many woman's lives every year.

Every cancer is different and so is every person. One size doesn't fit all, and every challenge demands a different solution. Cancer of the breast, cervix, uterus, ovary, oral cavity, lung, colorectal and skin are the common cancers occurring among women in India. The risk of developing cancer varies as per hereditary/genetic, environmental and lifestyle factors. General factors associated with a higher risk of developing cancer include a personal or family history of cancer, increasing age, obesity, alcohol, tobacco usage, diet (fried foods, red meat), reproductive history (early menarche, late menopause, no children), poor hygiene, sexual activity at a young age or with multiple partners, decreased immunity, exposure to radiation/chemicals and few specific infections caused by human immunodeficiency virus (HIV), human papillomavirus (HPV), hepatitis viruses, helicobacter pylori and others. However, no such risk factor may be apparent in more than one-third of cancer cases.

Cancer prevention using prophylactic vaccination against sexually transmitted HPV, Cervarix™/ Gardasil™ is recommended to prevent HPV-associated cancers like cervical, vaginal and vulval cancer in women. The current HPV prophylactic vaccines have indications for all women up to the age of 45 years but are routinely recommended to adolescents at age 9-15 years. It is extremely effective when administered before the first sexual intercourse. Healthy lifestyle changes, regular physical activity (exercise/yoga/brisk walks), avoiding tobacco/smoking/alcohol, consumption of a healthy diet- increased intake of fruits, vegetables & whole grains, decreased intake of fried, spicy food & meat, calorie restriction, maintaining personal hygiene, avoidance of unnecessary exposure to radiation, monthly self-examination (breast/oral cavity) to detect any abnormalities will also contribute in reducing the cancer risk. Genetic testing for specific gene changes (mutation) such as BRCA 1 & 2, TP53, PTEN, ATM and others, helps to estimate hereditary cancer risk.

Effective screening programs available for early detection of these common cancers can reduce the risk of death by nearly 80%. Women above the age of 40 years, with or without a family history of cancer should undergo annual mammography, annual cervical pap-smear test, screening of ovaries and uterus, annual colposcopy/sigmoidoscopy and/or faecal occult blood test, clinical oral examination to detect any changes. Screening with tumour-specific markers like CA-125 (in ovarian cancer), CEA (in colon cancer), AFP (in liver tumours) and a few others help in early identification. Early diagnosis with symptoms/warning signs of cancer includes any swelling, lump or unusual breast changes, abnormal vaginal discharge or spotting/bleeding, chronic non-healing ulcer, skin changes, chronic coughing, hoarseness, change in voice, difficulty in swallowing, abdominal/pelvic pain, persistent bloating, unexplained weight loss, loss of appetite and altered bowel habits could improve survival and cancer outcomes.

The treatment options for each cancer differ and as well as the prognosis. Most often, cancer treatment involves a multimodality approach of surgery, radiation therapy, chemotherapy, hormone therapy and/or immunotherapy. Cancer is curable if detected early and it is treatable in all stages, even in a very advanced stage when it is widespread to various body parts, it is still controllable. Effective treatments are now available that can make cancer patients live longer and better.

(The author is with Department of Radiation Oncology, Aster CMI Hospital, Bengaluru)