Call it the Jade Goody disease. The British woman who became infamous in India for heaping racial scorn on Shilpa Shetty in the reality show Celebrity Big Brother is staring at death. Sure, Goodys wedding to an ex-convict last week was part of an exclusive magazine and television deal —something that might prompt some to call Goody an opportunist. But it doesnt make her tragedy any less poignant.
For Goody is but one among millions of women who lose their fight against cervical cancer every year.
In India too, 1.3 lakh women are diagnosed with cervical cancer every year — and almost 74,000 of them die. India shares about one-fourth of the total cervical cancer cases in the world. People now talk freely about breast cancer. Its high time we start talking about cervical cancer as well, warns Dr Partha Basu, head, department of gynaecologic oncology, Chittaranjan National Cancer Institute, Calcutta, which alone handles 700 to 800 cervical cancer cases a year.
Shruti, 18, is a case in point. Shruti, who comes from a middle class Calcutta family, has been leading a double life for some years now. In the day time, she loves to hang out with her college friends; in the evenings, she works as an escort. She has had multiple sex partners — one of the factors that leads to cervical cancer.
Shrutis cancer was detected in its early stage and she will be cured in no time. But 42-year-old Meena of Tamluk is not as lucky. Married to a truck driver, she consulted a doctor about what she thought was an irregular bleeding problem after sitting over it for long. But it was too late by then. Doctors see little chance of Meena surviving the disease.
Cervical cancer, which usually develops in cells lining the cervix or at the mouth of the womb, is the first most frequent cancer among Indian women, particularly those aged between 15 and 44, says the World Health Organisation.
This is a bigger threat to women than breast cancer, stresses Sanjiv Navangul, director, sales & marketing, MSD India, a part of Merck & Co, the global pharmaceutical company that has come up with vaccines for cervical cancer. In India 30-60 women out of every one lakh women suffer from cervical cancer, as opposed to 20-30 newly detected breast cancer cases in every one lakh women.
MSD India has just launched a first-of-its-kind public awareness campaign on cervical cancer, targeting all sections of society. Titled Guard Yourself, the campaign features Bollywood film personalities — including Konkona Sen Sharma —urging women to opt for regular cancer screening. At the end of the message, a toll-free number is displayed for more information.
Experts feel the time has come to sound the bugle for a war on cervical cancer. The cancer is primarily caused by certain high-risk types of Human Papillomavirus or HPV, a common infection transmitted through sexual intercourse. Whats alarming is that there are no typical symptoms of the HPV infection.
The factors that increase ones risk of cervical cancer are multiple sexual partners, early sexual activity, sexually transmitted diseases (STDs) such as syphilis and gonorrhoea and a weak immune system.
Though effective screening programmes and methods of treatment are available in the country, lack of awareness is the reason the cancer continues to kill. First, the symptoms — such as vaginal discharge or irregular bleeding — are common problems associated with menstruation. Second, doctors say that even when the problems become serious women shy away from discussing the infection because of the connotations of an STD, still a taboo subject, or because of the embarrassment caused by an examination of the pelvic region.
And that is a pity, for the doctors stress that cervical cancer can be prevented or cured in its early stages. Any abnormality in cervical cells can be done away with by either freezing or scouring the cells from the tract.
But thanks to an abysmally poor awareness level, 70-80 per cent of the cases we receive are at advanced stages, says Dr Basu. We just need to get the message across — if women are getting abnormal vaginal discharge or irregular menstruation, they should immediately consult doctors and seek cervical cancer screening.
Dr Subhas Biswas, a professor of obstetrics and gynaecology, SSKM Hospital, Calcutta, stresses that cervical cancer is prevalent among women in all sections of society. But women belonging to lower socio-economic strata are more at risk primarily because of illiteracy and the lack of proper hygienic conditions that can be an accentuating factor, he says.
He adds that sex education can play a vital role in preventing cervical cancer. The sexual mores of our society are changing. In addition to sexual promiscuity, intercourse at an early age is a veritable risk factor for the cancer. Ideally the awareness programmes should begin in schools.
Nationwide, cervical screening programmes can go a long way in spotting cancer cases through regular testing. Pap smears, a procedure in which cells are scraped from the cervix and examined, and other tests that are conducted in hospitals and clinics, can pick up pre-cancerous changes.
The experts rue the huge disparity between the West and India insofar as cervical cancer control programmes are concerned. They started such programmes 25-30 years ago. Hence, in Western societies, the number of cervical cancer cases has come down by almost 80 per cent. In contrast, we are yet to have a foolproof and effective cervical control programme in our country, says Dr Basu.
The experts maintain that by getting vaccinated against HPV before she becomes sexually active, a girl reduces her lifetime risk of developing cervical cancer significantly. Safe and effective vaccines are now available in India, says Dr Basu.
But even vaccines come with problems. For one, the prices are steep. Three doses of one of the vaccines available cost around Rs 8,000, unaffordable for many sections of people. Second, traditional mindsets rebel against a vaccine to ward off STDs. We dont know yet how parents would react. As per our government guidelines, these vaccines have to be given to girls aged between 10 and 11. It can go up to the age of 26. But cancer will be the last thing on the minds of parents of 10-year-olds, says Dr Basu.
State-based doctors allege that the West Bengal government is yet to take a more proactive role in implementing the national cancer control programme. Under the national policy, all medical colleges in India have to identify two or three districts in each state for the implementation of the cervical cancer control programme. Not a single medical college has taken up this programme in West Bengal yet. There are no takers in Bengal for the Rs 17-lakh earmarked for this for each state. States such as Gujarat and Assam, on the other hand, have been following the guidelines.
But the state says plans are afoot to tackle the cancer. A pilot project is under consideration. We will use the funds available to conduct awareness campaigns in the audio-visual media. We will target all sections of the society, says Dr Satyaban Ghosh, assistant director, health services, oncology, government of West Bengal. We will seek the support of a non governmental organisation to conduct screening programmes in some districts in the next financial year.
If it does, women like Meena may get a new life. If it doesnt, the cancer will continue its killing spree.
(Names of cancer patients have been changed)