This week at Women DELIVER, we’ve raked with a fine-toothed comb over the various ties that have held women back and contributed to maternal mortality: culture & religion, rape & gender-based violence, HIV, limited access to information necessary to make decisions about family planning, etc. We have cheered and clapped as speakers reinforced the concept of continuum of care–the idea that women need healthcare and education throughout their lives–and yet, we do not yet practice what we preach. Cancer–one of the new leading causes of mortality among women everywhere–has been conspicuously absent from conversation. As Harvard School of Public Health‘s Dr. Julio Frenk emphasized in a poignant afternoon session yesterday: What if you survive giving birth and your reproductive years? Are you done? Are you off the hook? No. With chronic disease on the rise around the world, women of all ages need access to screening and treatment to prevent the C-word.
Unlike fistula (which have also been discussed at length this week, due to the UNFPA petition), cancer is not a disease largely limited to the developing world. Access to screening is a challenge for American citizens (thanks newly in part to the task force’s ludicrous new recommendations about mammography) just as it is for South African citizens. One major difference is the attitudes toward cancer; in the United States and Europe, nonprofits, NGOs, activists, and survivors have worked hard to make cancer an acceptable topic of public conversation; one might argue that their leadership has given way to new technologies and medical options.
In Africa, Eastern Europe, and many Asian countries, stigma around cancer is still largely a barrier to care. In countries with raging HIV epidemics, a bald, thin cancer patient is likely to be mistaken for an AIDS patient. In patriarchal societies, women do not have the option to elect to have a mastectomy because in that culture, their breasts belong to their husbands, not to them. Across the board, many people believe that cancer is a death sentence; as 75% of people in developing countries present to the doctor when their tumors are already at Stages III and IV (meaning that the cancer has spread beyond the original site, and therefore is much harder to cure), it is no surprise that this belief prevails.
In a session on cancer yesterday (one of just a couple at the entire conference), an OB/GYN graduate of Brown University’s medical school stated that we cannot think of the standard of care in North America and Western Europe as the standard of care worldwide. Where doctors might recommend regular mammographies starting at a certain age stateside, that technology is not widely available, and to put forth that recommendation when women cannot then access the services is irresponsible. Medical professionals have looked into self-exams as a cheap and empowering alternative to mammorgraphies in resource-limited settings- but without significant results. As I listed to all of this, I couldn’t help but think about Janet, a young pregnant Tanzanian woman from Christy Turlington’s film, No Woman No Cry, who very nearly tried to give birth at home because the idea of walking 5 miles to the nearest clinic (very small, basic services only) was unbearable. I cannot imagine that should Janet do the self-exam and discover something abnormal, she would make that trek to a clinic where she would likely be referred to the overwhelmed Mount Meru hospital at a significant cost to her family, to discover that her options for addressing this “abnormality” are limited, at best, and prohibitively expensive.
So, what needs to happen? From the medical side, find a way to bring clinical trials to even rural areas; there are hardly any clinical trials in developing countries, even though such trials might offer opportunities for treatment that might not otherwise be available. Additionally, we need to encourage countries to develop their own best practices in community outreach, stigma reduction, and medical opportunities. Link contraceptive care with cancer care; as part of the continuum of health care in a woman’s life, the two are connected, and one can most certainly influence the other. And lastly, to return to the refrain of Women DELIVER: Empower women and men with information. As Dr. Frenk said yesterday, “Include men in the solution. If you exclude them from the solution, they will continue to be part of the problem.”