Dr Kasturi Lal
Cancers that originates from the female genital organs are called gynaecologic cancer. These cancers affects 2.2% of the female population by the age of 65 years and it is the second most common cause of cancer deaths after breast cancer. There are vast regional variations in incidence, common sights of occurrence, age and stage of presentations. Each gynaecologic cancer which includes organs like breast, cervix, uterus, ovaries and vulva has different signs, symptoms and risk factors.
A significant proportion of patients from rural areas are unable to access and avail complete preventive diagnostic and therapeutic facility because of non-existence of cancer control policy. The cancer control policy includes awareness strategy, screening of population, investment in human resource development and creation of infrastructure. In majority of cases cancers are amenable to prevention and early detection. A patient in early stage of disease can be cured by inexpensive therapy and nature physiological functions can be preserved. There is no substitute to early detection or prevention than awareness.
Mass awareness only can stop the occurrence of female deaths caused directly by cancer and indirectly by the indifference of society and customs. The lack of awareness is attributed to social factors, society, attitude of family, neglect by relatives, unavailability of facilities and funds and finally unavailability of resource persons. A large section of society and media persons do not know that cancer can be cured, that cancer can be detected early, that there are newer methods of treatment, that life can be prolonged even in the late stage of disease with treatments and finally cancer is indeed preventable. Mass awareness through audio visual programs, seminars, symposia and workshops is viable solution for prevention and early detection. We have tocreate public perceptions that cancer generally occurs in all socio economic groups, that the disease can be prevented and the economic and social returns on the investment made in preventions is high. New advocacy groups have greater success in starting screening programs.
Health education and population based screening is cheaper and more effective in the management of most gynaecologic cancers. Health education about cancer should be institutionalized using mass media and other culturally acceptable means of community mobilization. Systematic available and affordable cancer screening techniques should be incorporated into basic health care. Knowledge of symptoms and self examination culture should permeate into the minds of people. Screening strategy can impart education about breast self examination, self examination of private parts, education about personal hygiene, nutritional assessment, annual health checkup of female senior citizens and sensitization of public to the roles of various methods of treatments.More representation should be given to early detection by visual inspection papsmear, HPV based screening in mass camps. Visual inspection with acetic acid applications is among the promising test for future. USG, Coloscopy, and mammography can be performed at district hospitals. Effective mass screening can reduce the incidence of cancer due to
1. Education of the population about risk factors
2. Improve voluntary acceptance to ensure that cases are detected in early stage or premalignant stage.
The course of malignant disease is determined by the biological behavior,how it responds to treatments is unknown but the exact assessment of the case is the prime function of the provider to prevent under or non-treatment. Here it is very important to focus on the exact and evidence based growth of the cancer treatment. Education for developing skills is significant in shaping the future of specialty, utilization of the resources such as equipment and technology. We have no choice except to practice under the umbrella of evidence based medicines. Public is now keen to be kept informed about the nature of disease and the chosen model of treatment. If we are sincere enough to use our skills on the basis of evidence based medicine, we usually may not fall in the trap of litigants.
We uphold the value of CME for updating knowledge. The existing dispensation of oncology services is not a cup of tea of many gynaecologists. We purposefully fight against all odds to bring change and innovation into the existing systems to disburse services to the patients in consonance with evidence based medicine. The mission of educating young generation of doctors would depend upon evolution of new strategies and innovation in the management of patients. Keeping aside the gaps of generations, we have to believe in regeneration of the energies to acquaint the gynaecologists about cancer management. It is possible for surgeon and nonsurgical specialists to undertake a broad range indigenous research of projects and improve the delivery of cancer care. This will undoubtedly foster a future of excellence in gynaec cancer care. It would improve contact among professionals for reliable advice. It will provide unparalleled access to opportunities for professional development and exposure to clinical expertise enabling the local specialist to be the best provider of care. Research in developing countries should emphasize on feasibilities of treatment plans, provision of affordable chemotherapeutical drugs, surveillance of genital cancer, family therapy and the vital role of councilors and social welfare practitioner in care of cancer.
Journey of miles begins with a single step. It does not matter how slowly we go as long as we get it right. Our greatest glory is in never falling but in rising every time we fall. What defines us is how well we rise after falling. Is it our position or our actions which govern our performance? It has become necessary to distinguish. Proactive would look forward to development for better provider family relationship. Future is not predetermined. It can be shaped. Something that needs fixing, we should get involved rather than blaming the system. It is better to light one candle than to curb darkness. Encourage other to light more candles and sooner than you know it, you will illuminate a path for a better future. The walls, the bars, the guns and the guards can never encircle or hold down the ideas of the people.
Early detection campaign, multimodal management, improving compliance of treatments, declaring cancer as a notifiable disease, equitable affordable treatment for all, prevention of waiting lists for cancer patients in institutions, improving manpower and infrastructure in institutions and finally skill development courses for the gynaecologists to keep them informed about the latest evidences in therapy are the priority areas which should need attention. Health care practitioner needs to accept limited life expectancy in patients with advanced cancer who need palliative care. Collaboration between gynaecologist and palliative care physician and general surgeons is essential for optimal gynaecological cancer care. Consequently there is a role of understanding the concept of cancer care and creating infrastructure. When the mind of provider is not focused on reimbursement and liability concern which so frequently haunts them, they will show sincere and genuine humanitarianism in their efforts to help unfortunate patients who otherwise would have no choice and no opportunity to the necessary care.
During celebration on 13th March 2016, the National day of female cancer, the stakeholder must be engaged in sensitizing the community towards preventive and therapeutic measures.
(The author is Director IOGH Lajwanti Medical trust , Kunjwani Byepass,Jammu)
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