A six-letter word – cancer. You can write so many words with six letters, but none would be as frightening as this one. None can give you sleepless nights, and days full of agony and stress. There are so many things we wish to do after knowing the diagnosis, but are unable to do. There are so many if onlys. One thing is for sure, all of us – whose lives have been touched by cancer – have thought this at least once: “If only I went for an early check up!”
While early signs and symptoms are not known for all types of cancers, for several cancers – breast, cervical, colorectal, skin, oral, and some childhood cancers – the benefits of having a systematic approach for early detection and care save lives and money. Despite the evidence, the importance of early detection and seeking care when symptoms are present is not well understood even among literate and able communities, particularly in low-resource settings.
Lack of information and awareness about cancer is a critical impediment for effective cancer control and care in low and middle income countries (LMICs) like Bangladesh. Among other reasons for the delay in detection for countries like Bangladesh, a critical shortage of trained health professionals to diagnose and manage cancer is a key barrier to the delivery of effective and quality early-detection strategies.
For any country – developed or developing – any comprehensive
early-detection program should include strategies to improve knowledge of cancer across all communities. However, understanding and responding to cultural beliefs, traditions, rituals, and practices are essential, particularly among communities with misconceptions about diagnosis and treatment. Stigma associated with cancer and social inequities can also lead to delay in care.
Along with that, it is also equally important to have strategies for encouraging health-seeking behaviour, including awareness and education of ways to recognise the signs and symptoms for some cancers. Identification of early warning signs of some cancers is particularly relevant in the context of primary care in a resource-constrained country like ours.
For instance, currently, breast cancer tops the rank of cancers among women, and screening for this cancer is easy. Even in low-resource settings, it is cost-effective and in some cases does not require any specialist diagnostic technologies. The clinical breast examination that can be performed by primary healthcare workers has an immense potential to detect breast cancers earlier.
For cervical cancer – another major killer in Bangladesh – the WHO guidelines for screening and treatment of pre-cancerous lesions for cervical cancer prevention recommend the screen-and-treat approach combining visual inspection with acetic acid (VIA) or human papilloma virus (HPV) DNA testing coupled with cryotherapy of pre-cancerous lesions for primary screening for cervical cancer.
Though the availability of the HPV testing is resource-dependent, an HPV test can be provided over VIA where it is available, affordable, implementable, and sustainable over time.
However, within all these rays of hope, the critical issues for all screening programs are to select the test that is most appropriate for the context in order to achieve high-screening coverage, high-quality testing, and reliable follow up. Eventually, the success of any early detection program can be measured by a reduction in the stage of the cancer at diagnosis with earlier diagnosis associated with a reduction in the risk of dying from cancer.
Despite all these, it is not impossible to meet the challenges present in the current health system if awareness is recognised as the first step to early detection and improving cancer outcomes. With the demand side creation, simultaneous actions should be taken to tailor resources along with cultural beliefs and practices. We have to keep in mind that screening and detection should not be a stand-alone vertical system.
Screening programs are integrated into the health system. There is strong evidence that screening can reduce deaths from cervical cancer by 80% or more among screened women. Even a single screening between the ages of 30 and 40 can reduce a woman’s lifetime risk of cervical cancer by 25-36%. Just think about the number of lives we are talking about!