cancer

2014/03/06

Dr Ophira Ginsburg

“Women often aren’t the primary decision maker for their own healthcare.” Ophira is a medical oncologist at the Women’s CollegeRead more →

2014/03/05

Dr Kelly McQueen

“Women with cancer in the early stages with the hope of treatment and cure often have no access to anRead more →

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Dr Ophira Ginsburg

“Women often aren’t the primary decision maker for their own healthcare.”

Ophira is a medical oncologist at the Women’s College Research Institute in Canada. Her work focuses on women’s health equality and global cancer control. As the winner of a Grand Challenges Canada award, she and her team are using mobile phone technology to improve breast cancer diagnosis and care in Bangladesh.

Is global surgery for women just about obstetrics?

No, it’s about women’s health – which is about much more than just reproductive health.

Of course access to safe surgery is critically important for complicated births – we lose thousands of women unnecessarily in so many countries for lack of obstetric care. But what a colossal shame for their child to watch them die of breast or cervical cancer ten years later because basic surgical care was unavailable.

What is the reality for a woman with cancer in a low-resource country?

It cuts down women in the prime of their lives. Most of the world’s deaths from cervical cancer are in these countries, and breast cancer strikes at a much lower age – in Canada on average at 61, in India and Bangladesh it’s about 42, 44.

These operations aren’t difficult to teach. But despite all the attention we pay cancer in high-income countries, there is silence on the topic of high-quality – or even basic – surgical intervention for women in low-resource settings.

Is there a gender imbalance?

Gender inequality really plays a role, especially in rural Bangladesh where I work. Women often aren’t the primary decision maker for their own healthcare. Most of the cases we see at our clinic are very advanced (and of course there’s a lack of palliative care) primarily because women aren’t coming when surgery would have made a difference.

They see that their aunty, their mother doesn’t come back – instead they need to see that effective surgery can save their life.

So do women with cancer get no surgical treatment at all?

Sometimes it’s worse than that. A third of the women we interviewed for a study published in the International Journal of Breast Cancer had already had ‘surgery.’ That is to say they’d had a suspicious lump partly cut out, highly unsafe surgery with no pathology, no follow up.

So here they are again a year later with a fungating [necrotic] tumour. It’s a profoundly morbid situation that absolutely could have been prevented with proper surgical management.

What is the wider impact of lack of access to safe surgical care?

Beyond the obvious of women dying unnecessarily? Effectively, orphan children. Children younger than ten may not immediately die from malnutrition, but they’re ostracized, impoverished, less likely to complete school – imagine what happens to them later in life?

Limited access to surgery, inadequate or unsafe surgery, directly contributes to the cycle of poverty.

 

 

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Dr Kelly McQueen

“Women with cancer in the early stages with the hope of treatment and cure often have no access to an exam or biopsy”

Kelly is Associate Professor, Department of Anesthesiology and Director of Vanderbilt Anesthesia Global Health & Development Affiliate Faculty at the Vanderbilt Institute for Global Health, and president of the Global Surgical Consortium.

How is surgical need related to gender?

The health of men and women over a lifetime is associated with risks specific to their gender and to their roles in society.  For women, there are several unique periods in her life when the availability of safe anaesthesia, and emergency surgery is vital – the most obvious time frame is during childbirth.

The biggest risk to mothers worldwide is peripartum haemorrhage, often requiring surgery.  In low-income countries the risks are even greater because they relate to a lack of access to an emergency cesarean section for obstructed labor and for seizures related to high blood pressure.

Access to surgery and safe anaesthesia for these conditions – haemorrhage, obstructed labor and eclampsia – will save the lives of mothers and babies, and prevent related complications such a vaginal fistula and stroke.

Is it just about reproductive health?

Cancer affecting women specifically also illustrates the important relationship between certain surgeries and gender.  Cervical and breast cancer often require a biopsy for diagnosis, and frequently surgical intervention for treatment, palliaton and cure.

Cervical cancer when diagnosed early has a very good prognosis.  But when diagnosed late – often when the kidneys are blocked, or the tumour is so large that it protrudes from her body – there is little hope of treatment.

The later is a common outcome in the poorest countries, and the unnecessary death of a women often leaves children in need of care behind.

Why is this a global rather than local concern for women?

Disease for the most part knows no geographical boundaries.  But the prevalence of surgical disease does correlate with increased non-communicable disease such as heart disease, trauma and cancer that we’ve been seeing for many years in higher-resource countries.

Recently in low-income countries, non-communicable disease has been increasing and therefore the need for safe surgery and anaesthesia has as well.  The needs for these same services are commonly required by women all over the world, and so women from every country must engage to create awareness about the role of surgery and safe anaesthesia in our good health.    

What is the reality of the situation faced by a woman in need of surgery when she lives in a low-resource setting? 

In the lowest-income countries, need for surgery has never been greater.  Sadly it’s in these same countries that access to safe anaesthesia and surgery is most often unavailable.

Organizations such as the The Global Surgical Consortium are committed to revealing the unmet need, and advocating for availability: in many hospitals surveyed we note a lack physicians and other providers, the absence of essential medicines including oxygen, and the absence of safety equipment and basic surgical supplies

This means that many women who need an emergency Caesarean section never receive one or are delayed until after the baby has died and the mother has birth trauma – which will affect her the rest of her life.  Women with cancer in the early stages with the hope of treatment and cure often have no access to an exam or biopsy, and therefore are diagnosed very late in the disease when it is too late to provide definitive care.

What role do women play in delivering healthcare worldwide?

Of course women in every society are often engaged in care-giving.  In lower-resource countries this is especially true within the home, and also in the nursing profession.  They’re also physicians, but many fewer of them have the opportunity for the extended education that is required and available to their higher-resource counterparts.

More women should be given the professional opportunity to work in health care for one very important reason we’ve seen. Women are much less likely to leave their families to seek higher pay or new opportunities outside their community – the retention of women in professional roles in the low-income countries is higher than for men.   

For someone who has never worked in a low-resource setting hospital, or thinks safe surgery is a luxury –

Just a few hours in a hospital of a low-income country bears witness to the vital role of safe anaesthesia and surgery in the lives of women.

Women die in childbirth everyday because of a lack and unsafe practice of anaesthesia, and limited or no access to a life-saving surgical intervention when they need it.  Their babies die too because of the mothers excessively high blood pressure or being stuck in the birth canal with no availability of a cesarean section.

Walking in the halls you see women with large tumors protruding from their breasts, or large thyroid goiters taking over their neck.  Visiting the Emergency Department you see women – mothers, sisters, aunts – morning the loss of a husband or son, because there is no access to emergency anesthesia and surgery for trauma.

Safe anaesthesia and basic surgery can be provided in a cost-effective and appropriate manner. There is no doubt that the lives of women around the world are impacted daily by lack of access to it.