New Delhi: Young Indian girls who develop cancer may not receive diagnosis and treatment due to inherent societal biases and the large financial obligations often required for care, a study by the All India Institute of Medical Sciences (AIIMS) in New Delhi has concluded.
A study published in Lancet Oncology, reviewed data from two population-based cancer registries (PBCRs), one from Delhi and the other from Chennai. The researchers found that in Delhi, for every two male children diagnosed with cancer, only one female was diagnosed. In Chennai, there was only one female for every 1.44 male children. Additionally, data from the three cancer centers showed a combined male-to-female ratio of 2.06.
To explain differences in the incidence of childhood cancer in boys and girls, the study examined the male-to-female ratio (MFR) of childhood cancer (in those aged 0–19 years). He found that while the ratio for India is 1.6, it is 1.1 and 1.2 in high-income countries like the US and the UK, respectively.
“The study reveals that the gender ratio of childhood cancer in India is skewed in favor of boys at the level of diagnosis,” the researchers wrote. They added that the level of disparity appears to vary according to social differences in different regions of the country and is exacerbated by increasing costs associated with treatment.
These data “could be extrapolated to other chronic childhood illnesses that require financial commitment from caregivers,” the researchers noted.
The gender gap in childhood cancer treatment could potentially be reduced by implementing government policies aimed at raising awareness of the importance of gender equality and reducing the financial burden on families of cancer treatment, the researchers added.
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‘Very large deviation in favor of boys’
The study collected and analyzed data on approximately 11,000 children enrolled in two population-based cancer registries and approximately 22,000 patients from three large cancer centers in indifferent parts of India. These are Rotary Cancer Hospital Drs. BR Ambedkar Institute at AIIMS, Rajiv Gandhi Cancer Institute (RGCI), New Delhi and Women’s Association of India [WIA] Chennai Cancer Institute. An estimated 75,000 new cases of pediatric cancer are diagnosed every year in India.
Dr. Sameer Bakshi, professor of medical oncology and lead author of the study, told ThePrint via email, “We observed that among the nearly 11,000 patients registered in the PBCR, there was a significant bias in favor of boys who developed cancer. Similarly, among 22,000 children with cancer included in three hospitals, we noticed that more boys sought treatment than girls.”
However, this gender bias is not apparent when a child is diagnosed, Bakshi added.
“[W]when we looked at the gender ratios of patients seeking cancer care in the context of the gender ratio at diagnosis, the skew in the gender ratio was no longer apparent,” Bakshi wrote. “This tells us that the bias against boys comes from the community level. Once children are brought forward and diagnosed, there is no longer a gender bias in seeking treatment.”
The north-south divide
The study found that fewer girls seek treatment at cancer centers in North India (IRCH, AIIMS and RGCI) than in South India (WIA, Chennai).
According to Dr. Bakshi also found that the gender gap was greater in patients coming from rural areas compared to urban areas.
“This may have to do with differences in the social fabric in different parts of the country. We also saw that fewer girls came to the hospital when the distance of the center from their home was ≥ 100 km, which means that the bias would likely increase if the costs associated with treatment increased,” he wrote.
However, he pointed out that the male-female ratio in Delhi has been improving over the past 15 years.
He added that this difference has been studied in such detail for the first time in India.
“While they may have these differences in some other countries, these differences appear to be greater than what we see in high-income countries and even in some other lower-middle-income countries. It should also be noted that sufficient information on the existence of these disparities may not be readily available in some countries … (the figures show) that this disparity in favor of men in India is evident,” Bakshi said.
The disparity in pediatric cancer diagnosis is consistent with disparities observed in general pediatric health care, the authors wrote in the study. They found that the disparity was greater in hematological cancers than in solid malignancies.
“Among hematological malignancies, the largest gender ratio favoring boys was observed in patients with lymphomas. This finding could be attributed in part to an initial phenotype of indolent disease in some major subtypes, such as Hodgkin’s lymphoma, and possibly to a higher threshold for seeking medical care in girls than in boys,” he wrote in the paper.
They added: “Other studies have similarly observed a male predominance in lymphomas. It is likely that the high level of gender disparity could be due to unknown biological factors rather than just social or economic factors.”
(Edited by VS Chandrasekar)
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