New Delhi: Young Indian girls suffering from cancer may be missing out on diagnosis and treatment because of inherent societal biases and the huge financial commitment often necessary for care, a study by the All India Institute of Medical Sciences (AIIMS) in New Delhi has concluded.
The study, published in The Lancet Oncology, looked at data from two population-based cancer registries (PBCR), one from Delhi and another from Chennai. The researchers found that in Delhi for every two male children being diagnosed with cancer, only one female child was receiving a diagnosis. In Chennai, for every 1.44 male child, it was only one female child. Further, data from three cancer centres showed that the overall male-to-female ratio was 2.06.
To account for differences in the incidence of childhood cancers in boys and girls, the study looked at the male-to-female ratio (MFR) of childhood cancer (in those aged 0–19 years). It found that while the ratio for India is 1.6, in high-income countries like the USA and UK it stands at 1.1 and 1.2 respectively.
“The study reveals that sex ratio in India for childhood cancer is skewed in favour of boys at the level of diagnosis,” the researchers wrote. They added that the degree of disparity seemed to vary based on social differences in different regions of the country, and intensified with increases in costs associated with treatment.
This data “could be extrapolated to other chronic diseases in childhood that mandate financial commitment from caregivers”, the researchers noted.
“The sex gap in childhood cancer care could potentially be narrowed by the implementation of governmental policies aimed at creating awareness about the importance of sex equality and at decreasing the financial burden incurred by families in the treatment of cancer,” the researchers added.
‘Significant skew in favour of boys’
The study collected and analysed data of around 11,000 children enrolled in two population-based cancer registries, as well of around 22,000 patients from three large cancer centres indifferent parts of India. These are Dr BR Ambedkar Institute Rotary Cancer Hospital in AIIMS, Rajiv Gandhi Cancer Institute (RGCI), New Delhi and Women’s Indian Association [WIA] Cancer Institute in Chennai. An estimated 75,000 new cases of paediatric cancer are diagnosed every year in India.
Dr Sameer Bakshi, professor of medical oncology and the lead author of the study told ThePrint via email: “We observed that among nearly 11,000 patients registered in the PBCRs, there was significant skew in favour of boys for getting diagnosed with cancer. Similarly, among the 22,000 children with cancer enrolled in the three hospitals, we saw that more boys were seeking treatment than girls.”
However, this gender bias is not evident once a child is diagnosed, Bakshi added.
“[W]hen we looked at sex ratios among patients seeking cancer care in the context of sex ratios at diagnosis, the skew in sex ratios was no longer apparent,” Bakshi wrote. “This tells us that the bias towards boys originates at the community level. Once children are brought forward and diagnosed, there is no further gender bias in seeking treatment.”
The study found that fewer girls were seeking treatment at cancer centres in North India (IRCH, AIIMS and RGCI) than in South India (WIA, Chennai).
According to Dr Bakshi, the disparity between the genders was also more for patients coming from rural areas as compared to urban areas.
“This may have to do with variations in social fabric in different parts of the country. We also saw that fewer girls were coming to the hospital if the distance of the centre from their home was ≥100km, signifying that if costs related to treatment increase, the bias would likely increase,” he wrote.
However, he pointed out that the male-to-female ratios in Delhi have been improving over the last 15 years.
He added that the disparity has been examined in India for the first time in such detail.
“While some other countries also may have these disparities, it appears more than what is observed in high-income countries and even some other low middle income countries. It must also be kept in mind that sufficient information for the existence of these disparities may not be easily available in some of the countries…(figures indicate) this disparity in favor of males in India is obvious,” Bakshi said.
The authors wrote in the study that the disparity in paediatric cancer diagnosis is consistent with inequalities observed in general paediatric healthcare. They found that the inequity was more in haematological cancers than in solid malignancies.
“Among haematological malignancies, the highest sex ratios favouring boys were observed among patients with lymphomas. This finding could be partially attributed to the initial indolent disease phenotype in some major subtypes, such as Hodgkin’s lymphoma, and to the probably higher threshold of health-care-seeking for girls than for boys,” the wrote in the paper.
They added: “A male preponderance in lymphomas has similarly been observed in other studies. It is plausible that the high degree of sex disparity could be a consequence of unknown biological factors rather than due to social or economic factors alone.”
(Edited by V S Chandrasekar)