Monthly Report, March 2001

Main Stories

CPAA Observes Women’s Day

Department Reports

Prevention and Early Detection

Insurance

At Smt. Panadevi Dalmia Cancer Management Centre
At Tata Memorial Hospital
"Can I Help You?" CPAA’s Desk at Tata Memorial Hospital’s Private OPD
At Bai Jerbai Wadia Hospital for Children
Palliative Care Unit at Tata Memorial Hospital
Counseling at Cama & Albless Hospital Cancer Ward
Nair Hospital (Radiation Department)

Rehabilitation

CPAA Observes Women’s Day

March 8^th is observed the world over as "Women’s Day." This year CPAA was pleased to perform a much-needed service to women at large by providing free cancer screening to 2000 women all over Mumbai. CPAA is also participating in a study being done by researchers at Fairview Hospital’s Department of Surgery, Cleveland, USA who are investigating the fact that while breast cancer risk factors among South Asian and American women remain essentially the same, the survival rates are much lower in South Asian women. Given below is a report of the camps we have been holding and our participation in the ongoing investigation.

March 8^th has been designated Women’s day- a day for all women to take some time off from their regular routines and assess their lives. A typical Indian woman today juggles a full time job involving tiring, time consuming commuting, running a home, cooking, cleaning and caring for children, husband and parents-in-law. She has to be a SuperMom if she is to master all the conflicting responsibilities. In her list of priorities, looking after her own health ranks very low. On the occasion of Women’s Day 2001, CPAA felt that a special effort should be made to reach women at their workplace, providing a cancer screening facility. Thanks to the efforts of Dr. Shashi Bakre, Rotary Club Bombay Midtown and generous financial support from KSB Pumps, CPAA organised camps covering 2000 women in their offices. The exercise started on 7^th March with a camp for 75 women at the Central Railways headquarters at the Chhatrapati Shivaji Terminus and will continue over the next month.

In the same strain, CPAA is involved in generating data to investigate breast cancer incidence in South Asian women in the US. The following is an extract of the Literature Survey done as a preliminary to the study, entitled "Breast Cancer in South Asian Women" by Serene Perkins.

"Breast cancer is a disease that affects all racial and ethnic groups. While breast cancer risk factors among South Asian and American women in the US remain essentially the same, the survival rates have been found to be much lower in South Asian women; the distinguishing factor appears to be the late stage of presentation at the time of diagnosis. Studies done by researchers have attempted to define, from an anthropological viewpoint, the cultural, educational, financial, and/or religious factors that may contribute to the late presentation of this disease in South Asian women.

The purpose of this study is to examine whether or not there is a difference in the incidence, mortality, or survival rates of breast cancer between native South Asian women versus immigrants. In addition, the general participation of South Asian women in breast cancer preventive practices such as breast self examination (BSE), mammography, and physician examination will be analyzed as an indicator of attitudes of South Asian women towards breast cancer prevention.

The risk factors predisposing women to breast cancer remain comparable among native South Asian women and Caucasian women. However, the relative risk for some of these factors was found to be much higher in South Asian women. In a study done in Bombay, it was found that unmarried status, nulliparity and late age at first full-term pregnancy were factors which carried a statistically significant increased relative risk. Lactation, nutritional habits and literacy status were not found to be statistically significantly related to risk of developing breast cancer. Other studies found similar results for these risk factors, and included age at diagnosis as an additional risk factor.

These are the same risk factors that have been established in studies done in the United States. However, while unmarried American women carry a relative risk of 1.1-1.9, in South Asian women this value increases to 1.9-2.3. With regards to nulliparity, American women’s relative risk number 1.1-1.9, while in South Asian women it is 2.2. American women whose age at first pregnancy is more than 30 carry a relative risk of 2.0-4.0 where as South Asian women who bear children after age 30 have a relative risk of 5.4. Age at diagnosis carries a similar relative risk of 4.0-4.5 between both American and South Asian women.

Many different preventive measures have been proposed among various populations of women in an attempt to facilitate early diagnosis. However, in developing countries where few patients can afford consistent health care, cost issues are of considerable concern. Financial hardship also hinders the availability of mammography for many women. While breast self-examination (BSE) would appear to be the most cost-effective method for early detection, investigators have found that many South Asian women do not practice BSE. The lack of participation in breast health programs have been thought to stem from intrinsic cultural beliefs as well as the pressures from day to day life faced by most women.

A very low proportion of women ever examine their breasts in their lifetimes, let alone have a mammogram. Apart from socioeconomic and linguistic barriers, the specific cultural beliefs about breast cancer that most likely prevent the South Asian woman from being diagnosed early were felt to be a sense of privacy and confidentiality which keeps her from reporting if any family members had cancer, as this is related to keeping the family’s honor. A high degree of modesty prevents her from examining, or allowing a doctor to examine, her breasts. There is a strong feeling that cancer is untreatable and is a disease to be feared; other investigators have coined this as a sense of "destiny".

However, the investigators did find that South Asian women wholeheartedly follow physician advice and family counsel when conducted in the form of a longstanding trust relationship between the patient, her physician, and her family.

CPAA was asked to participate in the study by circulating a questionnaire about awareness of various breast cancer prevention and early detection techniques like Breast Self Examination (BSE), mammography and regular check-ups by doctors. These questionnaires were given to the women who attended the Cancer Screening camps at the offices of the Central Railways, Income Tax, Provident Fund, BMC and at the Goregaon Doodh Sagar Residential Colony. As expected very few women had heard of mammography or practiced BSE. Even fewer underwent regular breast examinations by their doctor. Many women asked if the doctors would be male or female. They were less apprehensive of the examination when told that all gynecologists would be women.

Along with many requests to hold camps regularly, to provide similar camps for their male colleagues and in villages, a number of women took the time to express their feelings. The feedback was enlightening. A sample is reproduced below:

"The camp was useful, especially in making women aware, removing doubts and helping to reduce the fear of cancer." Goregaon Doodh Sagar Residential locality.

"Since it was free even ordinary women could take advantage of it."

"Because of a lack of time, it was never possible for me to get a complete check-up done, I am grateful to you for providing me that opportunity today."

"Such camps are important in catching cancer at an early stage. Very few women are mentally prepared to go to a doctor for check-ups. As a result, symptoms are ignored and by the time treatment starts, a cure becomes impossible. Through these camps it will become easier to fight cancer."

"Your camp was extremely praiseworthy. I felt I saw a reflection of Mother Teresa’s work in your programme. In the 21^st century world of computers and internet, the average woman sets out of her house to earn a living and to satisfy her aspirations. She is very well educated, yet she is trapped in the four cornered enclosure defined by her home, job, family and society and is forever busy running around within these boundaries. She has no time to pay attention to her own health. Disturbed though she is, she is still forced to neglect it. Also, her knowledge about medical diagnosis and treatment is limited. Under such circumstances, your screening camp today was a wish come true. I would request you to organise such camps for the benefit of daily wage workers, housewives and for literate and illiterate women in villages." (BMC)

"Your programme was extremely valuable. Please organise such camps at other offices and not just for Women’s Day."

"The entire health check was useful and appropriate. Thank you for making it possible for me to fulfill a long-standing wish."

"Even today women are afraid when they hear the word "Medical". Your lectures and talks were very important in removing doubts." (Central Railways)

"I felt that the entire check-up was very good, especially since it was held free of charge during office hours."

"By taking advantage of such camps, women can get their breasts examined regularly, because most women will not go to a doctor on their own." (Provident Fund)

There is a long way to go before Indian women become convinced about the importance of breast cancer preventive measures. Camps such as these will raise awareness and help reduce the fear of cancer. CPAA is committed to providing the means to as many women as possible in a manner that they will find convenient.

Department Reports

Prevention and Early Detection

46 camps and OPDs were held during the month of March. Out of the 33 camps held, 6 were organised at Lourde’s Community Centre, Orlem; 4 for the Rotary Club of Mulund; 2 each for ONGC; Sporting Union Club; National Railway Mazdoor Unions, CST and Dockyard Road; Mahindra and Mahindra, Bhandup; BMC, Palton Road; Income Tax Chambers; Goregaon Dudhsagar; Pidilite Ghatkopar and GIC; and one each for Pidilite Industries (Head Office); Mazgaon Docks and Film City, Goregaon.

A total of 1064 people, 197 males and 867 females were screened in the camps. 258 people were advised follow up. 13 OPDs and clinics were held during the month. 81 males and 120 females were screened. 52 people were advised follow up.

4 cases of cancer were detected during the month. Two cases of Head and Neck cancers were detected in our clinics. These include a woman who has been attending follow up camps since October 1999 when she underwent her first screening. Through our initiative for Women’s day, two more women were found to have cancer. The first was detected with cervical cancer at the Lourde’s Community Centre at Orlem.

The fourth case is a special triumph for CPAA’s Diagnostic Department. The cancer screening consists of examination by 4 doctors, an ENT specialist, a physician, a surgeon and a gynecologist. In addition, we perform a simple blood test to rule out leukemia. This test forms a large part of the total cost of the screening since disposables, such as needles, slides, solutions, cotton, tissues and gloves are required for it. Over the years there had been some debate on whether the test is worth the expenditure incurred. The answer came this month when a smear result showed abnormally high WBC count. On further investigation, a possible case of Chronic Lymphoblastic Leukemia was detected. The woman has now been directed to Tata Memorial Hospital where a CPAA representative will follow up and guide the patient.

When CPAA began 31 year ago, the main aim was to help poor and needy patients. Over the years, it was perceived that the problem in India was one of lack of awareness on what causes cancer, how it can be prevented and the importance of early detection in effecting a cure. From an early beginning through OPDs at Sophia College, CPAA’s Diagnostic Centre is today the fruit of the labours of several dedicated individuals over the years that have nurtured the activities to their present level. It is tiring, painstaking and often thankless work, very much like the proverbial search for a needle in a haystack. It is therefore a matter of pride that we have played a part in saving the lives of almost 100 people whose cancers were detected at our diagnostic camps.

Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre

The Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre screened 191 persons during March. 528 tests were performed, out of which 448 were pathology tests. 3 free OPD patients were seen. 12 sonography, 47 x-ray and 21 mammography investigations were carried out.

Insurance

41 new policies were registered in March, bringing the total to 6743. 95 people were examined, of whom 35 had come for the first check-up and 60 for renewal check up. One of our policyholders, who had a brain malignancy, expired during the month.

Patient Care

At Smt. Panadevi Dalmia Cancer Management Centre

A total of 631 patients were aided, counseled and given guidance at our 5 locations-Srimati Panadevi Dalmia Cancer Management Centre; at Nair, Cama & Albless, Wadia and Tata Memorial Hospitals and the Palliative Unit at TMH. 108 patients availed of ambulance facilities, including 8 patients who availed of the stretcher service for long distance. 50 persons were given clothes, 150 packets of biscuits and 65 boxes of Complan were distributed. 12 home and institutional visits were made. 4 of our patients expired during the month. Donations amounting to Rs. 1,32,700 were collected and Rs. 2,35,183 were disbursed.

At Tata Memorial Hospital

200 patients were aided, guided and counseled by CPAA’s Halima Aurangabadkar at Tata Memorial Hospital during March. 200 packets of biscuits were distributed. 38 patients were given clothes, 6 kgs of sweets were distributed. 18 referred cases were helped. 12 ward visits were made. 8 patients were given medicines and toys were distributed to 56 children. 128 patients were given Complan and Horlicks. 189 patients utilized the ambulance facility including 6 for long distance travel.

"Can I Help You?" CPAA’s Desk at Tata Memorial Hospital’s Private OPD

This month, Jennifer Quadros helped 618 patients, providing information and literature on various kinds of cancers to 149 patients and their family members, helping 187 in filling up registration and other forms and answering questions about the hospital for 204. 11 ward visits were made.

At Bai Jerbai Wadia Hospital for Children

40 new patients were registered during the month. 547 patients attended follow up of whom 138 patients are undergoing chemotherapy. 30 patients were counseled and given guidance and 15 patients were visited in their wards. 5 group meetings regarding cleanliness and diet were organised.

On behalf of Mrs. Sonia Mehta, CPAA’s Ms. Zakia Topiwala distributed biscuits to 20 children at the hospital. A special thanks to Mrs. Mehta for her sustained involvement in our Patient Care activities.

Palliative Care Unit at Tata Memorial Hospital

28 patients, 19 males and 9 females were counseled during the month of March. There were 13 cases of Head and Neck cancers, 3 cases of cancer of the abdomen, 3 cases of cervical cancer, 2 cases of brain tumours, 4 cases of osteosarcoma and 3 other cases of cancer.

Cancer can change the course of the life of not only the patient, but his family members as well. When told that a loved one’s cancer is terminal, family members are devastated. It is especially difficult for a parent to accept the approaching death of a child. Hopes, aspirations that have been focused in the child over so many years from their first step have to be reconciled. At a counseling session in the TMH Palliative Care Unit recently, Mrinal Marathe met a father who was asked at retirement what his savings were. He answered that his son, a brilliant student with a bright future, was his life investment. It is indeed hard for him to accept that this son is now fighting a losing battle against cancer.

Counseling at Cama & Albless Hospital Cancer Ward

A total of 47 patients were counseled and given guidance. Among these are 12 new patients. 14 patients were registered with CPAA. 23 patients were counseled and given guidance in the OPD and ward visits. 47 patients of cervical (19), breast (9), rectal (4) and ovarian (14) cancers and one patient with multiple myeloma were visited in the wards. 4 terminally ill patients were referred to Shanti Avedana Ashram. Rs.3000 was provided towards radiation treatment and Rs. 2433 for medicines.

Nair Hospital (Radiation Department)

From this month a new counseling centre was initiated at the request of Nair Hospital’s Radiation Centre. 28 patients were counseled and given guidance. 3 patient visits were made. 3 terminally ill patients were referred to Shanti Avedana Ashram. A total of Rs. 20,000 was contributed towards radiation treatment and medicines. 50 bottles of Horlicks, 2 kgs of chocolates and 2 cartons of clothes were distributed. The counseling falls into mainly three categories, namely guidance regarding alternative medicines (10), diet (18), cleanliness and hygiene (8). Patients expressed their gratitude at the useful inputs provided by the CPAA representatives.

Rehabilitation

The Rehabilitation Centre adopted two new patients this month. A total of 70 patients were helped. Three cases of mastectomy were attended and breast prostheses were provided. 259 patients were given rations worth Rs. 26,729. Rs. 13,200 was spent on teachers’ salaries, for patient education and vocational training. Rs. 1 lakh was spent on patients’ wages and Rs. 21,157 was spent on welfare activities, conveyance and diet supplements.

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