Men carry the HPV virus. And cervical cancer, of which India has one-fourth the global burden, is preventable, so reaching out to men is an important first step.
An Indian woman has a higher chance of developing a cancer compared to a man. While for some cancers women are as much as 20% more at risk, for others, it’s as much as 50%. This gender gap in cancer rarely gets the attention it deserves.
Researchers from the Indian Council of Medical Research (ICMR) pointed out in an editorial published in the Indian Journal of Medical Research that while the incidence of cancer in India is 92.1-126.1 per 100,000 for men, it is 107.8-142 per 100,000 for women. Incidence refers to the number of new cases that is likely to be reported in a population every year.
This is the opposite of what’s happening elsewhere in the world, where more 25% more men are affected by cancer, although there are large variations from region to region and depending on the type of cancer. “The patients not reporting to good facilities are mostly missed from the hospital based cancer registries. Further, patients going to alternative system of medicine are also usually missed from hospital-based registries,” Ravi Mehrotra, director of the ICMR’s National Institute of Cancer Prevention and Research and co-author of the editorial, told The Wire.
Cancer is the result of a cell division gone wrong. Cancerous cells are the ones that continue to grow and divide, both out of turn and uncontrolled. In some cases, they then move to other parts of the body, invading new areas, and often with fatal consequences for the individual.
Tobacco, genetic factors and some environmental toxins have been known to push the rates of cancer up. Then there are the viruses. Cervical, penile, anal and oral cancers can be triggered by the human papillomavirus (HPV). We must pay attention to this mode of transmission because cervical and breast cancer are together the most common cancers in women in India and contribute to over a quarter of cancer deaths.
The HPV virus can cause the cells in a woman’s cervix – commonly known as the mouth of her vagina – to grow uncontrollably.
But here’s the deal: men carry the HPV virus. And cervical cancer, of which India has one-fourth the global burden, is preventable, so reaching out to men is an important first step.
As common as common cold
The papillomavirus is common – almost as common as the common cold, according to Amita Maheshwari, a gynaecological oncologist at India’s largest cancer hospital, the Tata Memorial Centre (TMC) in Mumbai.
Studies suggest that one in 10 women across the world carries an HPV infection at some point in her life. For the most part, their bodies will fight against the infection but on the rare occasion the fight fails, the result is cervical cancer. “Cervical cancer is a rare complication of a common infection,” Maheshwari said. Most women never show any symptoms – nor do most men.
So why focus on men’s role in cervical cancer? “They are the culprits,” according to Maheshwari. HPV rarely causes any complications in men; they are just the carriers. The virus is transmitted when the man has bad hygiene or has multiple sexual partners. Condoms provide some protection but can’t go all the way: the virus is also spread by external genitalia. And in a small percentage of men, HPV will trigger penile, anal or oral cancer. (The numbers are so small they don’t even make it to the list of top-10 cancer sites in men. While oral cancers make 3.9% of all cancers in men they are also caused by tobacco so there is no way to attribute certain cases to the HPV virus alone.)
And not just transmission – man also make financial and healthcare decisions in most households in India. Research suggests that when male partners are educated, they encourage their wives to seek better healthcare. There is also evidence that when men are not focused on key health outcomes among women, the latter suffer, and not just for cancer care.
As partners, fathers or as colleagues, men can facilitate access to medicines, greater movement for women – especially in rural areas – and support them in sticking to treatment regimes.
In breast cancer, the mother’s age at birth of her first child plays a crucial role in prevention, a decision expected to be taken jointly taken by partners in most cases. Men can also offer emotional support. “I know of a man, my patient’s husband, who shaved his head at the same time his wife started chemotherapy. I think that was a very sweet thing to do,” Shalaka Joshi, a surgical oncologist at the TMC, said. “People go to Tirupati to donate their hair or some get wigs made from their own hair. All these things can reduce the trauma associated with treatment.”
And yet the discourse around cancer prevention in women leaves out the roles of male partners.
Not part of the conversation
First off, many outreach programs don’t target men at all, nor are healthcare workers – including doctors – trained to address men. Some studies, such as this, suggest that lack of male engagement in women’s healthcare could worsen if the hours the doctor is available clashes with their work timings, the healthcare workers are rude to them during the visit or if other female patients find their presence in the health facilities discomfiting and they have no separate waiting area.
Getting more men involved also means one has to make them unlearn the gender roles they are taught growing up. “While men are initially hesitant to be a part of discussions on women’s health, in our experience, after a little counselling they are not averse to helping,” said Kalpana Apte, the secretary general of the Family Planning Association (FPA), which routinely holds sessions on sexual health for both men and women.
Reaching out to men also requires innovative approaches as they are reluctant at first to be involved in discussions on women’s health. The FPA uses panchayats and hobby groups, like trekking groups, for example, as entry points to starting a dialogue on topics specific to the group, and gradually introducing concepts like health and empowerment.
While consistent dialogue and communication work, it is easier to do so in cities. Reaching out to men in rural areas where gender stereotypes can be strong takes time.
Ankita Sharma, who works for an NGO in the tribal block of Ghatol Rajasthan, says that often the biggest pushback often comes from women themselves. “I’ve found men curious to learn more about issues like menstrual health and they have a lot of doubts – but often women are resistant and insist on them being kept out of sessions.”
Disha Shetty is a freelance science journalist.