Nordan Otzer during a cancer awareness event in a village in Ladakh, India. Credit: Athar Parvaiz/IPS

By Athar Parvaiz
LADAKH, INDIA, Nov 29 2023 (IPS)

While working as a doctor in the initial months of his medical career in southern India, a telephone call from his home in the Ladakh Himalayas convinced Nordan Otzer to involve himself with cervical cancer awareness.

“While I was working in a hospital in rural Tamil Nadu (in 2007), one day I received a distressing call from my family informing me that my mother’s health had deteriorated and she urgently needed my presence back home,” says Otzer, an ENT surgeon who is now in his mid-40s and works as a medical practitioner and social worker in Ladakh, a cold desert in the Himalayan Plateau in India.

“When I saw my mother lying on the bed, she was hardly recognizable. It was only at that point that she disclosed to me that she had been experiencing persistent spotting and occasional abdominal pain that had worsened over time,” Otzer tells IPS.  “Unfortunately, she only sought medical assistance when her pain (because of cervical cancer) became intolerable.”

According to the WHO, a large majority of cervical cancers (more than 95%) are caused by human papillomavirus (HPV), which is the most common viral infection of the reproductive tract.

“Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer,” reads a segment of a fact sheet about cervical cancer on the WHO website.

“When screening detects an HPV infection or pre-cancerous lesions, these can easily be treated, and cancer can be avoided. Screening can also detect cancer at an early stage where treatment has a high potential for cure,” the WHO fact sheet says and urges the countries that screening (of women for HPV infection) “should start from 30 years of age in the general population of women, with regular screening with a validated HPV test every 5 to 10 years, and from 25 years of age for women living with HIV.”

Cervical cancer is the fourth most common cancer among women globally, with 90 percent of an estimated 604,000 new cases and deaths worldwide in 2020 occurring in low- and middle-income countries, according to the WHO.

Otzer says his mother was flown to the All India Institute of Medical Sciences (AIIMS) in New Delhi for treatment, but her condition deteriorated, and she succumbed to the disease within days.

“Throughout the journey from my home to Delhi, she held my hand, perhaps also hoping that her doctor son would save her life. But unfortunately, I couldn’t do anything except watch helplessly while she slowly faded away,” Otzer recalls ruefully.

As someone who has studied medical sciences, says Otzer, “I knew my mother’s life could have been saved if she was aware of cervical cancer and its preventable measures.”

“My mother’s death due to cancer altered the course of my career, leading me to make the choice to remain and contribute to my own community.” Since those days, Otzer says that he started making efforts to launch an awareness campaign about cervical cancer and screening of women for HPV infection in Ladakh, a remote mountainous region more than 14,000 feet above sea level in the Tibetan Plateau, which remains cut off from the rest of the world in winters.

Since 2009, Otzer, with the help of his local supporter, Stanzin Dawa, and visiting doctors from Singapore led by Swee Chong Quek, has organized over 140 awareness and screening events for women across Ladakh, where villages are spread out across the terrain and not easily reachable.

“We have conducted screenings for 12,400 women thus far, among whom one out of every 10 women has precancerous lesions. This implies that without timely treatment, these lesions could progress into full-blown cancer,” Otzer says.

Besides the logistical challenges, such as travelling long distances and traversing tough terrain, other challenges, according to Otzer, included women being too shy and reticent.

“Women in Ladakh tend to be reticent about discussing women’s health matters openly, not even with their own family members. Therefore, when I initially launched a cervical cancer screening program, there was a noticeable reluctance among them to undergo checkups,” he says, adding that initially, women would avoid making eye contact and refrain from asking any questions.

“However, with the passage of time, they gradually became more receptive and started attending our screening camps for examinations.”

Cervical Cancer Awareness and India

In India, cervical cancer is the second most common cancer in women, and India contributes the largest proportion of the global cervical cancer burden. In December last year, the federal government in India urged the state governments to create awareness and take steps to prevent cervical cancer.

According to an article published by Lancet in March 2023, the Indian Ministry of Health and Family Welfare plans to vaccinate 68 million girls across India against human papillomavirus (HPV) by the end of 2025, which will be followed by vaccination of a further 11,2 million girls aged 9 years and older each year.

Cervical cancer accounted for 9.4 percent of all cancers and 18.3 percent (123,907) of new cases in 2020 in India, says this December 2021 Springer study, adding that cervical cancer is still among the most common cancers in India and a leading cause of cancer-related deaths in women in low- and middle-income countries.

According to the Springer study, cervical cancer is the second leading cause of cancer deaths for females in 12 Indian states. “The situation is more alarming in rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer and healthcare resources are scarce.

Research has established that awareness and the availability of medical infrastructure play a significant role in preventing cervical cancer. Results of a study published in the Asian Pacific Journal of Cancer Prevention have confirmed that stages (of cervical cancer) “are strongly correlated with survival outcome, and early stages of the disease are associated with an exceptionally favourable prognosis provided they are adequately treated, whereas survival for stage III and IV cancers was dismally low.”

A study published by Lancet in October 2023 found heterogeneity in cervical cancer survival across India, with higher survival rates in urban areas where healthcare facilities are much better than predominantly rural and mountainous north and northeastern regions.

“The disparity in survival between the populations could explain the overall effectiveness of the health care system. This informs policymakers to identify and address inequities in the health care system,” the study says, emphasizing the “importance of promoting awareness, early detection, and improving the health care system.”

IPS UN Bureau Report