This post is written by Dr Judith Fletcher-Brown at the University of Portsmouth, UK.

  • The problem: Pre COVID-19, breast cancer rates in India were at epidemic proportions because of a lack of government strategic focus on cancer, and the rate is set to grow.

  • Why it matters: The pandemic has further compounded issues in women’s breast cancer healthcare as mortality is predicted to rise due to delays in diagnosis.

  • The solution: Research suggests better targeted breast cancer health interventions using mobile health (m-health) technologies operated by frontline health workers would enhance healthcare delivery, alongside bold investment and innovation in strategic public health policy.

Pre COVID-19, breast cancer rates in India were heading towards epidemic proportions. Whilst the survival rate for women with breast cancer in the UK is approximately 85%, in India it’s barely 50%, with the highest female mortality rate found in those aged 25-50 years of age.

The two reasons for this situation are firstly that there has been no large-scale implementation of a breast cancer prevention awareness campaign (since a national cancer control programme in 1976) to promote awareness of the early warning signs. A slight change in focus was seen in the National Health Policy (2017) when the percentage of GDP by 2020 for healthcare rose to 2.5%: a rise of 1.5%, but without a strategic focus on cancer.

"The legacy of such fiscal investment in m-health technology would be the normalisation of breast cancer discourse and the technical up-skilling of ASHAs."

Secondly, India’s cultural complexities surrounding the female body render cancer a taboo. India is still a patriarchal society and while women have an element of economic independence, men are still considered the head of the household. Even educated professional women do not discuss private matters about their bodies with their husbands, fathers or brothers. This situation causes many women to access medical help too late. India therefore operates a fragmented approach to constructing a nationwide system for breast cancer healthcare. Observers have also witnessed a less than substantive investment in educational resources to normalise breast self-examination, or technological innovations to aid prevention activities.

The impact of the pandemic

The management of healthcare for India’s population of over one billion citizens is the responsibility of the state governments, with overall control held by the central Ministry of Health and Welfare. Over the past two decades, the inadequate flow of public health information about breast cancer has not enhanced the ministry’s reputation as a quality health provider. Further, the national health institution is now overwhelmed with administering care for COVID-19 patients and desperately trying to roll out a vaccination programme which has left India’s health system struggling to cope. Many cancer centres have been converted to treat COVID-19 patients, further compounding women’s breast cancer healthcare problems by delaying diagnosis and treatment. Consequently, mortality is predicted to increase in the next 5–10 years. The magnitude of the problem is enormous and has major policy implications for the Indian government to tackle. Pre-pandemic, the fiscal resourcing of women’s breast cancer care was weak, but government investment in normalising ‘how to self-examine breasts for early warning signs of cancer’ could improve mortality.

Technology is one way forward

The pandemic has prompted patients to access cancer care closer to home, which encourages a distributed model of care. Recent research in India revealed the essential cog in the prevention wheel are community nurses known as Accredited Social Health Activists (ASHAs). In particular, these frontline workers are responsible for disseminating maternal and child health knowledge and treatments. It is their unique standing within the community which provides the potential for a mobile health (m-health) innovation operated by ASHAs to develop a targeted breast cancer health intervention to improve self-examination knowledge. This would require India utilising its strengths in information technology innovation to equip ASHAs with a digital device to operate a bespoke application which could disseminate information about self-examination and early warning signs. The legacy of such fiscal investment in m-health technology would be the normalisation of breast cancer discourse and the technical up-skilling of ASHAs. Overall, investment and innovation in strategic public health policy would enhance the capability of the national health service in India to improve women’s breast healthcare.—Dr Judith Fletcher-Brown

References

Fletcher-Brown, J., Pereira, V., & Nyadzayo, M. W. (2018). Health marketing in an emerging market: The critical role of signaling theory in breast cancer awareness. Journal of Business Research, 86, 416-434.

Gupta, K., Malik, M. and Baig, V.N., (2017), “Need of a New Frontline Health Functionary Dedicated to Non-Communicable Diseases in India”, International Journal of HealthCare _Education and Medical Inform_ation, 4(2), 2.

Khokhar, A. (2018), “Breast Cancer Literacy amongst Office Going Women of Delhi”,Clinical Oncology, 3, 1430.

Ranganathan, P., Sengar, M., Chinnaswamy, G., Agrawal, G., Arumugham, R., Bhatt, R., & of India, N. C. G. (2021). Impact of COVID-19 on cancer care in India: a cohort study. The Lancet Oncology, 22(7), 970-976.

Fletcher-Brown, J., Carter, D., Pereira, V., & Chandwani, R. (2020). Mobile technology to give a resource-based knowledge management advantage to community health nurses in an emerging economies context. Journal of Knowledge Management. 25(3), 525-544.

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