Thursday 21 November 2013

Childhood Cancer and Gender Bias - Where are the missing girls?

I always enjoy my annual trips to the SIOP Congress which besides being a source of acquiring knowledge, is also an unparalleled opportunity to meet like-minded individuals (who are now friends) who are continuously striving to improve the outcomes of children with cancer across the world. Often at these meetings happened to meet a person or hear a presentation which leaves you spellbound. It was Shalini's presentation at SIOP 2012 in London and this year it was Ritu's presentation at SIOP 2013 in Hong Kong.

Ritu Bhalla is a two time childhood cancer survivor. She was diagnosed with non-Hodgkin lymphoma at the age of 4 years and with Acute lymphoblastic leukaemia at the age of 7 years. She now works for Cankids India ( and is their assistant awareness officer and girl child ambassador. Cankids is the larger childhood cancer support group in India and works in 34 centres across the country. They provide medical assistance and counselling and emotional support programs. One such centre is the Pt. BD Sharma PGIMS at Rohtak in Haryana. When they organised the International Childhood Cancer Day in Feb 2013, they felt that there were relatively few girls (patients or survivors) present. That was the stimulus to look more closely and identify the "missing girls".

There were 123 children with cancer in Rohtak from 2006 to 2013 who registered with Cankids. 1 out of 3 children at diagnosis were girls. However only 1 out of 13 children surviving at the end of treatment were girls. The was a disproportionately higher rate of abandonment of treatment among girls (14%) as compared to boys (6%). The gender of the child was a risk factor for adverse outcome (mortality or abandonment of treatment). The female gender has been previously reported as a risk factor for abandonment of treatment from India and China but this association is not consistent and studies from Central America and Indonesia did not show the same association. This may be a reflection of the variation of societal prejudices across the world.

Ritu and Cankids now want to take this forward and address the issue with the ultimate ambition of making sure that no girl with cancer in India has any lesser chance of diagnosis and treatment as a boy with cancer. I wish them all the best.

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