Bangladesh has made notable progress in public health over the past decades. Maternal mortality has declined, immunisation coverage has expanded, and community-based health delivery has saved millions of lives. Yet, behind these gains lies a disease that continues to expose the structural weaknesses of our health system: ovarian cancer.
Findings from the Bangladesh cohort of Every Woman Study, a multi-country observational study across 22 low-and-middle-income countries, offer a sobering account of what Bangladeshi women endure from the first symptoms of ovarian cancer to life during and after treatment.
The findings do not point to indifference. They reveal women who recognise that something is wrong, families who exhaust every possible resource to keep loved ones alive, and clinicians doing their best within significant constraints. At the same time, the evidence exposes persistent gaps in awareness, diagnosis, financial protection, and psychosocial care - gaps that cost women time, dignity and, too often, survival.
Nearly half of the women interviewed for the Every Woman Study had never heard of ovarian cancer before their diagnosis. Even among those with some awareness, only a small fraction understood how the disease typically develops. Knowledge of genetic risk was even rarer, with most women unaware that a family history of cancer could increase their own risk. This matters because ovarian cancer rarely presents with clear warning signs. Its symptoms—persistent bloating, abdominal or pelvic pain, difficulty eating, urinary urgency—are common, easily dismissed, and often normalised. In Bangladesh, almost all women experienced symptoms before diagnosis, but without awareness, these signs were frequently ignored until the disease had progressed.
This lack of awareness reflects deeper social realities. Almost one-third of the women had no formal education and more than half lived in households with below-average income. For many, access to health information was constrained by literacy levels, geography, and digital exclusion. Awareness efforts that rely primarily on urban, online, or technical messaging will continue to miss those most at risk. What is needed is community-based, culturally grounded communication that reaches women where they live and in language they understand.
The study also challenged the assumption that late diagnosis is driven by reluctance to seek care. Most women reported feeling concerned about their symptoms, and nearly nine in 10 consulted a healthcare professional, often within weeks. The failure occurs after the first consultation. Many women visited doctors repeatedly, sometimes up to 10 times, before receiving a diagnosis. This pattern points to missed opportunities within the health system, particularly at the primary and secondary care levels, where symptoms are not consistently recognised as potentially malignant and referrals are delayed.
This is not a matter of individual blame but of systemic preparedness. Ovarian cancer may be relatively less common, but this does not justify repeated misdiagnosis. Evidence from the study highlights the need for continuing medical education, clearer symptom-recognition protocols, and stronger referral pathways so that a patient’s concern is met with timely investigation.
Additionally, diagnostic access further compounds these delays. While abdominal ultrasound and CA125 blood tests were commonly used, access to transvaginal ultrasound, an important diagnostic tool, was strikingly low. Genetic testing after diagnosis was almost nonexistent. These services exist in Bangladesh, but availability does not equal accessibility. Women in Bangladesh reported some of the longest travel times among all countries in the study, with many travelling more than five hours to reach a hospital. For women already weakened by illness, distance becomes yet another barrier.
Once diagnosed, treatment outcomes reveal both strengths and vulnerabilities. Treatment generally begins quickly and surgical outcomes are comparable to global standards, reflecting the skill and commitment of oncology teams. However, this clinical capacity is undermined by overwhelming financial burden. More than 90 percent of women relied on family members to pay for care and most reported severe financial impact from treatment costs, diagnostic tests, travel, and accommodation. Bangladesh stood out in the study for its heavy reliance on crowdfunding and NGO support—clear indicators that families are pushed beyond their limits in the absence of adequate financial protection.
World Cancer Day (observed on February 4) is a good opportunity to remember that cancer is not a short-term crisis. Yet, health financing in Bangladesh continues to treat it as one. Without structured support, families are forced into debt, asset sales, or dependence on charity. Financial protection must be recognised as a central pillar of cancer care, not an afterthought.
Equally concerning are the findings on emotional and mental health. Fear—of death, recurrence, and treatment failure—was widespread. Most women needed emotional support at diagnosis and during treatment, yet almost none were offered professional psychological care. Families provided comfort and practical help, but that alone cannot replace trained mental health services. Cancer is not only a physical illness; it is an emotional and psychological rupture. When mental health needs are ignored, quality of life suffers and recovery becomes harder.
Access to information mirrors these challenges. Nearly all women wanted more information about their disease and treatment but many lacked internet access or did not use it for obtaining health-related information. Women expressed a clear preference for hospitals and healthcare professionals as their primary sources of information. They want clear, trustworthy guidance in Bangla, delivered throughout their cancer journey—from diagnosis to survivorship or palliative care.
When asked what should change, almost every woman interviewed for the study believed the government could do more. Their priorities were clear: free or affordable access to treatment and diagnostic tests, and stronger investment in early detection. These demands need to be translated into concrete policy actions, such as, national awareness initiatives, continuing medical education, expanded diagnostic services, financial protection mechanisms, integrated mental healthcare, and patient-centred information systems. None of these ideas are radical; all are achievable and long overdue.
Ovarian cancer in Bangladesh ultimately poses a moral question. The women whose experiences inform this evidence travelled long distances, endured repeated consultations, exhausted family savings, and relied on loved ones and strangers alike to survive. They did their part. The responsibility now lies with policymakers and the health system to act. Early diagnosis, equitable access, financial protection, and emotional support are not optional—they are the minimum standards of dignified, rights-based care that Bangladeshi women deserve.
Rafe Sadnan Adel is a board director of the World Ovarian Cancer Coalition.
Views expressed in this article are the author's own.
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