Why India must launch a nationwide programme to screen for the dread disease
When it comes to cancer research and treatment we still consider the US numero uno. In January last year President Barack Obama had announced the establishment of a 'Cancer Moonshot' to accelerate cancer research.In 1971 we had another American president, Richard Nixon, declare a 'war against cancer': “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.“
For too many, for too long, a cure for cancer has felt like wishing on a lucky star. If we are to believe published reports, however, a cure is imminent.Money is being poured into immunotherapy and personalised treatments based on genetic biomarkers, in the hope that a breakthrough is around the corner. Not so fast, warn research scientists who have been wrestling with cancer cells for the past 50 years in the laboratory.
Stephan Tanneberger, a long term cancer researcher, provides a historical perspective in an article in Cancerworld: “In a programme that spanned ten years, we realised then that the existence of a single 'cancer state-specific cell defect' is nothing more than a scientific illusion.“ What he means is that given the biological diversity and continual evolution of tumours it was and continues to be naive to believe that cancer can be cured using a single targeted therapy . As an illustration, he refers to the disappointing results of cancer drug therapies so far.
In the November 2016 issue of the British Medical Journal, Peter Wise takes up this theme and raises the question of how much of the improvement in cancer survival rates can be attributed to drugs. He cites studies that show that newer drugs, on an average, prolong survival in metastatic cancer by no more than a month or two. This leads him to ponder how ethical it is to continue to invest huge sums and promote more and more expensive drugs with limited efficacy and get patients to take them.
The question is especially pertinent for India. The majority of our cancer patients come with advanced disease, lack information, have limited means and no insurance cover to speak of. On the other hand, we are today witnessing a proliferation in the number of private cancer hospitals fuelled by the scent of money .
With a million cancer patients being added annually to the existing pool of 15-20 million patients there is much lucre to be made. What is a matter of concern is that patients will be ill served by the punitive and expensive treatments offered, which will destroy the quality of their lives, reduce their already straitened circumstances and provide little benefit in terms of significant longer survival. For almost 80% of our patients, who come with disease that has already spread, treatment given with the purpose of keeping them functional and preservingtheir quality of life without breaking the bank is of utmost importance.
And yet, if newer drugs have not met the expectations they raised, what explains the 20% increase in five year survival rates in US adults with solid tumours in the recent past? The US has experienced an increase in survival rates for these cancers largely because of prevention and early detection. When you consider that in India the majority of our cancers are preventable and can be detected early , surely this is where our efforts must focus if we are to save lives. We need to launch a nation-wide screening programme for our major cancers.
Tobacco related cancers continue to dominate the landscape by contributing to almost one-third of our cancers.Cancer of the uterine cervix, for which there is now a vaccine, still takes an unacceptable and avoidable toll on the lives of women.
It has recently been relegated to second place in our National Cancer Registry not because of a significant decline in incidence but because of the precipitous rise in breast cancer rates among women in all our major cities.Going by the prevalence rate today, 1 woman out of 28 will develop breast cancer in her lifetime. She will have a 50% chance of survival if she catches it early and gets timely treatment.
The benefits of early detection cannot be over emphasised. By catching cancer early you cut down on the cost of treatment, preserve quality of life and save a life. It is more than doable for our major cancers. The early signs of malignant changes in the oral cavity, the uterine-cervix and the breast can be detected by visual inspection alone. You do not need sophisticated technology .
This is not to say that we should not continue to invest in more research and better cancer treatments, but to argue for an approach that is more suited to our needs. One that is both relevant and ethical. To quote Tanneberger: “My plea, particularly to the new generation of colleagues, is: when you look at someone's tumour to understand its driver mutations, don't forget to also look in their eyes, understand the person, and 'personalise' that human being in the room with you.“
Source: Times of India