Is cancer still a death sentence?
Most cancers are preventable and also treatable. Cancer diagnosis and treatment have grown by leaps and bounds. We know the cause of at least 70 per cent of cancers now, around 60 per cent of cancers are now preventable and 80 per cent of all stage 1 and 2 cancers are completely treatable. I have over two lakh cancer patients who are now doing well. It is unfortunate that the largely preventable disease comes in for clinical treatment at the third or the fourth stage, when the survival rate is only 20 per cent. Half of all cancer patients now survive at least 10 years. The survival rate for all cancers has gone up; topping the list are prostate, breast, bladder and kidney cancers. Childhood leukaemia, a disease that was a big killer of the children when it struck in the 1970s, is now one where 70 per cent patients survive. The glass, however, remains half-empty as many other cancers still defy treatment: lung to pancreas, liver to oesophagus. There is no need to fear cancer. I am confident that scientific research is going to provide the lead in resolving most of the issues of human sufferings from cancer in the coming years.
Dr GK Rath, Chief, National Cancer Institute, AIIMS
Can it come without a warning?
For most cancers, there are warning signs and symptoms and the benefits of early detection are indisputable. How people with possible cancer symptoms decide whether or not to seek medical help determines their chances of cure and survival. We find that patients often dismiss their early symptoms, especially if the “red-flag” warning symptoms are painless or sporadic. Some just watch and wait, some are afraid of poor prognosis, some lack confidence in doctors, and some think their problem is related to ageing. As a society, we have a particularly poor suspicion index for cancer and it leads to delayed diagnosis and treatment. For any symptom that continues for more than three weeks, do not rule cancer out. Treating cancer early means you have a far better chance of beating the disease.
Dr Harit Chaturvedi, Surgical oncologist, Chairman, Max Institute of Oncology and Indian Cancer Society
What has changed in the way cancer is understood, diagnosed and treated?
There are major developments happening in cancer. New techniques and technologies are being developed that have helped in the better understanding of the biology of cancer. This, in turn, is improving the ways we could help diagnose and treat cancers. For example, the growing list of targeted therapies’ available is a shift away from the conventional toxicity-prone chemotherapy. One of the targeted therapy, Imatinib, used in a form of chronic blood cancer, has not only helped control the disease much longer than we could do earlier using the conventional chemotherapy but also several patients can be considered to be cured. Another major advancement over the past few years is Immunotherapy, wherein the patient’s immune cells are helped to fight and eliminate cancer. In particular, new monoclonal antibodies targeting an immune pathway called PD-1 and PD-L1, which is used by cancer cells to escape detection by the host immune cells, have shown some very good results in advanced cancers and have been approved by the Food and Drug Administration (FDA) for treating cancers, including that of malignant melanoma [an aggressive skin cancer], kidney cancer, lung cancer, urinary bladder cancer, a form of lymphoma. The downside, however, is that these newer therapies cost a fortune. Pembrolizumab could cost upwards of Rs 50 lakh, which most Indians may not be able to afford.
Dr T Rajkumar, Professor and Head, Dept. of Molecular Oncology, Cancer Institute (WIA), Adyar, Chennai
Where does India stand in cancer research and treatment?
There are many hospitals and laboratories in the country that offer targeted next generation DNA sequencing which allow us to determine the specific genetic change driving the tumour. Thankfully, these labs offer such tests at a fraction of the current western costs. The FISH (fluorescence in situ hybridisation) test that maps the genetic material in human cells and MRD (minimal residual disease detection) test that finds evidence of residual malignant cells are now being developed in many tertiary care centres and commercial labs. The radiotherapy departments in many centres have the best equipment available anywhere in the world. Stem cell transplantation for blood cancer is available in India at Rs 12-25 lakh as compared with $250,000 for a similar transplant in the US.
However, cancer treatment is expensive and many of our patients can neither afford the tests required for personalised medicine nor the new small molecules which specifically target the tumour cells. A patient with chronic lymphatic leukaemia with a 17p mutation requires treatment with a BTK inhibitor, ibrutinib, which costs Rs 24 lakh for one year. Also, the infrastructure to treat cancer is inadequate considering the population that needs such treatment.
Dr Mammen Chandy, Director, Tata Medical Centre, Kolkata
What percentage of cancers are hereditary in nature?
There are two categories. The first is familial or cancer running in the familygene flaws that can be transferred from one generation to another. About 10 per cent people belong to this. The other is when family members have cancer, but there is no genetic inheritance involved. It could be because a family is living in a coal mine area or near farms that are always full of insecticides and chemical fertilisers. Such families are exposed to so much environmental pollutants that they end up developing cancer. Another 10 per cent get this. Cancer does not develop in a day. It’s a complicated process that takes time. Your stress levels, your body physique (tall people are at slightly greater risk as they have more cells in their body in which dangerous mutations can occur), if you are obese, if you are a red meat eater, if you don’t take plenty of fibres and vegetablesall these factors play a significant role. Cancers of the bowel, breast, ovaries, colon-rectum, kidney, skin (melanoma), pancreas, prostate, eye (retinoblastoma) and thyroid are some that have a genetic component. It is possible to get genetic tests done to check if you are carrying any risk in your genes. However, I have seen people with a strong genetic history of cancer not getting the disease, even at age 70, because they lead a very healthy lifestyle.
Dr Amit Verma, Molecular oncologist and cancer geneticist, Max Cancer Care, Delhi