Decoding cancer scenario in India

Stanley M Marks is the chairman of UPMC Cancer Center, Director of Clinical Services and Chief Medical Officer for UPMC Cancer Center and the University of Pittsburgh Cancer Institute, USA. He is also a significant contributor and member of the tumor board, American Oncology Institute (AOI). Recently, he was in the city to participate in International Cancer Conclave-2018. He spoke to The Hans India and shared his views on the cancer scenario in India. Excerpts:

What is the cancer scenario in India?
Globally, 14 million new cancer cases are detected every year leading to 8 million deaths every year. Nearly 1.1 million of these new cancer cases were reported in India in the year 2015 with a total incidence of cancer reported to be around 3.9 million. Recorded incidence of cancer per 100,000 of the population in India is approximately 100 and is roughly about half of the world average (182 per 100,000) and about one-third of that of developed countries (268 per 100,000).

In India, many cancers in the past that were simply not diagnosed or reported are now being reported due to a significant increase in public awareness, cancer diagnostics and treatment facilities over the last decade. However, still a lot of cancer cases in India are underdiagnosed and under-reported especially in rural areas which forms the bulk of the population. Cancer-related mortality in India is double that of developed countries, mainly due to patients being diagnosed at a late stage and due to lack of adequate preventive screening programmes.

What are the root causes of cancer and how can the same be prevented?
Cancers are preventable and are caused by identifiable factors like tobacco products, obesity, infections, diet, smoking and alcohol. There are some cancers that are not related to any environmental factors and are sometimes purely genetic. However, this is only to the extent of about 10 % of cancers and most cancers are preventable. We strongly believe that prevention and early detection of cancers with screening mechanisms can dramatically improve the outcome of cancer, for patients in India.

What are the key challenges that India is facing in cancer care?
Early detection of cancers can be done through screening programmes including mammograms, PAP smears Prostatic Specific Antigen (PSA) and a low dose chest CT scan in case of smokers. The other challenge is the availability of high-quality cancer care. There are tremendous variability and lack of standardization amongst laboratories and treatment protocols. At AOI, every case is reviewed by a UPMC oncologist and all these cases are treated using our pathways and protocols giving standardized care.

What are the new developments in cancer care?
Currently, the research at UPMC is focused on prevention, early detection and newer therapies for the whole spectrum of cancers. Many of the researches are in the area of immunotherapy, using one’s own immune system to fight cancer. This includes monoclonal antibodies, checkpoint inhibitors, dendritic cells, TIL cells and vaccinations. Some of these immunotherapies are available in India though costs are still of concern while many of them are in advanced stages of investigation and approval. AOI is committed to bringing these therapies into India soon after they are available to patients in the developed world.

How do you bridge the quality of cancer care between America and South Asia?
We at AOI offer comprehensive cancer care including radiation oncology, medical oncology, surgical oncology and heamato oncology and BMT across 10 cities in South Asia. AOI plans to add another 6 centers in the next 12 months across South Asia.

We use state-of-the-art technologies such as ‘Truebeam StX’ and Calypso backed by the most modern diagnostic equipment such as ‘PET-CT’ and digital mammograms to ensure that our diagnosis and treatment are precise and effective. American Oncology has been a pioneer in bringing the US university-level care to the underserved areas across India and South Asia.

What is the significance of international cancer conclave organised in Hyderabad?
In India, there exists a tremendous opportunity to bring quality at par with standards of cancer care that exists in the western world. There is enough opportunity in terms of standardization of treatment delivery based on protocols that can create better outcomes for the patients. Another aspect is the gap in the adoption of newer therapies and overall lack of investment in clinical research towards newer therapies.

The conclave gave us an excellent platform for discussing the recent advances in cancer care across the globe and gave us an opportunity to share the best practices from the west to the clinicians of South Asia. The conclave was truly an opportunity to bring together the best minds in oncology practice from west and east together.

BY Dr G Balakrishna