Prof. Chintamani, President – The Association Of Breast Surgeons Of India, Vardhman Mahavir Medical College Safdarjang Hospital, in conversation with Shahid Akhter, ENN, discusses the onco challenges
Today cancer has percolated into our daily life, like never before. It is in the air, food and water. Despite cutting edge treatments, cancer figures continue to remain stubbornly high. Cancer seems to be tightening its grip on India. Despite cutting edge treatments, We are stiil grappling with the high price of cancer care.
Where are we heading to? How do you envision the Indian onco-scenario?
It is indeed a reality and we need to understand that now we live in the midst of disease and preventive oncology is assuming great relevance in developing countries like India. There is great concern about the environmental insult as you mentioned but the major impact has been on account of lifestyle that has changed drastically and is still changing. The so called “burgers cola culture” that we have adapted along with the western lifestyle and element of stress is contributing a great deal. Our rivers are polluted beyond repair; there is a high dose of carcinogens in the food and water that we are consuming, so on and so forth. Even the mother’s milk has been found to have a high percentage of chemicals and metals that are believed to be damaging. This epidemic has already hit India big time. Breast cancer is fast catching up as the most common cancer in the Indian women and tobacco abuse has already made oral cancers the most common cancers in Indian males. This needs addressal at the earliest.
Cancer continues to sound like a death knell to a layman in India. More precisely, what exactly does it mean to be a poor and suffer from cancer as well ?
How does he cope with the trauma ? It cannot get any worse than that. Poor man and cancer is a deadly combination. The management of cancer is very expensive and the cancer drugs, radiations and surgery are beyond the reach of a sizable majority. India is indeed a land of paradoxes; while at one end of the spectrum there are centers that are at par with the best in the world and at the other end there are still issues with basic health care for the majority of Indians.
How do you compare the diagnostic costs and screening programmes in India with that of the West ? To what extent are the government policies responsible in meeting the oncochallenges that we face today ? There are no screening programmes in India for any cancer except the cervical cancer and the obvious reason is the cost involved. Screening although now being challenged did play a very significant part in the management of various cancers in the West, especially breast and colorectal cancers. I am sure the government is doing its bit but we need to do more in health care and especially cancer needs to be given the priority it deserves in a civilized world.
As the President of the Association of Breast Surgeons of India, how do you address the breast cancer epidemic that is set to overtake cervical cancer as the most common cancer in women?
Ever since I took over as the President of this National body “The Association Of Breast Surgeons Of India” we have been conducting various cancer awareness programmes and seminars and conferences to educate the care providers and cancer patients across the country. We are the first breast cancer related National association and it has been our endeavor to deal with basic issues and we are focusing on smaller cities and centers that often cater to the majority of our patients at peripheral levels. Working at a tertiary cancer care center I have realized that there is more of “bankruptcy of thoughts and training” and we have taken upon ourselves the responsibility to conduct some training courses for basic doctors including imaging, core needle biopsies etc. We are putting in a serious effort to find and share the “Indian solution to Indian problems”. We are working towards increasing breast cancer awareness (various pink ribbon marches, seminars etc.) and also planning screening programmes that can be in the form of clinical breast examination, self breast examination etc.
“I am sure the government is doing its bit but we need to do more in health care and especially cancer needs to be given the priority it deserves in a civilized world. Cancer care in India is still struggling to reach all sections of society and is thoroughly disorganized”
How active and effective is the support service for cancer patients and care providers?
The cancer care in India is still struggling to reach all sections of society and is thoroughly disorganized. There are very few dedicated centers to have a “holistic view” of the problem and there is too much of red tapism in state run services. Support services and nursing care to these patients is appalling. How do you compare cancer care in India with that of the West? Indian cancer has been shown to behave differently. In a study that we had conducted and published it was observed that unlike in the West where the incidence of breast cancer increases with age reaching a peak in 60s, we observed two peaks, one in 30s and 40s and the other one in 50s.The cancer occurring in the younger age groups was found to be more aggressive and associated with a poorer outcome. A special aggressive type of breast cancer (triple negative cancer) has been found to be more common amongst Indian women occurring at younger age when compared to the western world. This cancer has been found to have a bad prognosis. The classical “Indian oral cancer” involving the lateral sulcus has been linked to the peculiar habit of consuming the tobacco in the form of “quid” or khaini. The increasing abuse of this smokeless form of tobacco (Pan masala etc.) is a cause of worry. The Indian cancers and Indian patients with cancers behave differently from their western counterparts.
Early detection of cancer is the key to successful treatment. Unfortunately, in India, patients come for treatment in stage 3 or 4. Why do they present late ?
Who do you think is responsible for the delay? You are right and the best bet is to get the cancer early. We are struggling on this front as even today most cancers that we manage are advanced at presentation. We often attribute it to the lack of education and awareness amongst our patients, however we observed in a study that we had conducted and published that the delays are most often due to the delayed diagnosis by the providers .This therefore would mean that we need to prime and train our doctors into making an early diagnosis. In one case during this study we had observed that there was a delay of 35 days before a classical case of breast cancer could be diagnosed at a tertiary care center.
In Indian perspective, how do you envision cancer detection and management in near future?
We cannot have an American or English solution to an Indian problem. We need to tailor the entire effort to our patients. India is a vast country with highly skilled health care providers. The need of the hour is to standardize our efforts rather than the “free for all” kind of scenario, as it exists today. The management of cancer patients requires a multimodality approach and we need to bring all these specialties on board to improve the outcome. It is of course easier said than done but I am very optimistic about the future.
Please elaborate on dermatoglyphics in cancer detection?
You are perhaps referring to my study on using dermatoglyphics or finger printing for screening breast cancer. This, in simple terms is to exploit the understanding that there is a genetic basis to breast cancer and the kind of fingerprints that we carry. One can say that we are carrying our genetic code on our fingertips as the patterns are unique to an individual and these patterns do not change as we grow. In our study we observed that some finger print patterns are more often seen in breast cancer patients. We had published our study in a leading International cancer journal and are still working to find out if these can help us as a screening modality along with CBE (clinical breast examination).