Dr V.P. Gangadharan established the first medical oncology department in Kerala at the Regional Cancer Centre at Thiruvananthapuram and the first blood stem cell transplantation units in both government and private sectors in the state. He is 62 and holds postgraduate medical degrees in radiotherapy, internal medicine and medical oncology. He is the head of department of medical and paediatric oncology at the VPS Lakeshore Hospital, Kochi. A prodigious writer of numerous articles in both national and international journals, he has also authored several chapters for medical textbooks. He has a keen interest in breast and gynaecological malignancies and has received several awards for his work in oncology and in these areas. He speaks to Minu Ittyipe on the need for prevention, early screening and detection to stem the surge of the disease in India.
According to the Indian Council of Medical Research (ICMR), the projected figure for new cancer cases in 2016 is 14.5 lakh and by 2020, it is expected to rise to 17 lakh. One in eight Indians is likely to develop cancer. Will cancer overtake cardiovascular diseases and become the emperor of all maladies in India?
The way it’s going, it is likely to be one of the major catastrophes in the country. At the same time, I have to say more people are also getting cured. Since I started practising in 1989, there has been a lot of advances all over the world as well as in India. Now, the thrust should be on preventive and screening programs. People are still unaware about the gravity of the disease. I had a patient who was diagnosed with cancer five months back. Since she was constructing a house, she had decided to delay her treatment. The awareness about cancer is totally lacking in India.
How long do you expect the reign of cancer to last? How close is the world to finding a universal cure for the disease?
We are getting closer to finding a cure. In another 10 to 15 years, a cure is expected. It might be a small change in some part of the gene. In all probability, surgery, chemotherapy and radiotherapy will be obsolete at that point of time. It may even be a totally different approach, targeting what triggers the change of a normal cell into a cancer cell. Maybe in the future, someone may be treating the patient in the laboratory, identifying and correcting cancer at the molecular level, rather than an oncologist. That would finally be the direction of treatment.
The threat of cancer growing to epidemic proportions is real in India. What needs to be done to prevent this?
There are five important steps in the treatment of cancer—prevention, early detection, treatment and cure, prolongation of survival and palliation. In cancer, we always think about cure but we never think about controlling the disease and living like how a diabetes patient or hypertension patient contains the disease and lives. The preventive programs and screening programs should be much more active. If all this is done, then 15 to 20 years from now we would see a downward trend.
How active is prevention and screening in India? What are the challenges that our oncologists face?
Some programs are held, but there is no organised screening program in the country. For example, breast cancer is on the rise the world over but mortality is on the decline because of preventive and screening programs and timely treatment. There is definite dearth of surgical and medical oncologists in the country. People don’t know where to go and doctors tend to treat comprehensively instead of separating and focusing on the speciality. Also, there are no standard protocols which are accepted for the country as a whole. The treating doctor should look at the patient, the disease and the purse of the patient and then decide the course of the treatment. If the cure cannot be achieved, or if it is just for palliation, then on no account should a family be made bankrupt by going for treatment.
Breast cancer is the leading cause of cancer among women in India. Reports say that a high percentage of patients are below 40 years of age and there is also a rise in teenage breast cancer. What could be the reasons?
Breast cancer is generally on a hike in India. The ICMR in Kerala has projected that by year 2026, there will be 8,500 new cases per year in the state. Almost two third of breast cancer cases come in the advanced stage, which is incurable. Breast cancer is curable if detected early. The thrust should be to educate women to do self examination, get suspicious and go to a doctor. Earlier, it was a disease for those above 40 years of age, but in the last 10 to 15 years, the number of patients between the ages of 20 to 35 years has increased rapidly. It has a direct relation with one’s lifestyle—high fat diet, the use of hormones, obesity problems. Other risk factors are having the first child after the age of 30, not breast feeding the child etc.
Lung cancer is one of the leading cancer among men in India.
Tobacco related cancers are quite prevalent in males. There is no standardised foolproof screening program for lung cancers but the focus is on prevention. If detected, the cure rate is only 5 to 10 per cent and there is no way to detect it early. In 90 per cent of lung cancers, the only causative agent is tobacco and equally deadly is smokeless tobacco. Earlier, one saw an elderly woman in rural areas chewing pan, but now youngsters are increasingly using tobacco in different forms.
How big a role does genetics play in cancer?
The hereditary factor affects only five percent of cases. But in certain cancers like breast cancer in a young female, we look at the family history. If there is a history then one should screen for cancer.
The internet floats theories of eating fruits like jackfruit, soursop, guavas, and imbibing coconut oil to prevent cancer. What are the other options?
There is no limit to the fruits and vegetables that you should take. One should eat enough vitamins and minerals and phytochemicals and fibres. Red meat should be avoided and it is better to consume small fish. If you eat non vegetarian food then you should eat large quantities of vegetables. If one has to design the food on a plate then it should be 50 per cent fruits and vegetables, 25 per cent grains and 25 per cent protein. One should also practise yoga and meditation to improve the lifestyle, but once the disease is detected then only allopathic treatment provides a cure.
What is the biggest problem that hampers the control of the disease in the country?
There is no vision where cancer is concerned. The government thinks of building hospitals because they are tangible. If the focus is on prevention and screening then the country will see a change in a decade. Education has to be redesigned to teach about incorporate lifestyle diseases at the school and college level. There should be screening at all levels and even in the work place. To meet the high cost of treatment, there are enough political, religious and residential organisations that can help the patient.
