Cancer cure and treatment continue to be a formidable challenge despite the huge investments into research, primarily because cancer is a very diverse disease, says Sudha Sivaram, program director – South Asia Region, Center for Global Health, National Cancer Institute (NCI), United States.
Justifying the billions of dollars going into cancer research across the world, Dr. Sivaram, recently in Chennai as part of a reconnaissance visit to cancer research centres in the country, says most cancers today are manageable, if detected early.
“If you take conditions like Chronic Myeloid Leukemia, they are completely curable. Drugs are available for that. But yes, these are exceptions rather than the rule,” she adds.
However, she articulates her belief that we are poised at the edge of a cliff of exciting and challenging breakthroughs in cancer research, “The time is now. There is rapid urbanisation, better detection techniques, people are living longer…The tools, technology and expertise worldwide are at a stage when answers will come up in several areas: cell biology, assessment of pain, clinical implementation.”
Another reason why cancer remains a challenge is because it has still not evolved into a health systems project mode. “There is much more to do to strengthen health systems delivery of cancer care and community involvement. A study at Tata Memorial hospital showed that providing interventions at the community level through trained field workers worked well, even to downstage the cancer. This simply meant they were catching the cancers early, and therefore, outcomes were better.” In context, Dr. Sivaram also has a good word for the Tamil Nadu government’s cervical cancer detection programme.
The Center for Global Health was set up two years ago when NCI director Harold Varmus decided to set up an agency that would work facilitate research efforts that would help decrease the global burden of cancer by collaborating with various government agencies, governments, non-government organizations, and pharmaceutical and biotechnology companies.
Clearly, this kind of collaboration is essential, for the statistics are staggering. According to the International Agency for Research on Cancer estimates, there were 12.7 million new cancers cases globally in 2008; of which 7.1 million were in ‘developing’ nations. In the same year, of the 7.6 million cancer deaths, 70 per cent occurred in such countries.
About 30 percent of cancers are related to lifestyle factors, primarily tobacco, Dr. Sivaram says. “There is no overemphasising the role of tobacco in causing all kinds of cancers, apart from cardiovascular disease, and other non communicable disease. If we can do only one thing, it would be to invest energies to control tobacco use, and preventing youngsters from beginning to use tobacco products.”
In India, the Million Deaths Study showed that approximately 6 lakh deaths from cancer occurred in 2010. Of this, 42 per cent of male deaths and 18 per cent of female deaths were tobacco- related. “Here is further evidence that tobacco use is an important public health challenge. Tobacco control is some thing we have to speak loudly and repeatedly about. Add to that the risk from other lifestyle factors such as alcohol consumption, sedentary lifestyle and junk diets.” Lifestyle alteration to prevent cancers is some thing we have to speak loudly and repeatedly about.
In this, experts must take the lessons from malaria control, HIV and the Polio campaign: behaviour change must be context and age appropriate. Messages have to be tailored to the target group, in order for them to work, she says.
Dr. Sivaram is quite impressed by the work that is being done in preventive oncology across the country, her visit to institutions like Adyar Cancer Institute, Tata Memorial, Trivandrum Institute of Palliative Sciences, Pallium India. “I was trying to look at the gaps they see, what we can work together on. Our institute has a budget of five million every year, and 85 per cent of that is given as extra mural grants. We pick projects that guided by good science.”