On World Cancer Day but I thought I will share a few ‘contrarian’ thoughts :
- Cancer incidence is rising
- We are not making great headway in management of cancer so overall cancer mortality remains nearly static inspite of trillion dollar spend
- We have to discard the current conventions and adopt a different approach
On the basis of this, l challenge some conventional concepts to start thinking for alternate strategies.
1) Bigger surgery is NOT better.
This is a concept which has been challenged, thanks to surgeons who were keen observers who collaborated with their pathology colleagues and came to the conclusion that removing large chunks of tissue around the tumour would not be necessary. This led to less mutilating surgery. Classic example being breast surgery in which William Halsted, the pioneer, proposed the Radical Mastectomy with removal of muscles. Even without the modern chemotherapy or radiation therapy came the modifications involving less
aggressive surgeries. Yes, there was a time ultra radical surgeries were done but soon surgeons realised that it is unnecessary mutilation and resorted to more organ preservation techniques. The same thing also happened in rectal cancer surgery, where without having a permanent bag or colostomy, normal on using basic common sense and good pathology normal passage could be restored.
2) Population screening is NOT necessary – mass screenings is not an answer for early diagnosis because there is no way a population based screening can be done in a country of 1.2 billion people and this will lead to a lot more false positive results and lead to a panic amongst people. Then, is there any answer for this? I would again urge a selective screening. It doesn’t matter if a mammography detects a breast lump or a woman detects a breast lump after a little while at a 1 cm. or 1.5 cm. site. It is not a late detection. Likewise many of the tumours can be detected early if only we are aware of our body. That is the fundamental approach. We should be aware of our body and any change to be noticed and medical attention sought.
Selective screening is the mantra
3) Randomized trials in drug treatment are NOT way forward
This is the biggest hurdle for progress and also it is the most expensive part. Do you know that 90% of the randomized trials are neither conclusive nor have been completed particularly if you comparing Drug A with Drug B. It is a total waste of resources and giving a false hope to patient recruited. Drug companies spend millions of dollars on trials and obviously the cost of drugs, get passed on to the hapless patients.
4) Targeted therapy is NOT a miracle
Targeted therapy in limited instances has been helpful, rest of the time it has proven to be of marginal benefit and extremely expensive and also many times, toxic. So, chasing these targeted agents is the biggest myth. the intelligence of a cancer cell is far superior that that of a drug company and it immediately changes into different pathways which no longer are inhibited by the expensive chemotherapy drugs. So let us stop this chasing these targeted agents and stop doing these trials which have marginal benefits.
5) Genetic testing for every cancer is NOT necessary
The full page ads on gene testing is marketing gimmick without a scientific basis. I have not come across a single patient benefited by so called personalised treatment as the number of active drugs same few whatever the profile may say. The long reports have no value in practice.
Now that brings us to the big question – Do we spend the money on advanced cancers with diminishing returns or early cancers. Answer to this is obviously early cancers.
So stop investing funds on chemotherapy and targeted therapy. It is much better if we can only develop diagnostic techniques which are less invasive or non invasive which will detect cancers which are not symptomatic and that will be the biggest shift to bring us closer to reducing mortality in cancer.
As long as there is civilization, cancer will exist. The only thing we can do is reduce the deaths from cancer.