Dr Mohandas K Mallath, a senior consultant in digestive oncology at the Tata Medical Centre, Kolkata,
who is in Goa to deliver a lecture at the ‘6th Annual Goa Cancer Society Lecture’, in an interview with Rohan Shrivastav says that Goa needs to have advanced treatment facilities for cancer patients.
Q: Please tell us about your recent study on cancer. What are your findings?
The study is about the history of growing burden of cancer in India from antiquity to the 21st century. There are diseases described in Atharva Veda and if you put them together in today’s terms, we can say it was cancer. We don’t know what the quantum was and what percentage of cancer was present during those times. But cancer actually started getting diagnosed in India when the Europeans and Britishers came and started doing biopsies. Biopsy is a western concept, which was started 200-300 years ago. During the British time, their doctors had set up medical oncology and they started performing autopsies. It showed that a lot of patients suffered from cancer. So, in other words, cancer was always there in India but it was not getting diagnosed. Cancer mortality in India has doubled from 1990 to 2016. India’s cancer incidence is estimated at 1.15 million new patients in 2018 and is predicted to almost double as a result of demographic changes alone by 2040.
Q: What are the major reasons that could lead to an increase in the number of cancer cases?
Basically there are three different reasons – increased population, increased life expectancy and most importantly, the economic transition. If you take India as a whole, 25 per cent of all cancer cases are attributed to tobacco. So, if we eliminate tobacco then 20-30 years from now, we may not have any cases related to tobacco, but it will be replaced with another set of cancers. Cancer is a disease of aging and as you grow old, the risk of developing cancer increases, irrespective of what we do. India’s population is aging with a decreasing proportion of youngsters and increasing proportion of elders. Cancer burden will keep increasing with the increasing number of elders in India. Therefore, it is important to create adequate treatment facilities.
Q: Goa has witnessed a significant number of breast and colon cancer cases. How do you think the state can fight these cancer cases?
Some of the cancers you cannot fight like breast cancer are related to lifestyle. If you have children early in life and have more children and if you breastfeed the children for a very long time, then there would be fewer cases but you cannot expect today’s younger generation to get married at the age of 18 years and have five kids. Two things can be done to reduce the risk; however, it will not completely eliminate the risk of developing cancer. One way is to maintain body weight, have less fat and the other is to be physically active. Physical activity is a good immune booster. If you undertake continuous physical activities, your body’s immunity to fight various diseases including cancer improves.
Q: There were reports of formalin-laced fish being sold in Goa which many believe is a carcinogen agent and many have attributed the rising cancer cases in the state to formalin. Can you enlighten us on this issue?
Cancer doesn’t happen overnight, it takes 20-40 years for the disease to develop. By consuming formalin-laced fish in the last two years you are not going to get cancer. You cannot attribute cancer to formalin but it will cause other serious health issues and, therefore, you have to be away from it. It is a harmful substance. Hence, you ought to ensure that the food that you consume is not adulterated.
Q: A regional cancer centre will soon be set up at the Goa Medical College. The premier health institute has also established the Department of Medical Oncology in August 2018. What are the other proactive steps that the state government should take to provide cancer treatment?
Firstly, we should have a cancer registry, which will give an idea about cancer burden in Goa. Second important thing is to have a tobacco control programme, which already exists in Goa. We should also have vaccines that help prevent cancers. Next is to have cancer screening tests that will diagnose some of the cancers at early stage. Multiple things need to be done by the government. It is important to have advanced treatment facilities. GMC should procure medical equipment that gives precise results. Cancer is treated with at least three modalities i.e. surgery, radiation and medical oncology which means the GMC has to develop all these three facilities; just having one of them is not going to work. GMC should constitute a multi-disciplinary team (MDT). If a patient has advanced cancer then he should be sent to MDT, which then will have to decide what kind of treatment should be administered first, whether it is chemotherapy, radiation or direct surgery.