As the burden of cancer grows exponentially in India, Dr Shalini Singh, director of Indian Council of Medical Research-National Institute of Cancer Prevention and Research, Noida (ICMR-NICPR), tells Kavita Bajeli-Datt that a substantial number of cancers are preventable through risk reduction and early detection. Edited excerpts:
The government has reduced customs duty on 17 cancer drugs. How will it help?
Cancer treatments in India are usually heavy on the pockets, such as targeted therapy, immunotherapy, monoclonal antibodies, and novel small-molecule inhibitors’ therapy. Additionally, many medicines during the course of these treatments are imported directly, or are dependent on the active pharmaceutical ingredients (APIs), imported. Reduction in customs duty has lowered the landed cost of imported drugs, reduced the maximum retail prices (MRP), improved the affordability for middle-income and uninsured populations, alongside reducing catastrophic health expenditure. Further, reducing import barriers has enhanced availability of newer drugs in tertiary and private cancer centres, aided in adoption of global standard of care protocols, and unnecessary treatment delays due to cost constraints have been successfully avoided.
Due to financial toxicity, many people who are unable to afford prolonged treatment turn to alternative therapies. What are your views on it.
Prolonged treatments such as chemotherapy, targeted agents, and immunotherapy can cost up to several lakhs annually. Research in palliative care, nutrition advice, mental and psychological support to patients and their caregivers can help in treatment continuation and improvement in quality of life.
What are the new technology-driven innovations that are helping to make cancer treatment affordable?
Innovations such as biomarker testing, for example, in the case of HPV rapid testing, has resulted in early detection and such portable battery-operated systems have also reduced reliability on expensive centralised labs. NICPR has validated this device. Further, health information exchanges and national cancer registries can lead to better data linkage, allowing cost-outcome analysis, enabling policymakers to prioritise cutting low-value practices. Patient navigation apps can assist in appointment scheduling, medication reminders and symptom tracking and follow ups.
What measures can be taken by both the government and individuals to prevent cancer?
In India, cancer prevention would require a more coordinated, dual approach, wherein both - the government (at population-level) and an individual (at behavioural level) work together in their respective spheres. With approximately 1.56 million new cancer cases annually, and a lifetime risk of one-in-nine Indians, a substantial proportion of cancers are preventable through risk reduction and early detection.
One-third of cancer cases in Indian men are attributable to tobacco use and further, infection related cancers such as cervical and liver cancer remain significant, highlighting the importance of structured prevention strategies.
At the government level, strong regulatory and public health measures are required like strengthening tobacco control enforcement, higher taxation, plain packaging, strict advertisement bans, and cessation support.
Nationwide roll-out of the three pillars of cervical cancer elimination is needed including expansion of HPV vaccination, screening with clinically validated HPV DNA tests and treatment of positive cases. Policies that promote healthy diets and physical activities, including emphasising the need to prevent the consumption of trans-fat and ultra-processed foods and promote better urban planning for active lifestyle, are also required.
At an individual level people should avoid tobacco/alcohol use in any form. A healthy body weight should be maintained through a healthy and balanced diet, and exercise. They should participate in regular screening drives for breast, cervical and oral cancers, especially high-risk groups. Early medical consultation should be sought for persistent warning signs such as non-healed ulcers, abnormal bleeding, unexplained weight loss and chronic cough.