With colorectal cancer being the third most common cancer among Indian women and fourth in men, there has been an increase in the incidences vis-a-vis globally and Asia mainly because of poor health infrastructure and lack of awareness of the disease.
According to experts, it is also the interplay of genetic risk factor, environmental risk factor and exposure to western dietary pattern that has increased the risk of colon cancer in Asia and India in particular.
Says Dr. Vashishth Maniar, director and consultant, Mumbai Oncocare centre, “India is quite different from other countries because other countries have predominantly focused on preventive strategies regarding looking at various patient programs to decrease the incidence of colon cancer by improving the surveillance or may be early diagnosis.”
“However in India, it is a dynamic problem where you cannot focus only on treatment or focus only on prevention because although our priority is to diagnose a patient early, one cannot deny the fact that all patients who have been diagnosed deserve to be treated adequately first,” he adds.
In India, there is a lack of awareness on screening. Screening program in most countries, especially western countries, if you look at is driven by the nation. If you look at Europe, it is driven by National Health Services (NHS) where it is a part of the protocol.
Unfortunately there is no India specific protocol due to lack of guidelines. According to the global protocol, if you are a first degree patient who has history of colon cancer, then after you turn 50, you should undergo a stool occult blood testing and colonoscopy. If you do not have any relative who has been diagnosed with colon cancer, then after the age of 60, colonoscopy and stool occult blood should be done. And if it picks up any pre-molecular lesion, then they are put on a specific surveillance program.
There has been dramatic advancements in the treatment of colon cancer where at some point of time in advanced colon cancer one thought only chemotherapy is the solution. The median survival about a decade back with palliative chemotherapy was about 12 months to 18 months for a stage 4 colon cancer. Now over the last decade with the available anti-specific targeted therapies which target the cancer cells and improve the efficacy of the chemo backbone, the survival specific for stage 4 colon cancer has even crossed 4 and a half to 5 years.
“We have moved from giving the same combination of drugs to every patient to advanced genomics, where every patient of advanced colon cancer undergoes a specific genetic mutation testing to look at what is the driver mutation in their colon cancer and accordingly chemotherapy and targeted therapy is given to the patient. The chemotherapy is not very expensive but targeted therapies are expensive but more and more we tend to use it, more likely they will be cheaper over a period of time,” Dr. Maniar explains.
Talking about the diagnostic and treatment aspect, Prof. Heinz-Josef Lenz, associate director, Adult Oncology and Co-leader of the Gastrointestinal Cancers Program at the USC Norris, “There are drugs approved around the world which have showed to increase the cure rate, increase the survival rate and rather tripled the survival rate. But this is possible when you are taking advantage of approved and effective treatments. India is lagging behind in the approval and funding of these new treatments in the first, second and later stages of treatment. Doctors have the knowhow of the drugs and therapies but the limitation is of the financial support and insurance”.
“It is rather the lack of access of tests and drugs because of financial limitations. Molecular testing of the cancer has become an important tool to choose the most effective treatment combination. There is a need to implement the technology in all patients with metastatic disease through national insurance programmes”, he adds.
“Another hurdle is the financial coverage of the testing which is limiting. Molecular testing of the cancer has become an important tool to choose the most effective treatment combination. Treatment is not the same for all metastatic patients, so tailoring chemotherapy based on molecular characteristics will give the best outcome in the form of best tumour shrinkage rate, longest survival and highest chance of cure. We are in the middle of a molecular revolution and I think these treatments will eventually come to India. So my plea to the Indian community is to give patients the tools of molecular testing and give them access to the best treatments,” Prof. Lenz concludes.