Prevention is the Cure

Doctor's 6-point formula to win fight against cancer

Dr Siddhartha Mukherjee, author of the bestselling 'The Emperor of Maladies: A Biography of Cancer', has a six-point formula to help India control and combat the cancer epidemic.

"Put in place a strong tobacco control programme, initiate sexual health education to prevent sexually transmitted cancers like cervical and oral, encourage vaccination, conduct mammography and screening of vulnerable women for breast cancer and those above the age of 50, start screening for and vaccination against Hepatitis B that causes liver cancer and create centralized systems modelled on comprehensive cancer centres in the US that allow researchers to share data and engage in high quality clinical work," says Mukherjee.

It's simple and achievable advice. But as he says, "The will of the highest authorities is crucial." Currently an assistant professor of medicine at Columbia University, Mukherjee studied in St Columba's School before becoming a Rhodes scholar. With degrees from Stanford University, Oxford and Harvard Medical School, he feels sad when somebody refers to effective and affordable cancer prevention and care as synonymous with the first world.

"There are perfectly achievable goals in cancer treatment for all countries including India. Cervical cancer is initiated by a virus and is a completely preventable disease by vaccination and changes in sexual practice, which is highly achievable in India. Minimizing tobacco use will cut down lung cancer cases while routine mammography can diagnose and treat breast cancer early. None of these prevention mechanisms are complicated. The will of larger authorities is crucial," Mukherjee says.

But why is India suddenly reporting such a massive spurt in cancer cases -- 10 lakh new patients every year and four lakh deaths?

"Ageing of course. Also, early and accurate diagnosis is helping attribute the exact cause of death that didn't happen before. Environmental carcinogens too are playing a major role. Increase in tobacco smoking is another major determinant," says Mukherjee.

Calling cancer the next big frontier of medicine, Mukherjee explains cancer is not one disease but many diseases that share a common biological principle -- a cell that has lost control and is dividing abnormally. "Ultimately it's a gene that lives inside us unlike a virus. The challenge, therefore, is how to kill the cancer cells while sparing the normal cells before the former invades the organs and destroys their function."

Admitting a kind of nihilism that has risen around cancer in India upsets him, Mukherjee adds, "The oncologists here are exceptional. Visiting AIIMS is a moving experience. The kind of work being done in a place that does not have much resources to start with is unbelievable. The volume of patients is enormous despite which doctors show so such compassion. Surgeons operating in less than ideal circumstances and yet being able to deliver is very impressive. So there is no lack of committed medical staff. What is required are some alterations in policy."

Mukherjee's book, which took six years to write, documents eloquently a disease humans have lived with -- and perished from -- for more than 5,000 years. From the Persian Queen Atossa, whose Greek slave cut off her malignant breast, to the 19th century recipient of primitive radiation and chemotherapy and Mukherjee's own leukemia patient, Carla, "The Emperor of All Maladies" is about the people who have soldiered through toxic, bruising and draining regimes to survive and to increase the store of human knowledge.

So, what is his next work going to be on? "Culture and history through the eye of medicine maybe," Mukherjee concludes.

1: Stop Smoking