The Whole Truth | Ovarian Cancer Awareness Month: The emperor’s new hopes

The launch of the India-US Cancer Dialogue in November 2023 will begin a dialogue between both countries that will focus on advancing knowledge in cancer genomics, developing new diagnostics and therapeutics to enhance and strengthen cancer care, including for underserved urban and rural communities.

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September is Ovarian Cancer Awareness Month — the same month India and the US have agreed to join hands on the war on cancer. What does this tie-up mean?

The emperor here is cancer, as qualified by its most articulate researcher, healer and chronicler Siddhartha Mukherjee. He titled his Pulitzer-winning biography of cancer The Emperor of All Maladies (2010). Having survived stage 3 ovarian cancer, I have no doubt that the name is apt. Cancer has taught me many things; the foremost is to live well.

When at the recently concluded G20 Summit India and the US announced the India-US Cancer Dialogue scheduled to begin in November 2023, hopes lit among patients, care-givers, doctors and researchers in India. India’s struggle with spreading awareness about cancer, efforts for prevention and access to advanced treatment protocols are still confined to a few institutes and hospitals in the country. Most new breakthroughs benefit the wealthy. Memorial Sloan Kettering’s (MSK) India chapter, inaugurated in 2022, is for few who can afford MSK’s concierge model of care—the India team, based in Chennai, coordinates with patients and caregivers to schedule services such as online consultations with MSK’s experts at its headquarters in New York.

So what can a tie-up with the US, light years ahead of us in awareness, prevention — and ahead of us in treatment breakthroughs — mean for India’s massive cancer burden?

The Indo-US joint statement is clear on the intent: The launch of the India-US Cancer Dialogue in November 2023 will begin a dialogue between both countries that will focus on advancing knowledge in cancer genomics, developing new diagnostics and therapeutics to enhance and strengthen cancer care, including for underserved urban and rural communities. The leaders also highlighted the forthcoming US-India Health Dialogue, taking place in October 2023 in Washington DC., meant to strengthen and facilitate scientific, regulatory, and health cooperation between the two nations.

In reality, few people in India seem to be concerned about cancer. There’s a general attitude of indifference towards the disease. And when there is acknowledgement that cancer can affect any living being, there is fear, prejudice, exaggeration, even mystification. Take this number: According to the last global survey on cancer by the prestigious Union for International Cancer Control (UICC), only 43 per cent Indian respondents indicated that they were concerned or somewhat concerned about developing cancer in their lifetime compared to a global average of 58 per cent.  In my experience reporting on and researching the effect of the disease on individuals, families and communities, I have encountered people who don’t like to treat their family member at the Tata Memorial Cancer Hospital in Mumbai, the Mecca of cancer treatment in India for all economic brackets, because it becomes obvious they are being treated for cancer. Daughters of women with a history of breast cancer or gynaecological cancers find it difficult to find prospective husbands in an arranged marriage scenario. Storytellers usually paint doomsday pictures of cancer — the narrative hasn’t changed much since Rajesh Khanna in the film Anand (1971).

What India needs, as urgently as, say, a new side effects-minimal immunotherapy pill, is a hero like oncologist Ravi Kannan, who rightly received this year’s Ramon Magsaysay Award. Director of Assam’s Cachar Cancer Hospital and Research Centre (CCHRC), Kannan moved to Silchar with his wife in 2007 to take charge of the CCHRC. He worked earlier as a surgeon at Chennai’s Adyar Cancer Institute. Kannan, who believes healthcare facilities should be available in every locality, has helped start clinics in Assam’s Karimganj, Hailakandi and Dima Hasao to make follow-ups easy for patients. He said in a segment recently that CCHRC’s “follow-up ratio is more than 90 per cent now and that it was once below 50 per cent”. Kannan supervised the first microvascular surgery of a cancer patient there in 2012 — the first such procedure conducted in the Northeast.

Cancer treatment favours the wealthy more than any other disease does — especially in India, where, according to latest data of Statista as well as Niti Aayog, approximately 514 million people were covered under health insurance schemes in 2021, which is 37 per cent of the people in the country. Nearly 400 million individuals in India have no access to health insurance. The minimum price for cancer treatment is Rs 90,000, and the average cost is around Rs 5 lakh. Those who do have health insurance are entitled to be covered only if there’s a hospitalisation—overnight or daycare. Worldwide, there are major shifts in the form of medicines. Many new pharmaceutical companies now have frontline as well as maintenance pills as opposed to an IV drip which traditional chemotherapy requires. But most Indian health insurance companies don’t cover pills. I was on a sophisticated targeted therapy pill for almost three years after I finished frontline treatment that used to cost me Rs 1 lakh-plus per month, which my fairly robust health insurance policy didn’t cover.

The Indo-US handshake to change the cancer outlook and landscape in this country is right now, a grand, hopeful gesture.  When, as Dr Kanan believes, where a patient lives stops determining the outcome of their disease, we know the first war on cancer has been won.