Waging a war on cancer

The Tata Memorial Centre in Mumbai is a prestigious medical institution in the country specialising in cancer treatment. An advanced centre for treatment, research and education in cancer, TMC is receiving patients from across the country and abroad and efforts are ongoing to evolve cost-effective treatments for common cancers.

TMC has evolved a low cost screening methodology for cancer of the cervix using acetic acid for visual inspection. Trials conducted have shown a 31% reduction in deaths. Implementation of this methodology at the national level will help save the lives of 22,000 women every year. A low cost injection for breast cancer, given prior to surgery, has saved 28% of patients.

In an exclusive interview with Future Medicine, Dr Rajendra A Bodwe, Director of The Tata Memorial Centre, talks about the ongoing research and the latest treatments in its battle against cancer

By Sumithra Sathyan

How do you differentiate TMC from other hospitals specializing in cancer treatment in the country?   

The Tata Memorial Centre is fast moving into the eighth decade and has made significant contributions to pave the way forward in holistic cancer care.

There has been a gradual shift of focus in cancer care from ‘cells’ to ‘molecules’. The addition of a molecular diagnostic facility at TMC is part of this change. This state-of-the-art diagnostic facility will add value to diagnosis and management of many common cancers. Every year, nearly 43,000 new patients visit the clinics here from all over India and the neighbouring countries. Almost 60% of these cancer patients receive primary care at the hospital of which over 70% are treated free of cost. Over 1,000 patients attend the OPD daily for medical advice, comprehensive care or for follow-up treatment.

About 6,300 major operations are performed annually and 6,000 patients treated with radiotherapy and chemotherapy every year in multi-disciplinary programmes. At TMC, evidence-based medicine is the keystone. Apart from patient care and service, clinical research programmes and random trials contribute increasingly to improved delivery of care and the highest standards of work ethics. The strategies for early diagnosis, treatment management, rehabilitation, pain relief and

What are the advances made in the treatment of cancer and what is your contribution?

Many advances have taken place in every specialty. In surgery, concepts have changed taking into account the biology of cancer. Radical surgeries have yielded place to the conservative surgery with the very important objective of quality of life. The Tata Memorial Hospital was the first centre in the country to initiate bone marrow transplant in 1983. This was possible due to better total supportive care using newer antibiotics, nutritional, blood transfusion support and nursing.

Another important area of progress over the last few years has been radiological imaging techniques using ultrasound, CT scanners, MRI, more dynamic real time nuclear medicine scanning and the PET scan. A ‘first in India’ PET CT scanner has been procured to make this cutting edge technology available for cancer management here.

Basically I’m surgeon in breast cancer treatment and I think main contribution to the field is to ensure appropriate and timely treatment to the patient. The role of breast reconstruction in the Indian context is being evaluated. A total of 1,920 surgeries were performed of which approximately 50% were breast conservation surgeries. Twenty-four patients received plastic reconstruction with flaps. 2,252 minor procedures were performed. Advanced radiotherapy was given to 769 patients, 463 patients received palliative radiotherapy. The 30-day mortality rate was observed to be 0% and the rate of complications like infection, etc. was 8%. The overall disease free survival at five years was 82%.

What are the special factors of cancer care at TMC?

Of the 2 to 2.5 million cases of cancer in the country, over 70% of cases are detected late and report for treatment in very advanced stages. The emphasis on early detection would go a long way in dealing with the large numbers as well as to mitigate avoidable suffering and a financial burden. With this aim, TMC established its first Rural Outreach Cancer Centre at Barshi, Sholapur district in 1983. In 2003, the second Rural Outreach Cancer Centre was set up at Dervan, Chiplun, Ratnagiri District.

The Tata Memorial Centre is a recognized training Centre for cancer education and research by national and international organizations such as WHO, International atomic energy for agency(IAEA) and Union for international cancer control (UICC).

What is the latest research at TMC?

The Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), the R&D arm of The Tata Memorial Centre, is a unique model where basic, translational and clinical research on cancer is undertaken. It has played a pivotal role in co-developing and testing innovative, indigenous cost effective technology.

ACTREC has enabled India’s fruitful participation in the largest global mega-science project in cancer- International Cancer Genome Consortium. We have engaged with global leaders in cancer research, including the NCI (US), Cancer Research (UK) and others, in developing a multinational perspective for addressing the growing international challenge of cancer.

Do you think cancer has links with food/diet? If so, how can we prevent?

Yes, cancer has links with food/diet. Tobacco intake is the major cause of cancer in India. And another one is obesity. Changing lifestyles, mainly in metros, cause increase in cancer cases. If we ban tobacco permanently, we can save 40% of cancer patients in India. If we control food, we can save 20% of cancer patients and if we keep personal hygiene, we can save 10 % of lives. Compared to Americans, Indians are much better in cancer. In India, the number of cancer patients is increasing by 25% only. It is very high in the US. We can control cancer with intensive awareness programmes.

Is breastfeeding linked to cancer prevention?

There is convincing evidence that breastfeeding reduces the risk of breast cancer in women and probably helps prevent excess weight gain in their children. The protective effect of breastfeeding is likely due to the balance of hormones produced during the breastfeeding process. Lowering levels of some cancer-related hormones in the mother’s body, risk of cancer is reduced. Also, at the end of breastfeeding, the body gets rid of many cells in the breast, some of which may have DNA damage.

What about upcoming projects?

In addition to national funding bodies, TMC and DAEFCC have received aids from several international funding agencies for clinical research projects. TMC is currently conducting two largest randomized trials in the field of early detection and prevention of cancer. The National Cancer Institute in the US is funding one of these trials through a competitive RO-1 grant and the other by Melinda and Bill Gates Foundation through the International Agency for Research in Cancer, Lyon. In a significant step forward, TMC has entered into collaboration with Integrated Cancer Centre (ICC).

Any tie-ups with pharmaceutical companies? 

We plan to develop a curable medicine for cancer in a cost-effective way. Reddies, Sunpharma and Piramel are our pharma partners in the project which will start this year and I am sure it will be a remarkable one.

Future plans of TMC? 

We are in the process of setting up a national facility for Hadron Beam Therapy, a cutting edge technology for the treatment of cancers in children, head and neck cancers, brain tumours and many others. With the acquisition of land at the Haffkine Institute, Mumbai, it has become a reality.

The Tata Memorial Hospital

It was commissioned by the Sir Dorabji Tata Trust on February 28, 1941 as a centre with an enduring value and a mission with concern for the Indian people. In 1952, Indian Cancer Research Centre was established and later known as Cancer Research Institute (CRI). In 1957, the central government took over The Tata Memorial Hospital. The transfer of the administration of The Tata Memorial Centre (The Tata Memorial Hospital & Cancer Research Institute) to the Department of Atomic Energy in 1962 was the next major step. The Tata Memorial Hospital and Cancer Research Institute merged to become The Tata Memorial Centre in 1966. It was a classic example of private philanthropy supported by the government with a mandate for service, education and research in cancer.

 

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