Timely Referral and Awareness: Closing the Gap Between Early and Late-Stage Diagnosis

Personalised cancer treatment is already underway, though there is a long way to go. It is similar to culture and sensitivity testing for a urinary infection: molecular sequencing identifies which drug the tumour is sensitive to. Lung cancer has already seen a sea change this way, and a single daily tablet is now available for metastatic pancreatic cancer. If EGFR is mutated, for example, EGFR-targeted tablets can be given depending on what the patient can afford. The next ten years in oncology will be the decade of personalised cancer treatment.

Molecular investigation has a definite role in systemic treatment: where chemotherapy is used, molecular analysis can replace it with targeted therapy or immunotherapy in some cases. For localised cancer, surgery remains the mainstay and the most curative treatment, and cannot be replaced, though in advanced disease chemotherapy can be replaced by immunotherapy or targeted therapy. For radiation, adding radiosensitising drugs identified through molecular analysis can sometimes allow the radiation dose to be decreased. The larger goal should be prevention: a cervical cancer vaccine already exists, and a breast cancer vaccine within two to three years, with vaccines against most cancers within ten to fifteen years, would be the golden day of mankind.

As a tumour breaks down, its cells release DNA that circulates in the blood. Finding this DNA in a blood sample can be used as a screening test, prompting further investigation like colonoscopy, CT scan or mammography to locate the source. Measured before and after treatment, for example after three months of chemotherapy, a drop to absent or minimal levels indicates a good response. Checked every six months for years after treatment, a previously absent reading reappearing can signal recurrence. It is not yet fully specific and is still being researched, but is expected to be used more heavily in screening, diagnosis, prognosis, monitoring and recurrence detection.

CAR-T cell therapy, and immunotherapy generally, works on a simple concept: our own immune cells are competent enough to fight infection and cancer, but whenever cancer is present, immunity goes down. Immunotherapy retrains the remaining immune cells to fight again, rather than killing the tumour directly. The drugs make our own immunity more competent, cells that were lying idle are retrained and made to recognise the cancer as the enemy, and then they go and fight it.

The exact mechanism is still not fully known. But one clear factor is genetic aberrations that occur over time because of environmental exposure: if a patient achieves a cure but resumes alcohol or smoking, the damage caused by tobacco or other carcinogens affects the DNA again and dormant cells can get reactivated. That is one reason recurrence happens, though most of the time the actual mechanism is not known.

Because stage one or two disease translates into cure, while stage four disease offers very minimal chances of cure. Early diagnosis is the single biggest lever available.

Dr. Jain noted that around 1997, 75 to 80 percent of his patients presented in stage three or four; today, in metropolitan India, around 60 percent present at an early stage, a shift he attributes to sustained community awareness work.