Justin Stebbing, professor, Cancer Medicine and Oncology at Imperial College, London, was in India recently. He feels that personalised medicine can make cancer treatment affordable and effective. He talks to Gunjan Sharma about how genetics and immunotherapy can revolutionise cancer care.  
 
What brought you to India?
The burgeoning incidence of cancer in India and my desire to be a part of the fight against the deadly disease in the country brought me here. I have many patients and friends here. In India, around 1.5 million people are diagnosed with cancer every year and 3-4 million live with it.

Such high incidence of cancer can be attributed to smoking, alcohol, obesity, and urbanisation. It could also be because there is lack of awareness, late diagnosis, and issues regarding affordability and accessibility to quality healthcare.
 
How do you think India should fight cancer?
Personalised medicine is the way to go-- treating the right person, at the right time with the right medicine.

I focus on the treatment aspect of cancer care. If you look at the data, it can increase the cure rate, decrease the death rate and improve the life expectancy of cancer patients.
With advance and improved treatments, we can cure some cancers such as testicular cancer even at a late stage.

In other cancers, treatment becomes more effective when there is an early diagnosis such as breast cancer, colon cancer, lung cancer, prostate cancer.
 
How has cancer care evolved over the years?
Cancer care has evolved a lot from the time I started practicing medicine. Today, we have chemotherapy, hormonal therapy, radiation therapy and now immunotherapy, which is a big leap in cancer treatment. This can help people fight cancer like any other chronic disease. 
 
How does immunotherapy in cancer work?
Cancer cells have an ability to hide from the body's immune system. When we give immunotherapy, these cells get identified by the immune system of the body and get killed. It is a big step forward in cancer treatment.
 
These days a lot of cancers are being attributed to lifestyles. Is it correct to do so?
Age is a major factor in a number of cancers. As when we age, our cell's repair mechanism weakens. But definitely, you cannot underestimate the role of lifestyle-- what we eat, things we are exposed to, obesity and smoking. A number of studies show that lifestyle plays a major role in the manifestation of cancer.
 
What according to you should be the approach as far as the treatment of cancer is concerned?
Right now, the focus should be on controlling cancer.

Recently, American Association of Cancer Research found that in patients suffering from lung cancer, a combination of chemotherapy and immunotherapy can reduce the death rate by 50 percent.

At the same time, researchers have been trying to formulate a chemotherapy-free regimen for patients to save them from its severe side-effects. People don't prefer chemotherapy because of its side-effects.
 
How is the use of genetics changing cancer care?
The cost of DNA sequencing has drastically fallen. With newer devices and reagents, analysis of the disease is getting better. With its increasing demand and use in medical science, genome sequencing is also getting cheaper.
 
By sequencing 300 million letters in a DNA, we can design better drug therapy to target gene mutations.
 
Then by identifying the presence of particular genes such as BRAC 1 gene, which increases the chances of breast cancer by 90 percent, one can take adequate preventive measure.
 
How important is palliative care in cancer treatment?
 
Good doctors know when to treat a disease, the better ones know how to do it and the best ones know when not to. I believe that a doctor should treat every patient according to his/her wishes. A frank discussion between the doctor and the patient's family can change a lot of things.
 
Palliative care is important. When people are sick, they need companions. So, it is important that people take an informed decision and for that, we need to make cancer care accessible and affordable to people.
 
We have treatments that can, in 10 percent of cases, increase the life expectancy of a patient suffering from terminal cancer for three months to three years. We should tell people about the risks and benefits of a treatment, the cost involved and let them make a choice.
 
In India, malnourishment among cancer patients is a huge roadblock to treatment.
Cancer treatments have severe side-effects and to bear them one needs adequate strength in the body. Nutrition is an integral part of cancer treatment.

In some cancers such as breast cancer, women gain a lot of weight during the treatment. We have studied that women who gain more weight, have worse kind of tumors and the lesser chances of survival. A simple diet therapy can help these women in maintaining a healthy body weight, which will eventually help in cancer treatment.