This year when I was diagnosed with gastric lymphoma I took my treatment at Apollo, an extremely expensive hospital by Indian standards, largely because of the confidence that the young oncologist there was able to inspire in me. Having seen literally the best cancer hospital in the world, the Clinical Centre of the National Institutes of Health, the US government’s medical powerhouse, I found even Apollo to be very poorly equipped. I, therefore, find it hard to believe Dr Rajkumar’s claim that the Cancer Institute has facilities as good as any other international institution. All of us who work in India do our best to work with what we have. There is nothing wrong with that. And, therefore, I have no ill-will against Apollo or AIIMS. But there is no need to delude ourselves that we are the best in the  world because then we will not aspire to be better.

My point that cancer is a disease that is best prevented, especially in a country like India where there are many poor people, is sadly dismissed by Dr Rajkumar saying that the   Cancer Institute in Adyar treats poor patients free of charge. Is  he trying to say that the few beds that exist in this institute or a handful of others like it is enough to meet the cancer treatment needs of all our one billion people? Surely not. I had presented the figure of Rs. 2-3 lakh as the average cost of treatment for all types of cancers after talking to several leading oncologists. It is quite possible that my figure is on the higher side but my purpose was to see if an insurance scheme is feasible even with this high cost of treatment. I think it is possible and the government should seriously promote one.

 The Chennai Cancer Institute claims to be getting, in some cases, as much as 80-100 per cent cure, for costs that are as low as Rs. 20,000-40,000 (that US$500-1,000). If this be true then the institute should publicise its capabilities in the US and a multi-billion dollar cancer treatment industry will immediately move over to India. A cancer cure is claimed only if a cancer patient remains in remission (free of the disease) for five years from the end of the treatment. This is a long follow-up period. And I wonder how many Indian hospitals are able to do this.

Indeed, there are certain cancers like cervical cancer in which the cure rates are quite high worldwide. But when all cancers are taken into account, even the US has achieved a cure rate of only about 50 per cent. Brain and lung tumours, for example, have low cure rates. Indian authorities should publish a good audit of  our cancer hospitals to show what cure rates are being achieved in India. Indeed, cancer incidence data is available from 1982, as Dr Rajkumar puts it, but then why is it that the last year for which the data is available is only 1991?

All that I can say is that I am neither trying to "send wrong signals to the general population" nor am I trying to damage "the morals of patients suffering from cancer." The piece was indeed written with anger because I want Indians to get angry at the incompetence of our governments in dealing with the serious challenges facing this country and push them to take up purposeful policies. In the case of cancer, I want a powerful preventive policy and an insurance system which helps those who are unfortunate to get the disease. Unless we stand up and fight, our politicians will do precious little.

Before closing I would like to inform the readers of the Hindu about a path-breaking study on the cause of cancer just completed by the prestigious Karolinska Institute in Sweden, which selects the Nobel prize winner for medicine every year, and published in the most prestigious medical journal of the world, the New England Journal of Medicine, only a few weeks ago. The study analyses the environmental risk and the genetic risk in the causation of cancer and is bound to shake up the cancer establishment worldwide. It concludes that the overriding cause of cancer is environment and not the genes.

The Swedish study is huge – it covers nearly 90,000 twins – but very simple in its approach which makes it so powerful. Identical twins carry the same genes. So if genes predominate as a cause of cancer then each twin should get cancer and the same type of cancer. Non-identical twins share only half the genetic structure. The study found that 18 out of 27 cancers had no genetic risk. Only a few cancers like breast and prostrate appeared to have a stronger genetic link but even here the environmental risk was predominant. The results are clear: genetic factors are far less important than environmental factors (chemical pollution, radiation, smoking, diet, infection, etc.) in causing cancer. The ball is, therefore, in the court of the government.

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