Bengaluru: Dr Chandragouda Dodagoudar is the Director-Medical Oncology and Unit Head of BLK-Max Cancer Centre at the BLK-MAX Super Speciality Hospital on Pusa Road in New Delhi. In a free-wheeling chat recently he dealt in detail with the status of cancer treatment in the country, and the preparedness apart from the precautions one should take to get tested and treated at an early stage of infection. Excerpts from the conversation:
Q: How do you describe the growth of cancer treatment in this country?
Dr Chandragouda Dodagoudar: In Oncology, we mainly have three branches; Medical Oncology, wherein the doctors specialize in Chemotherapy, targetted therapy and immunotherapy; In Surgery Oncology, the job is to do surgery and Radiation Oncology where radiation is offered. All three are important while the allied branches like Psychology, Pathology, and Radiology are equally important when discussing Oncology.
Q: Where do we stand when it comes to treatment for various types of cancer?
Dr Chandragouda Dodagoudar: When you see the development of Oncology in India, it is there. What was there maybe two decades ago has transcended and transformed very very well. If you talk about the tier-one cities, the care is on par with the Western world. We do everything that is being done in the Western world and we are also part of randomised clinical trials. I also get part of the randomised clinical trials, which is on par with the Western world.
What about the diagnosis and treatment facilities in the tier-two and tier-three cities?
Dr Chandragouda Dodagoudar: But the problem is in tier-two and tier-three cities. We are not a good penetrator in India. In that regard, the premier institutes of India are doing a good job. Maybe the Tata Memorial Hospital, where the Cancer centres are proliferating into tier-two and tier-three cities and setting up radiation oncology equipment demand a huge investment. They have also especially done a lot of such initiatives in the North East and Assam and probably proliferating in other parts of India.
What about the governmental efforts in reaching the treatment benefits to the people?
Dr Chandragouda Dodagoudar: This trend has been evinced in the last few years and all such initiatives are on behalf of the Tata Trust. Even the All India Institute of Medical Sciences (AIIMS) and many other organizations are doing a yeoman service. But, it is not only these institutes, the government needs to support them. The government should make up its mind to percolate these facilities to the tier-two and tier-three cities.
Q: It looks like, as of now people have no other option but to go to tier-one cities for treatment.
Dr Chandragouda Dodagoudar: The technology drop is too much if you were to go from tier-one cities to tier-two and tier-three cities. So this technological drop is compelling patients from tier-two and tier-three cities to keep visiting tier-one cities involving several logistical problems, apart from the expenditure on travel. Be it financial or logistical, it adds to the woes of the patients as looking at the diagnosis of the Cancer itself is traumatic to the patient and the family. In that regard, if the patient has to travel a lot to take the treatment it is another extra burden. So, it is the collective responsibility of the public and the government institutions to have combined parallel institutions in tier-two and tier-three cities.
Q: What about the doctors in tier-two and tier-three cities? Are they merely qualified or experts?
Dr Chandragouda Dodagoudar: We have a shortage of hands when it comes to manpower; Now you have better Oncologists coming out of the centres and so also Radiation and Surgical oncologists. Hence, there is a necessity for all these experts to move to tier-two and tier-three cities so that patients there get the same facilities as in tier-one cities.
Q: What about the possibilities of the experts going to the tier-two and tier-three cities?
Dr Chandragouda Dodagoudar: In tier-two and tier-three cities what we are facing is a shortage of trained guys as they are just trained and not specialists, which may tend to compromise the treatment, although it may not hinder the treatment. But, it is going to compromise below the line. That is only a short-term goal whereas the long-term goal should be that the experts should go to the tier-two and tier-three cities. And, even for them to go there, you need to have better facilities for enabling whatever technologies they are in the know-how can also be applied there. In this way, we can prosper and give quality care to our countrymen.
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Q: Generally, what types of cancers are more prevalent?
Dr Chandragouda Dodagoudar: In this country, we have state-wise differentiation. But, by and large among males it is more of head and neck cancer which is a result of chewing a lot of beetle nuts, and tobacco apart from smoking. Then comes lung cancer and prostate cancer and after that gastrointestinal cancer. This is how it is common among the males.
Q: How about the types of cancer among the females?
Dr Chandragouda Dodagoudar: In females, now it is breast cancer surpassing cervical cancer. The cervix is the lower part of the uterus that connects to the vagina and cervical cancer used to be most common earlier. Various strains of the human papillomavirus, also called HPV, play a role in causing most cervical cancers. HPV is a common infection that is passed through sexual contact. Due to the increase in hygiene and vaccination available these days cervical cancer seems to have pushed down in the scale.
Q: Is it possible to prevent the number of cancers we are struggling with?
Dr Chandragouda Dodagoudar: Breast cancer is the most common ailment among females and then comes cervical cancer, gynaecological cancer, lung cancer and GI cancer. This is how they are common. However, a lot of them are preventable by having good lifestyle modifications. Good lifestyle modifications what I mean by is avoiding smoking.
Q: What is your take on cinema stars doing ads for Gutka products and companies?
Dr Chandragouda Dodagoudar: Some famous personalities give an ad to the Gutka companies, which probably encourages the younger generation to follow them. This is ridiculous and should be banned. I know a sense has to prevail in those personalities that we should not do these ads just for the sake of money. But, they think that they get the money and they should do it. This attitude sends a piece of wrong information to the younger generation and has a lot of bearing on the young minds. They start chewing and seeing the so-called heroes and eventually end up becoming victims of cancer.
Q: Is there any positive impact of cancer images on cigarette packs?
Dr Chandragouda Dodagoudar: The Tata Memorial Hospital took this issue to the Supreme Court and did a great job by following up in great detail until the pictures of cancer were published on the cigarette packs. There should be some regularization and stringent avoidance of smoking to control cancer. The risks are very very important.
Q: What do you suggest for preventing the occurrence of various types of cancers?
Dr Chandragouda Dodagoudar: Lifestyle modifications, diet and exercises will help in this regard in preventing cancer. What we cannot prevent is genetic risk. So, if somebody in the family is suffering from cancer, a lot of family members also have the risk. In such cases, the family members need to visit the Oncologist and we have genetic counselling to help out. Normally, the further tree can be broken down there so that the further progeny should not have cancer. The advice on how to tackle it will be given by the Oncologist.
Q: There is a perception among people that they come to know about cancer in the fourth stage as there were no symptoms earlier. What is the solution to this situation?
Dr Chandragouda Dodagoudar: We have screening tests for male and female patients. Of course, there are two to three types of cancer wherein screening is possible. If you ask, why screening; it is because it is easier to detect and cure them. So, in that regard, breast cancer is one such cancer which can be detected by a simple test called Mammography, which is a simple x-ray of the breast to test the cancer cells early likewise the cervical cancer which can again be detected early and treated. And the third one is the colonoscopy, wherein a stool test will be done and followed up by a colonoscopy. However, in other types of cancer, there is no benefit of screening.
Q: How can one come to know of the possible infection of cancerous cells?
Dr Chandragouda Dodagoudar: Let us assume that someone is facing problems like gas and if it continues to persist for more than two weeks please get it evaluated, which is very important. So, you don't neglect such symptoms. Many a time it so happens that such symptoms get neglected for months and by the time they come to us it would be in an advanced stage. Symptom-guided evaluation is very very important as the symptoms are indicators of probable infection. Second, is the screening in males for prostrate we do a simple blood test called the PSA, which helps us evaluate and also treat in the early stage of cancer. Though there is a controversy on the same we do the test for all people above 50 years. For somebody who is a heavy smoker, it is always better to get checked for lung cancer and likewise for colon cancer.
-Manohar Yadavatti
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