India to face 'tsunami' of chronic diseases like cancer: US-based oncologist

India will face a tsunami of chronic diseases such as cancer due to globalization, a growing economy, an ageing population and changing lifestyle, warns a leading oncologist, making it imperative for the nation to embrace technology-driven medical techniques to prevent health catastrophes in an effective manner.

Cancer vaccines for prevention and treatment, expansion of Artificial Intelligence & data digital technology, and cancer diagnosis from liquid biopsies are among the six trends that will reshape cancer care in this century, says Dr Jame Abraham, Chairman of the Department of Haematology and Medical Oncology, Cleveland Clinic, Ohio, USA.

The other three trends are the use of genomic profiling, the evolution of gene editing technologies and the next generation of immunotherapies and CAR T cell therapies, Abraham points out in an article in Manorama Year Book 2023.

"Digital technology, information technology and telehealth will narrow the gap between patients and specialists. This will also potentially enhance the availability of experts' care in remote parts of our country, including rural settings where the majority of our population lives."

India's biggest challenge will be how to make it affordable and accessible for millions of its people when these technologies continue to revolutionize cancer care, notes Dr Abraham.

"Due to globalisation, growing economy, ageing population and changing lifestyle, India will face a tsunami of chronic diseases such as cancer," the oncologist warns.

As per the Globocan estimates, the cancer burden worldwide is expected to be 28.4 million cases in 2040, a 47 per cent rise from 2020, due to demographic changes.

This may escalate by increasing risk factors associated with globalization and a growing economy. An estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths were reported across the world in 2020.

Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer while lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18 per cent), followed by colorectal (9.4 per cent), liver (8.3 per cent), stomach (7.7 per cent), and female breast (6.9 per cent) cancers, reveals the report.

Dr Abraham holds that cancer vaccines are an exciting research area having the potential to immunize people against various cancers. Researchers have developed amazingly successful mRNA COVID-19 vaccines. The fact is that mRNA-based cancer treatment vaccines have been tested in small trials for more than a decade, with some promising early results.

"Currently at Cleveland Clinic, our team is doing a clinical trial testing cancer vaccine in high-risk breast cancer," he says. Highlighting the role of cutting-edge technologies, he says computers using Artificial Intelligence (AI) can recognize variations in patterns from normal to abnormal in the biopsy, much more accurately than the human eye. These technologies will demand radiologists and pathologists to be more efficient and accurate. Genetic profiling or testing at an early age to detect the abnormal gene can find breast and colon cancers in their earliest stage.

"In a futuristic society, genomic testing will be widely used, like monitoring blood pressure or cholesterol, to identify high risks and find targeted treatments to kill cancer cells specifically. Doing testing in the population or high-risk individuals will allow doctors to intervene before cancer happens," he says.

Noting that scans, mammograms, colonoscopies or a pap smear are currently used for cancer diagnosis, the doctor says by the time the tumour is detected, it can be too late. "Hence, the treatment needs to be very aggressive. The emerging liquid biopsy technologies will help detect cancer from a drop of blood before it can be detected by a scan or it manifests as a lump or ulceration."

Genome or gene editing is an area of research seeking to modify the genes of living organisms and use them to treat genetic or acquired diseases. Gene therapy holds promise for treating cancer, cystic fibrosis, heart disease, diabetes, haemophilia, sickle cell disease, and AIDS.

Another trend in cancer treatment is immunotherapies, which, in combination with chemotherapy, have resulted in the complete disappearance of tumors in several cases. It is now a standard treatment currently in many parts of the world. Scientists are also using CAR T cell therapy, in which T cells are isolated from a patient's blood and modified in the laboratory to specifically attack cancer cells. Dr Abraham has a word of caution, too.

"When we develop novel technologies to prevent and treat cancer, we can't take our focus on cancer prevention. The most common causes of cancers are still tobacco, alcohol, diet and infections. Policies for tobacco and alcohol control have to be a national priority," he says.

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