Daijiworld Media Network - Raipur

Raipur, Sep 26: India needs a five-year policy agenda to make advanced genomic testing and targeted cancer therapies accessible to lower-income patients, said leading oncologist Dr Bhawna Sirohi on Saturday.

Speaking to reporters, Sirohi said precision oncology has the potential to transform cancer treatment, but high costs, limited access to advanced genomic testing and the steep price of targeted medicines remain major challenges in India.

Sirohi, consultant medical oncologist and medical director at Vedanta Medical Research Foundation-BALCO Medical Centre, Raipur, is the only cancer specialist from India on the new Lancet Oncology Commission on precision cancer, which was launched at the World Cancer Congress in Hong Kong on Friday.

She explained that unlike conventional chemotherapy, which can affect both cancerous and healthy cells, precision treatment identifies specific targets or biomarkers in cancer cells and matches them with appropriate medicines.

Precision oncology enables doctors to identify the biological drivers of a cancer and tailor treatment accordingly, helping individualise care, potentially improve outcomes and reduce unnecessary side effects, she said.

However, molecular testing and next-generation sequencing (NGS) can themselves be expensive. Medicines recommended based on these tests may also be unavailable in India or remain beyond the financial reach of most patients, particularly those from low- and middle-income groups.

This creates a dilemma for oncologists over whether to discuss expensive treatment options that most patients may not be able to afford, Sirohi said.

“In the Lancet Oncology Commission, we discuss the global landscape, but in India and other LMICs (low- and middle-income countries), this risks deepening a permanent, two-tiered global health system that delivers even more inequitable care,” she said.

She said the benefits of precision oncology are particularly evident in lung cancer, where patients with specific EGFR mutations can receive targeted tablets for years instead of conventional chemotherapy.

“Lung cancer is no longer one type of cancer but multiple different types of cancer with each type targeted with targeted therapy,” Sirohi said.

Such treatment is available under the Ayushman Bharat scheme, she said, although newer and more effective medicines remain largely constrained by their cost.

“All cancers can benefit from precision treatment in India, though how we deliver it to everyone remains a challenge,” she said.

Sirohi called for genomic and molecular diagnostic tests to be integrated into public healthcare schemes.

“Integrating diagnostic genomic panels into healthcare schemes like Ayushman Bharat is critical for lower-income patients,” she said.

She also highlighted the Department of Health Research and Indian Council of Medical Research-backed DIAMOnDS project, which aims to strengthen advanced molecular oncology diagnostic services and provide free diagnostic facilities.

Sirohi described the initiative as a good beginning but noted that it currently focuses mainly on selected markers for lung and breast cancers and some blood cancers. Designated regional laboratories largely use techniques such as real-time PCR, immunohistochemistry and fluorescence in-situ hybridisation.

She cautioned that sophisticated genomic testing without ensuring access to the medicines recommended on the basis of those tests could place an additional financial burden on patients.

Sirohi called for regular health technology assessments and implementation of guidelines covering newer medicines and technologies. She also stressed the need for greater investment in geneticists, molecular pathologists and bioinformaticians.

“India needs a five-year agenda for delivering precision cancer care, with a clear assessment of the pros and cons of tests and technologies. Those that are to be made universally available must be validated and meet global and national peer-review standards,” she said.

She further emphasised the importance of biobanking tumour, tissue, blood, saliva and stool samples to improve understanding of cancer biology among the Indian population.

On cancer care in Chhattisgarh, Sirohi said the state's large rural and tribal population faces several barriers, including poverty, long-distance travel, mistrust of large city hospitals and inadequate access to specialised treatment.

She welcomed the state government's decision to make cancer a notifiable disease, saying it would help establish the actual disease burden and enable policymakers to focus on major cancers such as breast, lung, cervical, oral and stomach cancers.

Government investment in chemotherapy daycare centres could bring treatment closer to patients, she said, but stressed that such facilities must provide safe treatment under trained personnel.

Fear, stigma, myths and misconceptions also remain major barriers preventing rural and tribal patients from seeking timely cancer care, she said.

Sirohi noted that cancer research remains heavily focused on high-income countries and called for research priorities to be rebalanced to address the specific challenges faced by low- and middle-income countries.

She also said BALCO Medical Centre had recently launched a cervical cancer elimination programme with the state government, focusing on HPV vaccination and cervical cancer screening to contribute to the WHO's 2030 goals.