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, leading oncologist Dr Bhawna Sirohi said on Saturday.
Sirohi said precision oncology has the potential to transform cancer treatment, but high costs, limited access to advanced genomic testing and expensive medicines remain major challenges in the country.
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 aims to identify specific targets or biomarkers on cancer cells and match them with appropriate medicines.
Precision oncology allows doctors to identify the biological drivers of a cancer and select treatment accordingly, helping individualise care and potentially improve outcomes while reducing unnecessary side effects, she said.
However, molecular testing and next-generation sequencing (NGS) can themselves be expensive, while medicines recommended based on such tests may not be available in India or may remain beyond the financial reach of many patients, particularly those from low- and middle-income groups.
Sirohi said oncologists sometimes face the difficult question of whether to discuss expensive treatment options with patients when such therapies are financially out of reach.
“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.
She noted that such treatment is available under the Ayushman Bharat scheme, although newer and potentially 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 testing.
Sirohi said the initiative was a good beginning but currently focuses primarily 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 conducting sophisticated genomic testing without ensuring access to the medicines recommended based on the results could place an additional financial burden on patients.
Sirohi called for regular health technology assessments and guidelines covering newer drugs and technologies, along with 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 also emphasised the need for biobanking of 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 challenges including poverty, long-distance travel, mistrust of large city hospitals and limited access to specialised care.
She welcomed the state government’s decision to make cancer a notifiable disease, saying it would help establish the true burden of cancer and allow policymakers to focus on major cancers, including breast, lung, cervical, oral and stomach cancers.
Government investment in chemotherapy daycare centres could bring treatment closer to patients, she said, but such facilities must provide safe care under trained personnel.
Sirohi also identified fear, stigma, myths and misconceptions as major barriers preventing rural and tribal patients from seeking timely cancer care.
She pointed out that cancer research remains heavily focused on high-income countries and called for greater attention to the specific challenges faced by low- and middle-income countries.
Sirohi said BALCO Medical Centre had also recently launched a cervical cancer elimination programme with the state government, focusing on HPV vaccination and cervical cancer screening as part of efforts towards the World Health Organization’s 2030 goals.