We are excited to launch a ‘Thought Leader Insights’ series platform on key decision makers in the healthcare space in India. This is the first such series from India where we will highlight perspectives and viewpoints of India’s key players in the healthcare landscape and review opportunities and challenges in disease management.
We start the first of this series with an interview with Dr Sumeet Shah, a leading surgical oncologist in Mumbai. Dr Sumeet did his residency at Tata Memorial Hospital, Mumbai and is a practicing surgical oncologist with Surya Hospital, and Holy Spirit Hospital in Mumbai.
Dr. Shah shares with us his motivation and vision for ‘The Pink Initiative’, a not-for-profit organization that runs an online portal called ‘Breast Cancer India’. The portal serves to address questions on diagnosis and treatment for breast cancer patients in India. Dr. Shah also discusses the most significant challenges India faces concerning breast cancer detection and diagnosis.
Congratulations on the incredible work you do with your not-for-profit ‘The Pink Initiative’. Please tell us what drove you to start this organization and your goals with ‘The Pink Initiative’?
When I was working at the Tata Memorial Centre, which is one of the largest cancer centers in Asia, the one thing which used to pain me was, many women used to come with advanced stages in breast cancer, which very much impacts the survival figures. Also, it’s not only the survival of the woman. It’s the survival of a family. Lack of awareness of symptoms of breast cancer, staunch beliefs in alternative treatment, financial constraints, lack of healthcare facilities, are some factors that impact survival rates. One simple and straightforward solution is to make women aware, to make people aware. The earlier they come to the right place, the more are the chances of survival. That was the aim with which I started ‘The Pink Initiative’, in September 2010.
I started doing breast cancer awareness presentations for various groups of women, educating them through pictures and videos. But I needed an identity through which I could function, and there was this long standing latent desire to help the underprivileged for extremely low cost breast cancer surgeries. With that in mind, I started ‘The Pink Initiative’, and later, I was joined by Ms. Ujwala Raje, in the work we do. Our primary goal remains only one – to create breast cancer awareness and to dispel all myths related to it. The idea is to spread correct information, in this era of social media, where people tend to believe anything they read, without confirming the facts.
Reports state that there is an increased incidence of breast cancer in India and other developing countries. Is this due to better diagnosis?
To a small extent, yes, better diagnosis has impacted the increase. But the more important, significant and disturbing cause, is a genuine increase in the incidence of breast cancer, especially in younger women. India’s population pyramid has a vast base, implying large numbers of population in 20’s and 30’s, and this also results in increased incidence of breast cancers in young, apart from other factors.
Are you also observing an increased incidence in any particular sub-type of cancer?
Statistics from India are not plentiful; it is difficult to answer this conclusively, but the general feeling is that there is a definite increase in the numbers of Triple-negative breast cancer and also HER2-positive breast cancer.
In your perspective, what are the challenges in breast cancer detection and diagnosis in India? Is this an affordability discussion? What type of insurance coverage or government plans are available for patients?
The biggest challenge is to get women to report to doctors on time. For most of the patients I see I ask them how long has it been since they noticed the lump, and I get a reply – ‘3 months’ ‘4 months’. The day they answer – ‘3 days’, ‘4 days’, is the day, I will consider India has progressed in breast cancer detection. Until then, much work remains to be done. Challenges are multifold – awareness, quality mammography centers with qualified radiologists, readily available healthcare centers without a long wait list and financial constraints to name a few. All these need work.
Slowly, more and more people are buying health insurances. For those in ‘BPL’ (Below Poverty Line), and in very low-income groups, all states have their respective government schemes to provide them with free treatment.
With several new genomic tests entering the Indian market, do you see an uptake in prognostic or prognostic assays?
Yes. India is still in a budding stage when it comes to these assays, but slowly (as costs come down), they will become more popular. Cost is a huge deterrent for these assays. To give you an example, initially, when Trastuzumab was very costly, just a small percentage of HER2-positive patients used to take Herceptin, due to financial constraints. But now, the cost is almost one third, and we are seeing an exponential rise in numbers of HER2-positive women taking Herceptin. Same holds true for genomic assays. Maybe in the next several years, as the cost comes down, and with awareness when there is a shift to detecting more of earlier stage cancers, these assays are bound to be more and more popular.
Most forms of breast cancer have a good prognosis if detected early. We have read reports that indicate prognosis and outcomes of breast cancer in India are poor compared to the west. In your opinion what can be done to improve prognosis?
First important thing – get the women to the doctor in early stages, primarily by generating awareness. The second important thing – make them land to right centers (instead of landing on to alternative treatments) for treatment, by increasing access to cancer care all over India, and also educate patients about the benefits of standard, scientifically proven treatment.
What about the patient? Are patients responsible about follow-ups?
Yes, most are responsible. In my practice, I feel more than 95 percent follow up rate is there. Though of course, I practice in a large city (Mumbai), the scenario might be a little different in a smaller town and rural areas. However, I wish to state, I have been exposed to populations from there as well, and as long as the medical team instructs the follow-ups correctly, I think most patients are responsible enough to follow-up. The fear of cancer does not let them drift away from the doctor, once they come to the doctor.
Finally, do you think that India is doing enough regarding research, education, and policies to combat the breast cancer epidemic? What can be done to provide good accessible healthcare to all?
I wish to give a very honest answer here, and my answer is going to be a bit emotional. India, as a country, can do more in terms of research. Especially, considering the enormous numbers of people with various cancers, there’s really lots than can be done; to start with, a simple epidemiology, which doesn’t even affect the patient or her treatment. But barring a few large institutes, research into anything, is nonexistent. For education and policies to combat breast cancer epidemic, the government has started doing its bit towards awareness and trying to make healthcare accessible to all, but more needs to be done. .
Providing good and accessible healthcare for all is a very broad question. It boils down to two things – providing healthcare facilities and providing good doctors. Outside of cities, India faces dearth of doctors. Indian doctors have done wonderful at most places in world, but India itself does not see its doctors as asset. India spends about 3.9 percent of GDP on healthcare as compared to 15 percent plus for most advanced nations. It is the smaller setups which have absorbed this lack of spend on healthcare by the government.
Thank you, Dr Shah for taking the time to speak with us. Your insights are greatly appreciated!
Disclaimer: Interviews are published unedited or with minimal changes.