Cancer - Causes, Awareness, Symptoms & Vaccines |Oncologist Dr Sewanti Limaye

0:00 The hard statistics from Globan 2023, one in two men and one in three women will be touched by cancer in her lifetime. My mom got diagnosed with advanced lung cancer. Had been screening for the routine cancers and she had no symptoms. 6 months back I lost my mother. >> The first question you tend to ask is why me? Cancer is a slow epidemic playing out.

0:31 >> Causes would you rate randomness as one of them? >> It is. So 20% of cancers are familiar. 80% are not familiar. >> We hear so many people share things like sugar is the food to cancer and it helps spread cancer cells faster or things like that. Would you second that? Coming on to the HPV age group where cervix cancer or HPV vaccine has to be given from the year 9 or 10.

1:01 >> These are the screenings I would do if I am a man. These are the screenings I would do every year if I am a woman. >> Excellent question. I feel that India is seeing younger and younger cancer patients. >> You also spoke of the progression of stages of cancer and detection happening at a much later stage. How can one make sure that they're vigilant about it to detect it early? Hello and welcome to the Kids Stopress podcast and today we have with us somebody who's taken a lot of time out of her busy schedule to be with us here today. It's a conversation that we don't want to have but is very important to have. Uh it is not about what we can do after but what we can do before. And it's it's always our endeavor at Kidstop Press to have conversations that empower parents to make informed choices through every single milestone. And yes, I know that we are a sandwich generation who's taking care of two dependent generations. And this is a conversation, like I said, we don't want to have, but this is a conversation that's very important to have. I'm very, very grateful to Dr. Seanti Lima who's here with us today. She's the director of medical and precision oncology at Sir Agent Reliance Foundation Hospital.

2:18 She's been involved in research at Memorial Sloan Ketering Cancer Center, Dana Farber Cancer Institute, Colombia University Medical Center and National Cancer Institute USA. She serves also on the board of Tata Memorial Hospital, the ethics board. and I'm so grateful that you've taken out time to have this conversation with us today. >> Thank you for having me. >> And just while we were chatting, you mentioned that you earlier were very focused on precision oncology, but something changed where you said that it's all about awareness and detection, which got you to come out in the open and talk about cancer and its awareness.

3:02 what what really changed and made you squeeze in this time to talk about it? So um it's almost two decades that I have been working on the subject cancer you know earlier pursuing it as a student then went in to do the residency fellowship and then as a faculty um a lot to give back and somewhere down the line realized precision a particular orientation to treating cancers was my calling and and I I pursued that subject pioneered that launched it in India and continue to practice. Around 2 and 1/2 years back, my own darling mom got diagnosed with advanced lung cancer. We um had been screening for the routine cancers and she had no symptom and uh she presented with the uh back pain which was thought to be completely unrelated and in the during the workup we realized it was actually originating from the lung and she had advanced lung cancer. Six months back I lost my mother. In this journey, I actually realized no matter what I do and no matter what we did, we could not save her. No matter what I do, I'll only be able to make a difference um that fills in the day as an oncologist. So if I were to sit down and put down commit all my time to oncology, even then I'll probably be touching x number of lives through the day because of what I see in the clinic. But if I pursue awareness and if I pursue the message of screening, that message could actually scale up, cascade and help touch thousands of lives. I feel that's the message that is most integral.

5:04 That's something that I would like to bring back. It is also a type of my coping for what I have gone through and what my family has gone through. We realize that in a resource limited nation, we can only do so much in treating cancers. If we are if we as a family struggle to treat our mother, what must be happening to the masses? And that is where I decided to put down my time beyond my routine work to cancer awareness and waging a revolution if I may on cancer screening.

5:44 >> That is so incredible and I'm so sorry for your loss. I think this sort of mechanism to cope and build for everyone else is what we really really need because like you said there is so much we can do in the preventive but there's so much that so much more that you can do in terms of awareness. So thank you for doing what you're doing. >> Absolutely. Do you as an oncologist in 20 years of practice feel like you are seeing it's it's literally becoming um without sounding non-empathetic it's literally becoming like a spread of virus or flu in terms of the number of patients that you are seeing today versus earlier.

6:26 >> Yeah. Yeah. So absolutely I do say this all the time and I do give an analogy of COVID. I say, you know, the world battled COVID and COVID was an epidemic. We don't really internalize it enough, but cancer is a slow epidemic playing out. It may not be as fast and as dramatic as COVID was, but it is equally dramatic if you see how things are. And each one of us will have a story.

6:59 >> Yeah. And I truly felt the impact because of being a caregiver because the realization came home that this statistics that cancer is going to touch all our lives that cancer does not discriminate and also the reality the hard statistics from global 2023 one in two men and one in three women will be touched by cancer in their lifetime. These are facts. One is not making up these numbers. And so if you think of these as being facts, we know cancer is an epidemic. It's happening. It's playing out. And uh it it is something that does not discriminate. It will touch lives. Whether we talk about friends, family, colleagues, community, work uh members, your colleagues at work, you know, it will touch lives and it is something that is front and center for us to take heed.

7:54 >> Right. Did you and I'm sure everybody who's watching and is a caregiver, the first question you tend to ask is why me? Right? Like why my mom, my dad, my sister, my friend, my cousin or my partner? That why me question or the fact that they've been living a healthy life like what just happened? So how do you address that question? >> You know, you asked a very beautiful thing actually. I am a medical oncologist. My brother is also a medical oncologist. He's 10 years younger. He's in the US. So we as a family were already dedicating our time to cancer care. So we as a family were quite mature in the understanding. We were struck. Uh I mean I don't want to ever project that we could take it in our stride. No, we were devastated. We were struck. We were completely struck. We are still devastated.

8:57 But we could internalize that fact that cancer does not have any rules really. And we internalize that very quickly. Not just me, not just my brother, but even my parents because they had raised two oncologists in the family. So they were able to internalize this that asking the why is not the answer. that there was no rule to cancer causation. That the world is today going wild with different kinds of cancers even in people who are not exposed directly exposed to carcinogens like smoking or chewing tobacco.

9:39 And uh there's a certain randomness to cancer that does not really um hold true when we ask the why. Having said that, the other reason why I never could ask why and why me or why her is because of um my mother's spiritual strength. I found her extremely strong, very brave.

10:14 She uh was a very religious person and even after her diagnosis, as she battled her disease, she never asked why. She stood in front of the mandr every single day without fail. even post diagnosis and even through her last days and that really gave a lot of peace to all of us and we live with that peace even today and we never asked the why >> because we knew the background of randomness and >> so it is random >> it is it is >> so if I was to ask you causes would you rate randomness as one of I mean >> it is so 20% of cancers are familiar 80% are not familiar out of those >> you say familiar >> they run in families >> yes >> so there are genetic mutations that cause cancers >> yes >> and they can run in families and those cancers are nearly 10 to 20% >> right >> the rest of the 80% is where carcin play a role. So like someone who has a heavy exposure to smoking, chewing tobacco, alcohol, red meat, all of these are obesity, diabetes.

11:46 >> All these have a cause and effect relationship with cancer. But then there are these thousands and thousands and thousands of patients or people who have none of these. Yeah. >> And still fall prey to cancer diagnosis. That's where we see the randomness. That's where we acknowledge that epidemiologically speaking, a lot of what is leading to my cancer is still not well defined.

12:24 And whether it is the uh the query of the new phone tower that is next to your home or the new plant that is draining industrial plant that is draining their waste into the water. We don't know. All these things remain quite random. And then people add in food and air and all of that into the many plastics and the >> you know so telephones and people ask me all sorts of questions and a lot of these actually one is still uh waiting for research to help answer epidemological research to help answer some of these question >> and food often gets categorized as one of the obvious causes. Maybe that person is eating too much sugar and we hear so many people share things like sugar is the food to cancer and it helps spread cancer cells faster or things like that.

13:27 Would you second that? >> No, I wouldn't because actually if you go to any uh guidelines and I'm talking about national cancer care network guidelines NCCN guidelines from the US cancer.gov gov which is one of the biggest reference websites for people, patients, families, doctors. NICE guidelines, European guidelines, ESMO, ASCO, none of these guidelines have um categorized sugar as the culprit and that is because we have lack of data. We really have no uh study and when I say no study no reproducible study >> right >> you know single study single center study some smaller stuff when in oncology we actually follow it's one of the most brutal subjects we follow very very hard endpoints >> and our end points of respect are only two one is called progressionfree survival and the other one is called overall survival. No subject can can be as cut and dry as oncology is.

14:46 >> If it does not enhance my longevity is it worth anything? It does not if it does not cut my longevity is it worth anything? >> That's overall survival. So a drug, a food item, anything that we take on as intervention either by omission or by commission has to either enhance my survival or contribute to decreasing my survival.

15:17 And if it doesn't do that, it's not important enough, >> right? >> That's overall survival. >> The second is progressionfree survival. Cancer grows. If 2/3 to 3/4 of cancers are being diagnosed today in advanced stages and if sugar is supposed to be feeding the cancer then the people who are taking sugar should see their cancers increase more. >> Yeah. >> So that's your progression free survival. Show me reproducible data where progressionfree survival of a particular cancer or many cancers or any cancer >> increased by giving sugar.

15:58 >> Right? >> No. >> Okay. >> So these end points were not changed. Responses were not changed in presence of sugar or absence of sugar. really it isn't worth my time to spend in omitting sugar or adding sugar to the diet you know either ways I'm not impressed enough >> to bring it into my main conversation >> the whole bit that we started with right that awareness screening awareness screening this whole conversation >> absolutely >> tell me what are and and let's break it by gender what are the kinds of do you I don't know if you want to start with symptoms >> that make you want to screen or after a certain age you want to start with these are the screenings I would do if I am a man these are the screenings I would do every year if I'm a woman >> sure so what do we want to screen in a man and a woman >> and what frequency >> huh and what's the data right so after sorry he said no very very genuine question. So these are all very established um questions. These are all very very established recommendations.

17:14 So I'll deal with this first then we'll go to um the symptoms because >> at least what I'm going to tell you right now should be >> followed right >> okay >> so in a woman if we start from the top every woman has to be mindful of their mouth. So oral cavity is a big cancer playing out in India. Oral cavity cancer. So anyone with any kind of ulcer lump in the head and neck region should seek medical attention. So oral cavity screening by the Indian government is being practiced as one of the core screening methods in women in India.

18:01 >> Okay. So oral cavity very easy just with the look of the mouth in different areas of the mouth you can screen the oral cavity the neck >> then comes the breast. >> So breast clinical breast examination comes in after but self breast examination is one of the most basic methods that a woman can practice with the opposite hand to the opposite breast. Generally we say in the shower because the uh clothes are off >> and u uh if the woman is of younger age where the periods are still ongoing then we say immediately after the periods >> because the breast could be cystic lumpy prior to the periods. Once the periods for that particular month or cycle has happened, the lump in the breast goes down, the breast becomes more homogeneous and a lesion or a lump or a mass may be more prominent and if there is then seek >> clinical or medical attention.

19:04 Then coming down beyond the breast, it's directly the colon >> for screening in terms of guidelines. So any abnormal bowel habits screen. But yearly breast examinations after the age of 50. When I say breast examination, I'm talking about yearly breast examination. I'm talking about mamogram. >> Yeah. Bilateral breast mamogram sonogram should be followed after 50 years of age. But if someone has a history of breast cancer, ovarian cancer or I say any cancer of any type of cancer in the family, start screening for breast cancer from the age of 40 especially if someone has a breast cancer or an ovarian cancer person in the family.

19:53 >> So that's for the breast cancer. When I talk about colurectyl, it's colonoscopy done every 10 years. So if someone has a full colonoscopy, it is only need it needs to be repeated only every 10 years. >> Mhm. >> If someone has a shorter form of colonoscopy, it's called sigmoidoscopy, then every 5 years. And if you don't want to do any invasive testing where you don't want to go through an office procedure then stool for occult blood successively three samples every year >> right >> that's a yearly thing >> okay then as a woman the gynecological organs the women's organs yeah >> so in that cervix >> cervix is the main cancer that has screening ovarian ovaries which are the eggs which which which where which where which where which where which where which where which where which where which where which where which where where our eggs are made or uterus where the the womb lies those don't have a screening methodology that I'll come to later but in regular screening cervix is something that can be screened and that gets screened with a pap smear starting the age of 21 yearly pap smear should be done if there is any abnormal finding If normal findings then every 3 years and we do it up to the age of 65 um beyond that only for symptoms >> right >> and if there is an HPV testing done because 98% of cervix cancers in India are as a result of human papilloma virus infection which we know today we have vaccine to prevent that to be given to young girls or boys. For cervix cancer, it's for young girls.

21:48 If someone has not had an HPV vaccination, which most of us who are screening for for cervix cancer now are not have not been vaccinated earlier because it's a new measure. Then the HPV testing should happen at the time of a gynecological examination and it needs to be repeated only every 5 years. So this is for the woman. For the man it's oral cavity again head and neck cancer. If the person is a smoker I need to mention that if the person is a smoker then lowd do CT scan of the chest should be done at an yearly basis. All of this especially after 50 years of age must colonoscopy again every 10 years and prostate serum uh total prostate specific antigens serum total PSA. It's a blood test for prostate should be done on a yearly basis after 50 years of age.

22:48 Anyone who has a cancer history in the family should start screening sooner. I would say 40. Cancer is a disease of aging. As we age, these risks increase and we should put ourselves out there for the screening even more particularly than we are at the younger age. So these are routine things that we screen for. These are standard of care screenings that are already available and in our guidelines a part of our guidelines. Now to answer the first part of your question, symptoms. So symptoms are very critical.

23:22 If you're having some symptoms that are not normal that are making you uncomfortable then I would say don't be with it for more than 2 weeks without interrogation >> like what would that uncomfortable be >> like chest pain or shortness of breath or cough that is not going away that is persistent swallowing difficulty that you're having beyond 2 weeks let's not sit on it today. We need to go and get that checked because we don't know. Most likely it would not be cancelled. Let's not be paranoid about it. But it may very well be.

24:06 This is the the these are the kind of durations we hear about when we are in the clinic. I hardly had anything. I just had this symptom and I got diagnosed. In this narration, there are also success stories where someone felt a small lump somewhere and went to seek medical attention and their cancer was diagnosed at an early stage. Right? >> So I think today we have to be a paranoid person getting to the doctor maybe just for a red flag.

24:44 >> Yeah. Nevertheless, I would be ecstatic if a person's tests are all negative and we send them home without any intervention and we congratulate them that they're all all their tests were completely clean. So, I think today we have to rejoice in the fact that we called out and that red flag turned out to be nothing, >> right? >> And all tests came back clean. And I know this is such an important thing and I want to re-emphasize this because the Indian mindset is >> you know and we take great pride that I didn't want to test only in the first place you forced me to test and see nothing has come >> right um and that's the joke but the truth is that thank god [Music] right otherwise that would be like so so I think the big message is that keep checking and be that paranoid person because what if right at least you're catching it early. Also to mention that you mentioned you know mamography after the age of 50. Do you feel we're seeing patients I mean I know so many of my friends in their late 30s or early 40s who've been through breast cancer. Um you think that age is coming down for both men?

26:04 >> Very good question. It's an excellent question. I feel that India is seeing younger and younger cancer patients. >> Are we as a nation in an anomaly? >> We are because you know um we are a younger nation and we are seeing a lot of our breast cancer especially young cervix cancer also happens in youngest uh population than other malignancies. If you see cervix cancer uh risk, it actually starts very young because that's how we are doing all the papsmears from the age of 21 and over because the exposure starts very young and the conversion into malignancy is also quite young. So I think in general we are seeing cancers at a median age at least 10 years younger than what the west is seeing.

27:03 So then how do we just follow the cutoff of 50? >> Yeah, >> that is why I have said after each sentence if there is any history. >> Yeah. >> And honestly if you look today everyone has a history. Everyone has a history. I may be exaggerating when I say that but almost everyone does have a history. And if there is a history start at 40. Not just that awareness. I think awareness and orientation to thinking cancer. It's actually very strange that when someone is short of breath in India, we traditionally have always thought of tuberculosis.

27:44 >> Yeah. >> But I want people to get oriented to thinking beyond tuberculosis and get oriented to thinking lung cancer. >> Lung cancer rates in Asia are rising leaps and bounds. It's truly an epidemic. So if we don't think lung cancer for someone who has been coughing, who short of breath, who is uh you know taking out sputum that may be tinged with blood, it's wrong.

28:14 Our first instinct should be to rule out lung cancer. >> You know, jump at ruling out lung cancer. Tuberculosis of course in parallel you have to think because we are also a a na a nation affected by infectious diseases. >> Yes. >> But in parallel we need to start thinking cancer malignancy and I mentioned this only because if someone has a symptom they should start screening early. >> Right. You also spoke of the progression of stages of cancer and detection happening at a much later stage. Um could you explain those stages and and how can one make sure that they're being more vigilant about vigilant about it to detect it earlier. Yeah. So you know what's happening right now is that cancer is getting detected randomly.

29:09 >> There are no well visits happening. There are no doctor person interface where a casual symptom could be discussed, >> investigated and a cancer detected early. >> Yeah. >> Just taking a leaf from our previous question and discussion. >> Younger patients are getting detected, right? So if a person who's 30 is not reporting for any clinical discussion at any time, >> yeah, >> how are they going to bring up a symptom soon?

29:49 >> Yeah. They're going to live with that symptom, not thinking cancer for much longer and then present to the doctor much later when the cancer may have grown in size, spread to local areas and spread to distant areas. >> Right. >> So two things, one knowing your cancer risks through the family. >> Mhm. to being fully aware and to a certain extent being paranoid also where you say okay there's a lump this could be cancer let me just get check this checked out awareness is the most critical thing this brings me to stages so if someone is aware and they feel a lump in the neck and they go to the doctor at the earliest because their brain is oriented to thinking Oh, this may be cancer.

30:45 They get to the good doctor. The doctor examines, feels that this is out of place. Let me have this biopsied that. Let me have this scanned. If it's nothing, great. Celebrate. If there is something, it is still a peanut size thing that can be removed, that can be treated versus someone who's just not oriented to what is happening in their neck. They don't think cancer. They're just living with it. 6 months, a year passes when the patient gets examined. This one lump has now traveled to 20 different places in the body. And such is the story with 23 at least of our patient population. We find that presentation lingering and by the time the patient reaches out to the doctor or to an expert the cancer has already sped spread. So twothirds of the cancers are found in a state of spread not localized. When things are local you can cut them out you can burn them with radiation and it's for cure.

32:01 When cancer has spread to multiple different organs, it cannot be cured. And even in treating such a cancer, even in treating such a presentation, it takes a lot of effort and it is also quite compromising for the patient because the treatment mostly entails harsh therapies like chemotherapy. If the surgery happens, it's a big tumor, it's a bigger surgery, bigger area being cut off rather than a peanut size thing. Smaller area being cut off, less morbidity, less number of treatments required.

32:42 >> Right. Also coming on to um you know the a part of the previous bit that you had answered that every doctor or medical practitioner today does not have a connection to the previous like you had a symptom and you showed it to a doctor and now that doctor is not communicating to another doctor because they completely you know earlier we had a general practitioner or sort of a common doctor that we went to versus now we're only seeing specialists where specialists are treating you for their specialization.

33:19 Do you feel like in this whole specialist bit we are losing a common pool of communication that was actually being >> um >> anchored by anchored by earlier. Yeah, those issues do come in. But it's very rare actually that I would see a patient who's gone to 10 different providers and still has not had the right diagnosis. Most that's an a very rare patient from my clinic of the day.

33:52 >> Mostly what is the story? Patients didn't reach in time. >> Seeing less people. >> Yeah. less providers, you know, not realizing this was important symptom. >> Yeah. >> To present, >> right? >> Picking up a sign too late. You know, these are more common than someone having. >> The symptoms are any symptom could be a cancer symptom today.

34:25 >> If you uh generalize, yes. Why not you know a a particular person could present with some typical and some atypical symptoms. So any symptom could be >> but body has a way of processing the symptoms that we get. >> Yeah. >> So if you are having a symptom that you're not deeply uncomfortable with most likely it's not cancer >> right >> and we don't need to rush to the doctor for that. For example, if I'm getting an itching, >> I'm not going to think I have cancer.

35:02 >> Yeah. >> Or if I'm getting a headache, >> right, >> it's not cancer. But if I'm getting persistent headache, >> Mhm. >> splitting headache >> very frequently, >> very frequently beyond a particular time period, two weeks, four weeks needs to be investigated. It may be as a result of some change in my eyesight. >> Yeah. But it may also be as a result of something else which is much more ominous. >> Right? >> So I think today we need to really pay attention to the symptoms that we are getting and if there is any symptom that is persistent we need investigate it.

35:40 That's that's >> right. >> Right. Uh coming on to again the you know coming again onto breast cancer. What are the kind of facilities or screenings or treatments that are being offered right here? Or what are the kind of procedural things that one could look at? Because I know a lot of people do get um overwhelmed with the amount of therapies that they need to go through and then they turn to alternate medication or alternative therapies. So what are the options available and what are the some of the options that you have available at Reliance as well?

36:22 >> So I'll talk about screening and then I'll talk about the treatment. So for screening it's bilateral breast mamogram mamogram sonogram. >> Um for women who are with increased risk for familial cancers. >> Yeah. Uh the offering is for bilateral breast MRI. >> There are new age tests emerging where a simple blood test will be able to predict whether someone has a high risk for any kind of cancer including breast cancer.

36:57 >> Right? Um but right now if you look at what how do we detect breast cancer screening wise it's clinical it's self breast examination clinical breast examination bilateral sonogram mamogram for younger women uh sonograms bilateral sonomo for above 50 and for increased risk someone who's coming with familial history u bilateral breast MRI >> right That's the ballpark for breast screening. In terms of breast cancer treatment, all cancer treatments, I would like you to imagine a marathon, not a sprint. So breast cancer treatment is a multimodality treatment. Most breast cancers undergo upfront surgery.

37:44 There could be a situation for giving chemotherapy, then radiation. Most breast cancers are hormone positive. They then undergo 10 years of hormonal therapy oral. So I mentioned a marathon. Yeah. >> It's a long run. One has to be prepared. Breast cancers are also highly curable. >> Mhm. >> Very high cure rates. So we have to be followers and believers. If you follow the path, there's a very high chance of complete cure. Two kinds of breast cancers where upfront surgery is not being practiced.

38:21 Upfront systemic treatment. So either chemotherapy, imunotherapy or chemotherapy, targeted therapy, then surgery, then radiation, then maintenance treatment uh may be uh need may need to be practiced and these are if we have a target positive breast cancer which is heru positive breast cancer or triple negative breast cancer where there's role of imunotherapy up front. So you treat with chemoimunotherapy and then you do surgery and then you do radiation and then you give the maintenance treatment with imunotherapy. So what I'm trying to project here which is the final message for treatment for breast cancer is that it is not a sprint >> it's a marathon >> it's a marathon it's a drawn out treatment but the bottom line is very high cure rates >> right >> so there is a goal >> right >> the goal is for cure >> right and then the obvious next question is relapse >> do I loom and live in the fear that this can come back and haunt me again.

39:30 >> So, you know, I am an eternal optimist. So, the same things I'll say in different words. >> Mhm. >> I'll take charge. I'll be proactive. I will not let it come back. I'll do everything in my capacity to prevent it from coming back and also be proactive enough to catch it at the earliest if it is to come back. >> Right? >> I will utilize methods so that I know it at the earliest and necessary actions can be taken.

40:03 >> I love that. I absolutely love your spirit. It's amazing. Um coming on to the HPV and cervical cancer. Um tell us a little bit about our generation being able to deal with it and how can we prevent the younger ones and about the vaccine of course. >> Yes. So um when we talk about HPV largely it causes cervix cancer in women and in men it can cause anogenital cancers, penile cancer. It can also cause uh throat cancer. So in the west HPV positive tonsular cancer or head and neck cancer is an epidemic at this time.

40:54 >> Okay. Just like here HPV positive cervix cancer is an epidemic. So how can we prevent our population that is already mature? By screening. >> Mhm. >> And by acting on any symptoms that may be coming our way. How do we screen? We screen for cervix cancer as I just described. by doing papsmears, by doing HPV testing >> and we screen from 21 year of age group to 65 >> and papsmears every 3 years, HPV testing every 5 years. Any symptom get to the gynecologist.

41:39 If we talk about prevention, prevention has to happen way early and it's applicable in our children, boys and girls both age group where cervix cancer or HPV vaccine to be even more broad I think we need to call it HPV vaccine today because it's applicable to both girls and boys has to be given could be given from the year 9 or 10 years of age group but should be given by 11 12 for sure because the vaccine then helps build immunity and memory in these children to fight HPV virus that comes to home into their bodies and cause the cancer in the areas of prediliction.

42:39 which is cervix which is throat which is you know penile area or anogenital area where even boys are at risk. So three kinds of vaccines out there. Gardisil vaccine by MSD by GSK we have cervix and we have cervac that is India uh made made in India and most vaccines are given in two or three doses. Uh we must vaccinate our girls and boys to prevent these different types of cancers.

43:19 The side effect from these vaccines are no bigger at all than a regular vaccination that our child goes through like an MMR vaccine or even lesser than a flu vaccine. >> So we we mustn't be afraid. We must vaccinate our children. >> Right. Um what are the common myths that people tell you that what and and why they're against the HPV? You know, people talk about uh the HPV vaccine leading to different kinds of cancers. Um people also talk about autism as a result of vaccination, which is this whole >> um cult following where >> antivaccinated >> antivaccine cult. Um I I I really don't think any one of those um are uh correct in terms of u the factual evidence to back anything and if you really go out there HPV vaccine may be relatively new for India but you have a decade worth of data coming from the west >> right it's that old >> and it's that old I when I was uh giving a recent talk I utilized slides that I had a decade old slidesh >> I utilized as my first HPV vaccine talk in India.

44:45 >> Mhm. >> We are that behind. So really enough and more has already happened. World has already witnessed HPV vaccination for over a decade. Right? >> If there was any significant um side effect adverse event playing out, you would have it >> everywhere backed by evidence by now which is not there which just goes on to say we are having we are being fearful for something that does not exist. We have to fear the cancer.

45:17 >> Yeah. >> Not the vaccine. >> Right. So that of course that that really helps and I'm glad that you mentioned that because I see a lot of people being hesitant towards the HPV vaccine thinking that this is very new and I want to wait it out because of lack of information. So I'm so glad that you've mentioned and I think another very very important thing that you mentioned which I think may be a complete eyeopener for many is that the vaccine is both for girls and for boys.

45:46 >> That's true. I think it's often misinterpreted as being only for girls. So I'm glad that you shared that and and busted that myth. Um the other bit that I want to ask is while you've we've spoken of preventive being screening and preventive um you know screening diagnosis all of that but we've seen people who've lived the healthiest of lifestyle and we understand cancer is random but I still feel like like the Greek philosophy says or like the Hindu philosophy say I want to do my bit of controlling what I can do what is in my hands. So really what is it that is in my hands as an individual to make sure that I'm not part of that random number unfortunately.

46:39 So I think a healthy lifestyle is um our responsibility. One of the things that has really stood out in you know from from and backed by data is exercise leading to decrease in cancer causation. Exercise leading to decrease in relapses in cancer patients who have been treated for cancer and exercise leading to enhancing longevity >> right >> in patients who are under treatment.

47:14 So out of everything it's eating right and exercising. These are the two most important things that we can follow in our lifestyle. And for those who are addicted to certain car carcinogens which are really considered a taboo, I would say you don't need it there. You really know don't need it to add to the numbers that are already existent as a result of the randomness. You don't need to add the risk that comes along as a result of being exposed to these carcinogens. So at least we should have that responsibility to cut out that risk.

48:02 >> Right. Um also doctor any new therapies or treatments that you would like to talk about because I I know you mentioned this um number which is 2/3 right um which makes me wonder that what can that 2/3 do so that is also a huge reality you know if someone is getting diagnosed today there are higher chances of that person having a cancer that has spread than to not have spread.

48:34 >> Mhm. >> If a diagnosis comes through, we need to make sure that the staging of the cancer has been done appropriately, that the tests that need to be done to stage the cancer are done appropriately. If someone is with locally advanced or advanced cancer, they should still not lose hope. You know we have to shun fear, organize ourselves, get to the right center to strategize the treatment. It's strategization of the treatment then then adds to the longevity of that patient. So what is new?

49:12 If a patient is diagnosed with advanced disease today, one of the new things which is no longer new I mean I've been practicing in my precision oncology center for the last five six years already is the methodology of figuring out what are the driving pathways. So doing genomic testing in a cancer patient's tissue, doing genomic testing in a cancer patient with their tissue and blood should be as simple as doing a CBC in a regular human being who has cough and cold and pneumonia.

49:49 So genomic testing helps dis distinguish what are the pathways in that particular patient's tumor. And if you figure out the pathway and you target the treatment and treatment strategy, personalize the treatment strategy, you are then able to deliver better care, higher uh or a longer life and less adverse effects. So preserved quality of life that is personalizing treatment for that patient. It's called precision oncology.

50:24 So I would say precision oncology is a newer way of treating our patients today. The second thing that I would like to bring to the forefront is imunotherapy and advanced imunotherrapeutics. So imunotherapy came in as a modality in cancer care. It's a systemic treatment given intravenous. But if it works for a patient, it can actually change the entire horizon for that patient. Change the outcomes, transform the outcomes. We see that happening in 20 to 40% of our patients today. Advanced imunotherrapeutics is what is being really talked about nowadays. It's in the vogue.

51:10 Cancer vaccines and CT cell treatment. These are advanced imunotherrapeutics or um even uh T- cell infusions. Those are cutting edge novel treatment modalities that are playing out in um many parts of the globe today including India. We in India are lagging behind because therapies in cancer medicine actually the novel therapeutics initially become available as a part of a clinical trial.

51:46 We as a nation do not participate um in a big way in clinical trials and so access to these novel therapeutics is a little behind but I understand from my dialogues with different regulatory bodies in the country that there is going to be a serious interest and engagement in opening more clinical trials in India and I would appeal to the masses to really be open to considering clinical trials trial options because access to novel drugs in cancer medicine happens as a part of clinical trials at least 10 years ahead of when it becomes available uh to purchase >> right >> so we have to be open because though for those patients who are diagnosed today remember twothirds are getting diagnosed in advanced stage and they don't have time so they need to have access to clinical trials to get the best drug as a part of a trial so that their lives can be transformed, the outcomes can be transformed.

52:49 >> Right? That's so beautifully said. And um last but not the least, I'd love to thank you >> um for being so open to sharing for sharing your personal journey with us, for sharing and and being so passionate about sharing everything that you know. uh and you know spreading as much awareness as you can on the pree preemptive versus um versus you treatment which is largely being discovered in uh the later stages of uh cancer. So thank you so much for sharing that with us today. Thank you for having me. And like I said earlier, um if I just participate as a treating doctor, I only do so much.

53:38 >> Yeah. >> If we get together and we revolutionize cancer screening in India, we really impact in a much bigger way than we can ever envision. And so we all must come together and thank you for giving me this podium and the opportunity to spread the word. Thank you. >> Parenting tips, celebrity interviews, recipes, conversations with experts, DIYs, and lots more. Subscribe to Kids Stop Press