'Many cancers are sheer accidents'

'The best way to face cancer is to get it diagnosed, staged and identify the best which line of management.'

Cancer surgeon Dr Ramakant Deshpande answers the most crucial questions on the disease. And offers very important advice on ensuring yourself a healthy, everyday life.

Part 3 of the must-read interview with Rediff.com's Vaihayasi Pande Daniel.

• Part 1: 'Cancer is not incurable'
• Part 2: How Young India can try and keep itself cancer free

How cutting edge is cancer treatment in India? What is your assessment?

We are practically there, actually.

The treatment which we are giving here at the Asian Cancer Institute is almost at par with whatever is being given in Europe or in Japan.

Except for certain things. For example, neurosurgery is fairly advanced in the US.

They have better equipment. Probably a little more experience than what we have. The overall set-ups (systems) which are there, they hang together much better abroad.

But as far as the top doctors are concerned here, they are practically at par with any of the best doctors anywhere else.

Anywhere?

Everywhere. Indian centres are as good.

Japan is one place which is very good. Singapore is basically a combination of the US and Japan.

China is basically a kind of unknown entity, we don't really know much about China, to be very honest. We get a lot of Russians here, in fact, as patients.

The US, of course, has certain nodal centres which are really world known.

And in your specific field of lung cancer?

We practically do the same thing that they are able to do. We have robotic surgery included here in this same hospital. We are world class. Absolutely.

So only for neuro cancers, maybe India is a bit behind?

Yes. And certain very, very critical areas (of other types of cancer), there are there even today, where people actually specialise in treating that abroad.

People once talked about cancer only in two ways: Cured. Or uncured.
When I first heard you speak at a recent press conference, you were instead talking in terms of adding years to life.
But what would be the quality of life of someone cured from a debilitating cancer? Also, they do live in fear of remission.

On remission: Once you get a cancer -- of any kind, say a lung cancer or breast cancer or anything -- there is a three to five per cent chance, during your lifetime, to get another cancer.

That practically (puts you in the same probability/odds bracket) as another person getting cancer, who never had cancer before.

But it can occur... Though that particular cancer may get cured, it can come in some other location, something else may happen.

On quality of life: Suppose (a patient has) a large tumour. There are targetted therapies which can make the tumour smaller. It may not disappear.

Once it becomes smaller, the pain related to that goes, obstruction related to that goes. Any other difficulty, like sense of heaviness, will disappear. So that improves the quality of life up to some level.

Making it quite decent?

It is much better than what it used to be. You can't make a person 100 per cent normal, but it is definitely near normal I would say.

When people get cancer they always wonder: 'Why me?' That's the first thought.
'Am I doing something wrong?'
'Is it something in my family?'
'Am I eating too much non-vegetarian food?'
Can you shed some light on that?

This sense of 'why me' is there in any kind of sudden occurrence in life.

Be it a diagnosis of cancer. Or tuberculosis. Or having an accident. Or some kind of disaster in the family.

That reaction is a human reaction to any sudden kind of problem which is faced in life. You can't really eliminate that thing at all.

But if you really analyse sometimes... For example if a chronic smoker says, 'Why me? Why should I get lung cancer?' the answer is staring in his face.

But by and large, many of these cancers are sheer accidents. You may not really drink and drive, but that does not mean you may never get into an accident.

What do you mean by sheer accident? Something that went wrong?

Yes, something could go wrong in your system and then you can develop a tumour. So that is a possibility.

More than 70 to 80 per cent cancers are like that.

If there is a genetic abnormality, it is a different matter. You know why it has occurred.

If there is a habit, or if there is a causative kind of irritating stimulus, like tobacco, you know why it has happened.

But almost more than 60 to 70 per cent cancers don't have an origin like this.

They have no known cause?

Yes. We don't know. As of today we don't know what may be the cause.

Ultimately, 30 years back, no one knew about this BRCA business, okay.

That time, many of these cancers that didn't have a cause. Today we know they had a cause which we did not know.

Eventually a time may come, 20-30-40 years later, when those 60 to 70 per cent (origin-less cancers) will also maybe get a kind of actionable prevention we may have.

The best way to face cancer is to get it diagnosed, staged and identify the best which line of management.

Instead of being philosophical?

Emotional reactions are bound to be there. They are part of life.

If we don't react, we won't be human, right?

But don't lose valuable time in that reaction.

In India people want to treat cancer through alternative medicine like Ayurveda.

We see a lot of people becoming inoperable because of this.

Sometimes they do it after everything else has failed.

If they do it after everything has failed, or alongside the conventional treatment, I think it is still acceptable.

There are certain areas where they could probably be useful. For example, reducing the side effects of chemotherapy. Or maybe recovery from anaesthesia. They could probably be helping.

But they are not a primary treatment for malignancy.

They have some value, but not necessarily?

But not as curative value in malignancy.

So never to replace the regular treatment?

No, no. The conventional pathway should not be (tampered with)...

But many Indian have faith in it?

Just show how people have suffered because of this.

Because they delayed seeking conventional treatment?

So many. So many.

You are not happy with the allopathic doctor -- what is the worst thing that can happen? He gets sued.

Have you ever heard of any alternative line of medicine consultant being sued because the patient became inoperable? Nobody gets sued.

They are the ones who are actually creating the biggest destruction.

If you treat a patient in an early stage, your results are better, complications are less, outcome is much more in line with the desirable one.

Whereas somebody who neglects for nine months or a year, comes in the third or fourth stage, expects miracles from a consultant and blames the consultant because of that.

Actually they are destroying and vitiating the whole system of healthcare.

You were talking about the overuse of Google. But there are many who don't like to Google or educate themselves when it comes to medical situations. They just go into treatment blind.
What do you think an average person needs to know, especially about cancer? What does he need to read up on? What does he need to equip himself with?

There are certain basic books, even matter which is available on the Net. Basic principles of treatment. Principles of what cancer is. The fact that it can be cured.

The American Cancer Society publishes a lot. For example, you asked about bras with metal straps, deodorants -- all the answers are actually available there...

When a cancer society publishes something -- be it the Indian Cancer Society or the American Cancer Society or the Asian Cancer Foundation -- all of these have authenticity associated with them.

I think some amount of awareness should be there. It is always easier to explain things to a person who is at least a little read and who is ready to communicate. It is better that patients also read up a little bit.

A lot of patients are ignorant.

Even those from well-educated backgrounds?

Yes. (Because of) Fear of it. They don't want to know about it.

You said India does not have a high incidence of cancer. Should people budget for cancer when they make a calculation on how much to medically insure themselves for, given that hospitalisation costs are so high?

I am not saying that India doesn't have a high incidence or anything. We don't have as high an incidence as the developed countries.

But medical insurance is like being in a rainy season and the care that you take, by bringing an umbrella (along), whether it rains or not, is in front of your own eyes.

Without insurance today every family is at risk. Because anything you do today is fairly expensive. Somebody slips on a banana peel, breaks one bone, in a decent hospital it costs you 4 or 5 lakh rupees.

So a decent amount of floating insurance for a family should be anything between Rs 5 and Rs 10 lakhs, is absolutely mandatory...

That will take care of any sudden cancer treatment cost?

Yes, it will...

If you ever faced a personal cancer experience, would you like to be treated in India? As a cancer surgeon do you feel confident of our centres?

One of the greatest surgeons of cancer, Dr Ernest Borges -- who has roads named after him; he was the person who brought Tata (Memorial Centre) its name -- was operated for gastric cancer.

Where was he operated at? In Tata Hospital, by his own junior.

(Tata Memorial Centre's) Plastic surgeon Dr (N M) Kavrana got bladder cancer. He was operated at Tata Hospital by (uro-oncologist) Dr Murali Kamat.

There are so many people like that. I don't see any necessity today to go abroad.

Congress President Sonia Gandhi goes abroad, reportedly for cancer treatment...

Sonia Gandhi is going abroad not because treatment is not available here. She is going for some other reason. She wants to secure the fact that she is being treated.

So many of my patients go abroad. They say I don't want other people to know I have cancer...

A very prominent person getting operated in any of the hospitals (and people get to know)... the nosiness of Indians is to be blamed. Abroad nobody will actually poke their noses.

It is probably for discretion that she is going rather than (anything else).

IMAGE: In this photograph shot on March 4, 2013, Raj Kishore Kumar, a 12-year-old cancer patient, rests with his mother inside his pavement dwelling outside the Tata Memorial Hospital in Mumbai. Photograph: Danish Siddiqui/Reuters