Friday July 19, 2019

Genetic analyses can benefit those at risk of hereditary cancer

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November 2, 2017:  Genomics and genetic analysis are the most effective ways to manage cancer, not only in India but also across the globe.

Hereditary cancers are seen in approximately 10 per cent of the Western population, with a higher incidence in India. Hereditary cancer has high prevalence in breast and ovarian cancer patients. We see a very strong shift in this trend, with an increased incidence of cancer in India’s younger population. The section of the population that is at risk of hereditary cancer will certainly benefit from genetic analysis.

With genetic testing, we can understand the genetic profile of the cancer. This knowledge leads to choice of targeted drugs that are designed to counter the cellular functions of the mutant proteins. Patients on active chemotherapy regimens are reassured that they do have alternative directed treatments if they do not respond to the ongoing treatment regimen. In the long run, targeted therapeutics would replace generic chemotherapy.

There is a great potential for targeted therapeutics. Cancer medicine, however, is evolving every day. There is much research and data to process and we still do not understand the full potential of genetic analysis and the benefits of targeted therapy based on the gene mutation. In such a scenario, if there is a targeted protein identified with effective medication available, then it would be better to treat the patient based on literature available after they have failed conventional treatment options.

New therapeutic drugs are being developed every year and their side effects are better controlled. Even though the cost of chemotherapy has drastically come down over time, targeted therapy has fewer side effects and causes lesser collateral damage to normal tissue. It is almost four to five times the cost of current chemotherapy regimens. As time progresses and these medications become generic, they would replace chemotherapy in the long run.

Genetic analysis of a tumour can support the choice of therapy at the initial stages of diagnosis as well as throughout the course of treatment. Cancer cells can mutate (change) and be present as a disease in multiple variant forms. This essentially means that we need a fresh “snapshot” of the genetic profile of each patient’s cancer at every stage of the disease. New target proteins are produced due to these mutations.

To introduce new drugs to target these changes, an understanding of the genetic profile of a cancer — quite like time-lapse photography to capture a sequence of events — is absolutely vital. Liquid biopsy is precisely the technique to use to achieve this.

The challenge in this setting is getting the patient to understand the concept in the first place and then accept the increasing cost with the recurring tests. This process of longitudinal cancer care with follow-up liquid biopsies is already the norm in the United States. It makes sense scientifically, and insurance companies cover the cost. In the long run, liquid biopsy-based personalised cancer therapy will become the norm in India as well.

(Dr. Gurdeep Sethi is Founder, Millennium Cancer Center, Gurugram. Dr. Sudhir Borgonha is Chief Medical Officer, Strand Life Sciences, Bengaluru. The views expressed are personal. They can be contacted at setgu@gssmcc.com and sudhir@strandls.com) – IANS

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Nigeria Spends More than $1 Billion Per Annum to Medical Tourism, Say Authorities

To provide access to high-quality care, authorities plan to build six new medical centers across the country, said Health Ministry official Nneka Orji

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To provide access to high-quality care, authorities plan to build six new medical centers across the country, said Health Ministry official Nneka Orji. Wikimedia

Nigerian authorities say the country is losing more than $1 billion annually to medical tourism as tens of thousands of Nigerians travel abroad in search of the best treatment. Nigeria’s Health Ministry says it is building several world-class health centers to address the issue, but not even the country’s president seems to trust health care in Nigeria.

Fifty-three-year-old Ibrahim Bello, a former Nigerian lawmaker from Kaduna state, lost both his parents to diabetes. He was afraid the disease might run in the family, so he went for a medical exam. Unhappy with the quality of care at home, Bello flew to India, like many of Nigeria’s well-to-do.

“Comparative analysis between Nigerian case and where I passed through in India, honestly, I cannot do it here because the margin is so wide that every Nigerian who has any health issue – his prayer is how can he be moved to India,” he said.

Bello is one of tens of thousands of Nigerians who each year opt to travel abroad for treatment. Health officials and some medical professionals argue that good care is available in the country – but at private clinics. Nadey Hakim, a transplant surgeon who has been practicing for more than three decades, is among those who argue in favor of domestic treatment.

“I don’t see why any Nigerian patient should go outside Nigeria to have a transplant when we can do it for them in Nigeria,” said Hakim. But for those who can’t afford private care, or medical tourism, there are few good options.

In April 2001, Nigeria and four other African Union countries met and pledged to target at least 15% of their annual budget for health care. Many years after, Nigeria remains far from reaching the goal and ranks at the bottom of global health surveys. To provide access to high-quality care, authorities plan to build six new medical centers across the country, said Health Ministry official Nneka Orji.

nigeria, medical tourism
Health officials and some medical professionals argue that good care is available in the country – but at private clinics. Wikimedia

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“These centers of excellence are supposed to deliver those cares, those interventions that people would naturally go outside to seek. Things like cancer treatment, brain tumors, brain surgeries, and fine surgery interventions,” Orji said. But even Nigerian President Muhammadu Buhari — with access to the best health care in Nigeria — made several trips to Britain for medical care in his first term.

In April, he railed against Nigeria’s poor response to public health crises, outbreaks of deadly disease, and mass migration of doctors. But critics who disagree will be waiting to see what the president will do to change the status quo. (VOA)