'More harm than benefit in some cancer screening'

MUMBAI: Actor Lisa Ray didn't read much into her constant fatigue until passing out one day. A blood test done during a routine investigation revealed a haemoglobin count of 4 as against 13-plus.
More investigations revealed multiple myeloma, a form of blood cancer, showing how tricky it is to detect the deadly disease.The actor is now well after stem cell treatment.
Many hospitals and laboratories in the city offer cancer diagnostic packages, costing over Rs 5,000 each. They include a physical exam, ultrasound imaging and biomarker blood tests. But not all tests are foolproof. For example, a CA-125 test could indicate only the possibility of whether a woman has cervical cancer. Mumbai businessman S Shah (name changed) undergoes another marker test called CEA every few months after being diagnosed with a rare form of stomach cancer a few years back.
Doctors say biomarkers cannot be taken as the reveal-all test. "Biomarkers can at best be considered for diagnostic purposes. Their use for screening is way too expensive and likely to raise several ethical issues,'' said Shastri. Experts feel that biomarker tests could cause unnecessary emotional turmoil. A person undergoing a biomarker test for liver cancer (AFP test) could have elevated levels of this protein for other reasons and not because s/he has liver cancer.
On the positive side, there are a handful of cancers that have good screening mechanisms, namely mammography for breast cancer or the pap smear test for cervical cancer. "Screening can also be done for the oral cavity, prostate and colon to detect early or pre-invasive stages of cancer," said a doctor.
The Tata Memorial Hospital has been working on a pilot project for breast, cervical and oral cancer screening in the Ratnagiri and Sindhudurg districts. "This programme, supported by the Department of Atomic Energy, has screened over 70% and 50% of the eligible populations of Ratnagiri and Sindhudurg, respectively, since 2003, treating over 1,200 cases till date,'' said Shastri, who is the programme's chief investigator. This drive has resulted in cost-effective screening methods. The work has been published in medical journals.
Cancer specialist Dr Arvind Kulkarni, who is associated with the NGO Indian Cancer Society, recommends a urine test that recently became available in India. "If a doctor suspects a patient has cancer, he or she could recommend the URC test, which is efficient in detecting abnormal cells in the urine,'' he said. The test doesn't reveal where the cancer is, but provides a starting point for further investigations.
Families in which cancer is genetic are often asked to undergo annual checks and blood tests. Dr Kulkarni's book, 'War Against Cancer', mentioned the anti-malignin antibody screen test, but this blood test is no longer available in India. Many cancer practitioners are against such tests. Shastri said, "Similar tests are often marketed in India. I would not touch them since the harm done by these tests are far greater than the benefits. They are not site-specific and do not diagnose the stage of the disease. Furthermore, all of us have some abnormal cells somewhere in our bodies." In other words, they may not be foolproof.
Cancer screening received a jolt last year when Richard Ablin, who developed the prostate-specific antigen (PSA) test 40 years ago, said he regretted developing it. "PSA testing can't distinguish between the two types of prostate cancer, the one that will kill you and the one that won't,'' he said, recommending that the test be scrapped.
A tome written in 1973 by two doctors from Parel's KEM Hospital also don't offer much hope. Dr Manu Kothari and Dr Lopa Mehta, while tracing the history of cancer, summed up in 'The Nature of Cancer' that the disease was incurable. Thirty-eight years later, Kothari still believes so. He told TOI, "For 5,000 years, mankind has learnt nothing about how to defeat cancer.'' A website set up recently on the basis of their book ominously states that "early detection is a myth".