Industry Odisha Bureau, Sep 26: India’s precision oncology push faces a stark affordability gap. Genomic testing and targeted therapies remain costly for many patients. A leading oncologist wants a five-year policy to bridge it.
Cancer treatment in India is becoming increasingly molecular and personalised. Yet the cost of those advances keeps many patients out. Oncologist Dr Bhawna Sirohi says India needs a five-year policy agenda. Its aim would be affordable precision cancer care for lower-income patients.
Sirohi is medical director at Vedanta Medical Research Foundation-BALCO Medical Centre, Raipur. She also serves there as a consultant medical oncologist. She is India’s only cancer specialist on a new Lancet Oncology Commission. The commission on precision cancer was launched at the World Cancer Congress in Hong Kong.
A Test Can Open an Expensive Door
Conventional chemotherapy can affect both cancerous and healthy cells. Precision oncology takes a narrower route. It looks for specific targets, or biomarkers, on cancer cells. Doctors then try to match those markers with a suitable drug. The aim is individualised care with fewer unnecessary side effects.
The pathway runs from molecular testing to biomarker identification to targeted therapy. But each step carries a cost. Next-generation sequencing (NGS) and other molecular tests can be expensive. The drugs they point to may be costlier still. Some may not even be available in India.
Lung Cancer Shows the Potential
Lung cancer offers the clearest example. Patients with specific EGFR mutations can take targeted tablets for years. In suitable cases, these replace conventional chemotherapy. “Lung cancer is no longer one type of cancer,” Sirohi said. She sees it as several distinct diseases, each with its own target. She believes all cancers in India could benefit from precision treatment. Delivering it to everyone, she says, remains the challenge.
Public Healthcare Becomes Critical
Some targeted treatments are already available under Ayushman Bharat, Sirohi said. Newer and more effective drugs, however, remain largely constrained by cost. She wants genomic diagnostic panels added to schemes like Ayushman Bharat. For lower-income patients, she considers this integration critical.
Yet financing tests alone may not be enough. Sirohi cautions that testing without drug access can add financial burden. A patient may discover a therapy they cannot afford. In her view, diagnosis and treatment must be planned together.
She also sees a wider risk. Unequal access, she warns, could deepen a two-tier health system. Wealthier patients may reach newer diagnostics and drugs more easily. Lower-income patients could fall further behind.
India Already Has a Starting Point
The DIAMOnDS project offers a foundation. It is backed by the Department of Health Research and ICMR. The project aims to strengthen molecular oncology diagnostic services. It also provides free diagnostic services. Its focus is on selected markers for lung, breast and some blood cancers. Regional laboratories mainly use real-time PCR, immunohistochemistry and fluorescence in-situ hybridisation. Sirohi calls it a good beginning, though still limited in scope.
Precision Medicine Needs More Than Laboratories
Her proposed roadmap would weigh the pros and cons of each test. Technologies would face the same scrutiny. Tests offered universally should meet global and national peer-review standards. She also seeks regular health technology assessments. Guidelines covering newer drugs and technologies should follow.
People matter as much as machines. Sirohi wants greater investment in geneticists, molecular pathologists and bioinformaticians. These specialists interpret the complex data that genomic tests generate. Their expertise helps turn results into informed treatment decisions.
Detection Is Only Half the Challenge
India is growing more capable of spotting molecular cancer targets. The harder question is whether matching treatments will reach most patients. Sirohi’s five-year roadmap remains a proposal, not government policy. But it frames the problem clearly. Precision cancer care will depend on science and affordable delivery alike.
