NEW DELHI: Being diagnosed with cancer is no longer a death sentence, but the battle is far from won and the focus now must also be on understanding deeper lifestyle factors such as stress and lifestyle diseases, according to Dr Ash K Tewari, one of the world’s leading doctors.
Dr Tewari, chairman of urology at Mount Sinai’s Icahn School of Medicine and a pioneering surgeon-scientist who has led breakthroughs in prostate cancer treatment, emphasised that while significant victories have been achieved in cancer treatment over the past 15 years, the focus must shift from mere survival to improving patients’ quality of life throughout their cancer journey.
“Currently, about 46 million people globally – equivalent to Spain’s population – are either fighting cancer or have beaten it,” Tewari said at the 22nd Hindustan Times Leadership Summit during a conversation with Sanchita Sharma, senior communications officer at WHO India.
This massive number underscores both the progress made and challenges ahead, as approximately 18 million new cancer cases emerge annually, with about 9 million deaths.
While certain risk factors such as smoking are well-documented, Tewari highlighted the critical role of often-overlooked contributors to cancer development. “A diabetic body is somewhat inflamed, and inflammation can be a friend to cancer,” he explained as an example, before adding that metabolic syndrome, diet, exercise habits, and obesity all play crucial roles in cancer development and progression.
A particularly significant factor, Tewari added, was stress. “Stress can impact whether someone develops cancer and affects outcomes for those who have cancer,” he noted. “In certain cancers like pancreas and prostate, stress can form a network of interaction between cancer cells and nerves. What’s happening in our mind may ultimately make cancer more aggressive.”
Addressing the rising challenge of prostate cancer in India, Tewari revealed alarming statistics. “In India, prostate cancer moved from number 11 about 10 years ago to number three among all cancers across genders today,” he said.
The Lancet predicts cases may double in the next 10-20 years. The disease’s silent nature compounds the challenge – by the time symptoms appear, the cancer is often advanced. “We don’t talk about it because it’s an organ whose function isn’t widely understood, and its location makes discussion awkward,” Tewari explained.
While 90% of prostate cancers are curable when detected in the US, India’s cure rate is only 50% due to an average five-year delay in detection.
Regarding screening, Tewari provided specific guidelines while cautioning against oversimplification. “Starting PSA screening at age 45 is generally advisable, but don’t continue beyond 70 years unless you have exceptional family longevity,” he advised. For those with a family history of prostate or breast cancer, screening should begin around 40.
Dr Tewari’s pioneering work in surgical techniques has significantly improved treatment outcomes. “In prostate cancer surgery, we work with nerves that control urinary and sexual function, literally millimetres from the cancer cells,” he explained, describing his development of robotic surgical techniques that preserve crucial nerve functions while removing cancerous tissue.
Looking to the future, Dr Tewari sees artificial intelligence as a potential game-changer in cancer care. “If we can collect information from millions of patients over the next two years and train AI to predict cancer risk levels, we could better direct screening and prevention efforts,” he said. This vision is particularly relevant for India, where widespread mobile phone access could facilitate large-scale data collection and analysis.
“India could be the launching pad for this million-strong project,” Tewari said. “With phones in everyone’s hands, implementing this technology is possible. I believe this is the best time for cancer treatment evolution, with AI as an equaliser.”
Reflecting on his journey into oncology, Tewari shared a pivotal moment from his medical school days in Kanpur, where saving a drowning child taught him the critical importance of timing in medicine. This lesson has informed his approach to cancer treatment, where early detection often makes the difference between cure and chronic illness.
Cancer develops through complex mechanisms, Tewari explained. Every minute, about 1 million cells change in the body, and roughly 1 trillion mutations happen daily – all normally controlled, he said.
“But sometimes, cells feel threatened by factors like chemical exposure, lack of oxygen, or inflammation, start behaving abnormally. These threatened cells, in their drive to survive, become super-smart and adapt, but forget to respect the body’s natural order,” he said.
“What begins as a survival response becomes a destructive force – the cells multiply uncontrollably, ultimately harming healthy cells around them.”
Tewari, asked about the role and motivation of Indian doctors like him who are now spearheading research and development in medical science, attributed the global success of the community to a unique combination of technical expertise and cultural traits. “We have more empathy than most cultures and want to get involved,” he said. This empathy, combined with strong parental influence on education and work ethic, makes Indian medical professionals particularly effective in patient care.