Last Updated on November 2, 2023 by Neelam Singh
Head and neck cancer in India is a major public health issue. A group of tumours known as head and neck cancers begin in or around the throat, larynx (voice box), nose, sinuses, or mouth. According to various studies, head and neck cancer is the 6th most frequent cancer in the world of which 57% patients are in India. Dr. Vishal Rao, the chief of head and neck surgical oncology and robotic surgery at HCG Cancer Centre, Bangalore, talks about the menace of tobacco, the potential of robotic surgery and the importance of mass media campaigns. Dr Rao is in the process of scaling up his pathbreaking invention – the Aum prosthetic voice box for throat cancer patients.
Edited excerpts from an interview:
What are the most common risk factors for head and neck cancers? Are there any emerging trends observed in recent years?
The most important risk factors for head and neck cancer are tobacco, tobacco and tobacco. Around 90% contributions are from tobacco. Alcohol is a co-contributor along with being an independent entity as a carcinogen. It’s also a co-contributor because it’s a good solvent so people who use tobacco and alcohol are at higher risk. And recently, the latest trend that has started is the human papillomavirus, which is working like a cancerous agent. We earlier knew that cervical cancer in women was caused by the human papillomavirus. There is a rising trend of human papillomavirus related cancers of the head and neck region or the neck region especially in patients.
In addition to this, we also get a small segment of people who have oral cancer, but haven’t consumed tobacco, arecanut or any of the other substances, but because of their sharp teeth and dentures, they have a tumor. It means trauma is also being picked up today as a cause for tumor because somewhere our immune systems have become weaker.
How has robotic surgery impacted the treatment of head and neck cancer patients? What are the advantages and limitations of this technology?
The most interesting part about robotic surgery has been that traditionally for me as a surgeon, I have small eyes and big hands, whereas the robot has big eyes and small hands. In addition to my 10 fingers, which are like 10 tools, the robot gives me more instruments in my hand and it can move 360 degrees. With massive pixelisations, beautiful visualisations, I am able to penetrate areas that, conventionally, I wouldn’t be able to go to. So I feel there has never been a better time in history when technology and humans have worked together to accelerate, accentuate human healing. Robotics has been a game changer in terms of access, giving good cosmesis blended functionality but having said that, it’s not a replacement for conventional surgery but machines are definitely working towards helping human hands. But everything shouldn’t be robotic. There is a place for it. Currently, it is at about 10-15% of the overall work and in urology it has been it been about 80-90 % in all the centres.
Can you share some examples?
A person came to me from the northeast. He had taken chemoradio therapy for the tongue cancer, which had failed after three months and the tumor recurred. So somebody had told him now there’s not much of an option you have to remove your tongue. He was 60 and felt devastated. He came to me after hearing about robotic surgery. We explained the complexities involved to the family and they agreed, saying we were ready to go with it but not ready to go with any mutilating surgeries that were offered earlier. We said we had some techniques and in fact, that was one of the first cases we had of devising a new technique. Today, when I meet him, I feel very satisfied that I have used technology to advance healing.
The costs have been a limiting factor, but I remember a patient of mine from Bijapur who’s a tailor. He came to me specifically because he only wanted robotic surgery. He had jaw cancer and had a large surgery. We removed his jaw and neck nodes. His joke is to ask people to tell which side he has been operated upon. With the amount of plastic surgery reconstructs, it will be confusing for one to figure out if he even had cancer.
What led you to devise a cost-effective prosthetic device for throat cancer patients called Aum? Tell us more about it.
There are only two patents in this field to date, the American one and the European one. And there was nothing for 140 odd countries. So my thought was who’s going to solve that. And that’s when I partnered with my colleague Shashank, who is a silicon expert and we both devised this whole thing. The intent at that time was to invent a new device that could help people and today it’s a US patent-granted device. It’s a new invention, a third that was recently showcased by the Government of India at the World Economic Forum in Davos. It has inspired millions of people and today I have more than 2,000 people speaking with it who have never spoken for 10 years. So I think I made a small dent and today I’m scaling it up, which is difficult. We are trying to create differential pricing using national pricing policy guidance. We are trying to look at differential pricing to sustain the initiative.
We have built a complete factory with an ecosystem so that we can invent more devices. In the future, Aum will be a gift of voice for thousands of people across 140 countries. Currently, under the Ayushman Bharat, it is given free to the patient. For the private sector they have kept it at about Rs.15,000.
Your efforts have led to a ban on gutka and other chewing tobacco in Karnataka, what does the government need to do?
I think we have to cut demand and supply. Every year, we lose about 14-15 lakh people to tobacco-related diseases. So, the tobacco industry’s main work is to how to recruit youth. Because at my age I’m not going to start a new habit. It has to be a youngster. So it is going to be from 15 onwards that they are going to try and recruit more customers – to be long term customers for them. And that is where the WHO needs to prepare a framework for tobacco control. India has been trying to understand and counter the tobacco industry’s efforts to promote tobacco products while helping farmers rehabilitate towards other alternative crops. At the same time, we are trying to phase out tobacco and all other alternative forms of nicotine delivery that are coming up. The government of India has banned e-cigarettes and its other forms. Karnataka has taken a step towards banning hookah. Tobacco is a gateway drug. 90% of drug addiction begin with tobacco. So in order to reduce the menace of tobacco, we need to reduce the menace of cancers.
Since healthcare services is a challenge to the underserved communities, what can be done to improve access to early diagnosis and treatment for head and neck cancers?
I think there are two big tools that we need to do – mass media campaigns and early detection. For early detection, we need to invest more in political bureaucratic and our manpower capital. That would give us better dividends compared to building more hospitals.
What are the key messages that should be communicated to the public to reduce the incidence of head and neck cancers?
I think the governments would need to invest more in mass media campaigns in order to increase awareness. It’s a key area that is lacking in India and we will need to put more emphasis on public health mass media campaigns that’s going to address the issues of health harm and try to take ownership of self-responsibility.
How does the prevalence of health misinformation on social media impact public awareness and treatment outcomes for head and neck cancers?
Misinformation is freely available across Internet and all social media platforms. There was also a recent study that talked about the limitations of Chat GPT in making choices related to cancer treatments. The question that we will need to ask and patients will need to understand is more guided information tools. That means we should focus on physician-assisted information tools which provide them terminologies and answers they searched for. That would help them make more better informed decisions.
How to counteract and mitigate the spread of health misinformation?
If you look at the way the young generation of doctors are evolving, they are becoming more and more social media savvy. To counter misinformation, I think print, electronic and social media should come together along with the physician associations. Several doctors are taking lead roles to counter misinformation especially after realising the sizable extent of health mis- and disinformation.
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