Cancer surgeon once hit Mumbai streets to screen breast cancer; saved thousands [details]

A good cause, a great hero and a happy ending; some stories have it all. If they happen to be also true, that saves the day for all those looking for hope and inspiration. That's why Dr Pramesh CS, from the Tata Memorial Centre, didn't need any trigger, or an anniversary to revisit and narrate a true story of a saviour. Here's how he went about it.

A remarkable and true story

In the 1990s, a maverick breast surgeon Indraneel Mittra at Tata Memorial Centre (fresh from his return from the UK) stepped up to do research. Thirty years ago, research on cancer among women was not as popular a subject as it is now, certainly not from surgeons.

That's the time Dr Mittra continued his research, when surgeons and especially cancer surgeons were renowned for their technical prowess, and their bravado. Their approach then would be, "Wherever the cancer, however advanced, I will take it out." and this surgeon-researcher was ridiculed for even attempting clinical research.

For a surgeon, he couldn't have chosen a worse topic to research on early detection. Nothing to do with surgery, or even treatment. Remember, this was the 1990s. Cowboy surgery was celebrated, and research ridiculed.

The hero, the reel real hero

The protagonist doctor had his reasons. Being a breast surgeon, he was troubled when women consistently come with advanced cancers, and he wanted to work on picking them up at an earlier stage. But the novel community-based early detection required money that he just didn't have.

So a call was made to a friend, who was a corporate leader with an Indian consumer company with a request to fund the pilot project and probably based more on friendship than his belief in the idea, the friend gave him a small grant.

"Our protagonist breast surgeon, accompanied by a couple of his co-workers go around the lanes of Parel (Mumbai) daily, examining women clinically to detect breast cancer early. They examine 4,000 women, and find two cancers," said a narrative about him.

The story takes a turn

By a strange twist of fate, in 1994, the annual congress Union for International Cancer Control was held in Mumbai by Tata Memorial Centre. "Our maverick presented these results at the meeting. What followed subsequently would be unbelievable in today's world. A tall American gentleman walked up to our breast surgeon, congratulated him on the study and suggested he apply for a grant from the National Institutes of Health. At the time, our hero had no idea that the American gentleman was in charge of grant funding at the National Institutes of Health," informs Dr Pramesh in a thread on Twitter.

Cutting the long story short

"The application was made (ambitiously for breast and cervical cancer) and our hero received an R01 grant! This is an extremely difficult grant to get." Soon after a community-based cluster of randomized trial evaluating the role of Visual Inspection Acetic Acid (VIA) and Clinical Breast Examination (CBE) for early detection of cervical and breast cancer was done in 150,000 women between 35 and 64 years in the slums of Mumbai.

Challenges galore

The journey was not without challenges. They ranged from sceptical women to sceptical families, not to forget the sheer logistics of screening 75,000 women with VIA and CBE every two years for eight years and following up with 150,000 women for 20 years; recording every cancer; recording every death.

Every hero needs a great cast to script great success. "He had great support: his mentee (Dr Rajan Badwe, who went onto become the Director of Tata Memorial Centre) some young, idealistic preventive oncology physicians (Dr Gauravi Mishra & Dr Shastri), over a 100 dedicated high school educated women as health workers," wrote Dr Pramesh.

From a steely intention to laborious efforts, it required everything. "Relentlessly screening, recording, documenting, following up every one of these 150,000 women, over 20 years!" And remember, these were Mumbai slums, where migration was the rule rather than the exception.

15 years later

"The cervical cancer screening results came in, a 31 % reduction in cervical cancer mortality, using a low cost, low tech method, which soon was adopted by several Indian states," stated Dr Pramesh. The cervical cancer mortality reduction was recognised and given the privilege of a plenary presentation at ASCO where 5 out of 35,000 abstracts were chosen.

Twenty years later, the results kicked in -- a 15 per cent reduction in breast cancer mortality in the study population, with a 30 per cent breast cancer mortality reduction in women above 50 years.

The moral of the story

There's just one moral. That true heroes don't actually come in any garb, that human will can overpower obstacles. That great stories need to be celebrated anytime anywhere. Dr. Indraneel Mittra with his vision and belief, saved thousands of lives of women with breast and cervical cancer.