From Microcosm to Macrocosm- Building Solidarity in Molecular Oncology Diagnostics
The battle between the human race and its formidable foe - Cancer, has raged on since the
dawn of history. Dating back to 3000 BC, the Edwin Smith Papyrus, an ancient Egyptian
manuscript on trauma surgery solemnly declares “There is no treatment.”, relinquishing all
control in conquering the Big C. John Hunter’s discovery on removing malignant tumours
foreshadowed the conception of anesthesiology a century later and it wasn’t until the 19 th
century that the world witnessed the birth of scientific oncology and precision diagnosis.
Today modern science and technology has expanded our repertoire to fight cancer and the
advent of molecular diagnostics marks a watershed moment in this war. Molecular
diagnostics is a technique used for the identification and analysis of genetic material or
specific molecules present in a given sample. It wields a lot of power in improving a patient’s
life by enabling the correct assessment of a disease at an early stage. The demand for
diagnostics has kicked off since the COVID-19 pandemic and the conversation has now
shifted to the fine prints of personalized medicine. Since the COVID-19 pandemic, there has
been a renewed emphasis on genome diagnostics with several private players heavily
investing in the diagnostic market. The Indian Molecular Diagnostics Market stood at an
estimated USD 934 million in 2022 and is projected to grow at a CAGR of around 10% until
FY 2026, predominantly on account of rising cases of fatal and chronic diseases.
The Government of India meanwhile has tried to fulfil its paternalistic instincts in the
diagnostic industry. At a time when the public sector is increasingly making space for private
players in critical sectors like health and education, a laissez faire approach to genomic
diagnostics could prove expensive in the long run. The government has therefore taken the
initiative to raise funds for the country’s molecular department. Special efforts have been
undertaken to create a conducive space for young academicians to conduct research and
come up with cost-effective assays and instruments for complex genome testing.
DHR-ICMR Advanced Molecular Oncology Diagnostic Services (DIAMOnDS) is a sub-scheme
established under the umbrella scheme of Human Resource and Capacity Development
approved for the 15thFinance Commission period 2020-21 to 2025-26. This initiative aims to
set up zonal oncopathology labs to provide basic as well as high-end advance diagnostic
services to cancer patients and research facilities for basic, translational and clinical
research. These laboratories are established in Government Medical Colleges that will
ensure the optimum utilization of facilities available there, in terms of equipment and
manpower. There are currently 4 centres i.e., AIIMS New Delhi, CMC Vellore, TMC Kolkata,
Tata Memorial Hospital (Mumbai) and 4 centres are set to be established i.e., State Cancer
Institute (Lucknow), JIPMER (Puducherry), Cachar Cancer Hospital and Research Centre
(Silchar, Imphal), AIIMS (Jodhpur, Rajasthan).
As per the approved SFC for 15th Financial Commission, 3 new DIAMOnDS Centers can be
established each year during 2020-21 to 2025-26. Therefore, following 3 centres during the
year 2020-21 have also been established: .
AIIMS Bhubaneswar
AIIMS Bhopal
Adyar Cancer Institute, Chennai
The Department of Health Research will fund all institutes selected under the DIAMOnDS
project and in the first round of project implementation, funds will be earmarked for
diagnostic and prognostic tests for two cancers highly prevalent among Indians- lung and
breast cancer. The nodal officers at the selected centres will be responsible for establishing
and standardizing the tests related to breast and lung cancer and developing a fast digital
system for provision of test reports.
The DIAMOnDS projects will encourage and strengthen diagnostic research in the field of
oncology. It will provide free of cost oncopathology diagnostic services to cancer patients
and strengthen the health technology infrastructure. It will ensure the geographical spread
of oncopathology diagnostic services, and cater to the needs of the un-served and under-
served cancer patients. Furthermore, it will pave the way for evidence based application of
diagnostic procedures/processes/methods through research.
These laboratories will be linked to health and wellness centres, primary and community
healthcare centres, districts hospitals, and medical colleges for proper guided referral to
receive samples for tests. There are several factors that affect regional variation in cancer
incidence and mortality and the establishment of zonal centres will pave the way for
studying the effects of lifestyle and environmental factors in different regions on cancer. The
National Centre for Disease Informatics and Research, (NCDIR) will assist each DIAMOnDS
lab in linking with the existing cancer registries to gather the data on cancer epidemiology.
This will help the government in its pursuit of information collection, collation and analysis.
Besides the DIAMoNDS project, the Government of India is also trying to build a robust
research base by conducting training courses on basic molecular biology techniques used in
cancer research. The government has undertaken substantial efforts for the skill
upgradation of faculty of medical colleges/institutes, mid-career scientists, medical
students, etc., by providing specialized training in priority areas of health research in leading
national and international institutions. The trainees receive government encouragement
and financial support in conducting research to address critical national and local health
problems.
The National Institute of Cancer Prevention and Research (NICPR) conducts research on pre-
cancer and cancers of the uterine cervix, breast and oral cancers and has made significant
contributions in the field of cervical cancer research. The concept of clinical downstaging,
visual inspection of cervix with selective cytology screening and development of novel
diagnostic approaches for HPV and other oncogenes have been introduced for screening
and early detection of cervical cancer. The MoHFW, facilitataed by NICPR has released the
“Operational framework document” for cancer screening and management, which has been
designed to carry out population-based screening in 100 districts of India using cost-
effective screening tools.
The centrality of innovation in diagnostics cannot be sufficiently underscored. The future of
cancer diagnostics rests on acceleration of R&D and innovation and India needs to expand
its knowledge base in a way that is all-encompassing as well as globally competitive.
Achievement of this ambitious goal, requires a shift in perception from identification with
the microcosm to identification with the macrocosm. To destroy the Big C, we must look
beyond borders and join forces in a display of solidarity against our mutual foe. That would
mark the true beginning of our pursuit of one-earth, one-health, one-future.
