Oncology has lengthy been described as a self-discipline dominated by biology. Tumor pathways, mutational signatures, margins, and survival curves dominate how we measure, categorize, and predict outcomes. We’re taught early in coaching that tumor biology is king, and far of our decision-making revolves round this reality. But, after years of training surgical oncology in India, I’ve realized that biology alone not often determines the destiny of my sufferers. Tradition usually does. And too usually, tradition has the ultimate phrase.
I nonetheless keep in mind one affected person vividly, a revered village elder whom I’ll name Bapu. He got here to us with superior oral most cancers. The surgical procedure was intensive, restoration was painful, and chemotherapy was grueling. Via each step, he trusted us utterly. His resilience impressed not solely his household however our whole workforce. After which got here the ultimate, most important step, radiation remedy. Science instructed us it was important, a non-negotiable a part of his treatment. However society whispered in any other case. “Radiation will burn you.” “You’ll lose what little power stays.” “Higher to depart it to destiny.” In the long run, the group’s voice drowned out medical counsel. Bapu, who had trusted us with a knife at his throat, turned away from the machine that might have secured his treatment. Months later, his most cancers returned, angrier, hungrier, and unforgiving. That was the day I spotted that biology could also be king, however tradition is queen, and in too many elements of the world, tradition checkmates biology.
The problem doesn’t finish with tradition. In at the moment’s digital age, misinformation metastasizes sooner than any tumor. WhatsApp forwards warn that sugar feeds most cancers. Neighbors advise towards surgical procedure, claiming it should trigger the most cancers to unfold. YouTube movies promise miracle cures with herbs, magnets, or diets. I’ve misplaced sufferers to not recurrence however to rumors, to not illness however to doubt. Households withdraw consent for therapy minutes earlier than incision due to one thing they heard the night time earlier than. That is the silent stage IV of most cancers care: the malignancy of misinformation. It doesn’t seem on scans. It doesn’t get staged in TNM. But it kills, silently and systematically, eroding belief at its very root. Until we deal with it with the identical seriousness that we deal with tumor biology, we’ll proceed to lose sufferers, to not illness development, however to myths.
This paradox performs out most starkly in low- and middle-income international locations, the place the hole between science and society is huge. At international oncology boards, discussions usually revolve round immunotherapy, precision diagnostics, and synthetic intelligence. These are extraordinary advances that encourage hope. However in lots of areas of the world, sufferers don’t falter as a result of a checkpoint inhibitor is unavailable. They falter as a result of stigma, worry, and misinformation stop them from finishing even probably the most fundamental therapy continuum. In high-income international locations, the query could also be which focused drug is handiest. In LMICs, the extra pressing query is whether or not the affected person will even full radiation, whether or not they can journey to the hospital, or whether or not they may default due to a WhatsApp ahead.
Most cancers outcomes are finally formed by three overlapping forces: biology, tradition, and programs. Biology tells us how aggressive the illness shall be. Tradition dictates whether or not the affected person will belief or resist therapy. Methods decide whether or not the infrastructure, workforce, and affordability exist to ship care. World oncology can’t be really international if it focuses solely on the primary and ignores the opposite two. A tumor’s genetic profile could also be studied in beautiful element, but when the affected person by no means arrives for remedy, it turns into an instructional train.
If oncology is to shut the worldwide care hole, we should broaden our focus. We should practice medical doctors not solely to interpret PET scans and molecular markers, but in addition to counsel sufferers with cultural sensitivity and empathy. We should spend money on affected person navigation programs that guarantee continuity of care, significantly in rural settings the place a single counselor can imply the distinction between abandonment and adherence. We should deal with misinformation as a public well being disaster, countering pseudoscience with the identical urgency as tobacco management campaigns. And we should rejoice the invisible heroes (nurses, social employees, and counselors) who usually do extra to construct belief than any superior diagnostic machine.
World oncology at the moment stands at a crossroads. Precision medication, AI, and immunotherapy promise a way forward for exceptional advances. However for tens of millions of sufferers worldwide, the decisive components are nonetheless myths, stigma, and misinformation. The most cancers cell could divide in silence, however so do rumors. Each metastasized. Each kill. Bapu’s story taught me that curing most cancers isn’t solely about conquering biology but in addition about confronting perception. Until we deal with the silent stage IV of misinformation and the cultural dynamics that undermine science, we’ll proceed to win surgical battles however lose societal wars.
The way forward for oncology is not going to be determined in journals alone. It will likely be determined within the tales communities inform, within the belief they place, and within the myths they overcome. Tumor biology could also be king, however tradition is queen. And if we’re to save lots of lives throughout the globe, we should study to play this sport of chess with each science and society.
Bhavin P. Vadodariya is a surgical oncologist in India.
