Looking Ahead – Molecular Diagnostics For Cancer
In clinical laboratory diagnostics, molecular diagnostics of infectious diseases, in particular, the nucleic-acid based methods are the fastest growing. We have been observing that the new applications are complementing, if not entirely replacing the traditional culture-based, biochemical, and immunological assays in microbiology laboratories. It is interesting to note that for a laboratory based in a remote corner of the country like Manipur in northeast India and catering to a specific patient demography, we have not remain untouched by the recent global trends happening elsewhere and that we are seeing fundamental changes and new techniques of molecular diagnostics being assimilated in our own diagnostic center.
When we started molecular diagnostic tests as part of our test menu with the installation of cobas Taqman48 way back in 2009, we did not actually foresee the rapid growth that would happen in our laboratory as well as globally in the molecular diagnostics area and the surging demand of molecular testing of infectious diseases. The growth that we experienced in terms of demand and the repertoire of tests has been phenomenal. Our entering into the relatively nascent molecular diagnostics sector a decade ago was mainly with a view to provide testing for HIV and detection of Mycobacterium tuberculosis. Our state was then grappling with the twin menace of HIV infection and TB with an alarming incidence rate in both cases. PCR-based HIV quantitative and HIV proviral DNA tests were introduced for the first time in the region. The response was nothing short of outstanding. HAIN tests for TB followed shortly and, we must say, there has been no turning back ever since.
With a robust molecular diagnostics laboratory now in our own set-up, we are going beyond the PCR-based techniques to include the next-generation sequencing (pyrosequencing) and cancer molecular diagnostics. Our focus areas have been cytogenetics, including FISH (fluorescent in-situ hybridization) and cancer molecular diagnostics. At the moment, looking at the most widely prevalent diseases in this part of the country, we have broadly categorized the molecular diagnostics sector into cancer diagnostics, TB, women’s health (HPV, in particular), and the infectious diseases (HIV, hepatitis B, and hepatitis C).
We have made significant investment in our molecular diagnostics laboratory in the past few years and the trend is expected to remain unchanged for at least some more years. If we are to identify one focus area in molecular diagnostics which will be on the top of our agenda, it will be cancer diagnostics. Chromosome analysis (including FISH) which involves the direct detection of individual cells with chromosomal translocation encounters problems of sensitivity. Hence, our interest will be in blood cancer diagnostics kits that are expected to have better sensitivity and with minimal chances of false-positive reactions because of contamination of samples. The cancer molecular diagnostics would be run on PCR platforms.
We are at the forefront in our state’s collective fight against viral hepatitis, in particular hepatitis C, and we have been partnering with some NGOs and the local clubs to conduct mass screenings for HCV. These are all done free of cost and we are targeting both the general population as well as the high-risk groups. The HCV-positive patients are then selected for further treatment and testing as per the existing protocols, the responsibility of which is taken up by the partner NGO. With our geographical proximity to the neighboring country, Myanmar and other Southeast Asian countries, we are keeping a close watch on the diplomatic developments between India and Myanmar. We are taking a special interest in the visa-on-arrival and on entry restrictions that are expected to happen in the near future for Myanmar nationals because we believe the potential for medical tourism is huge. There is a great demand for diagnostic testing for infectious diseases and cancer in this region and our own keen interest in molecular diagnostics and cancer diagnostics is in line with our vision to provide the best medical diagnostics services in the region.
