Healthy eating: the INDOX Cancer Research Network

Low and middle income countries have historically had much lower rates of cancer than the richer nations of Europe and North America. But with changes in lifestyle such as increased use of tobacco, that situation is changing. 'Cancer is already the second most important cause of death in India, and the incidence is expected to double in the next 10 years to 2 million cases a year', says Dr Raghib Ali of the Oxford's Cancer Epidemiology Unit, 'and most modern cancer treatments are unaffordable.'

Before 2005, the few clinical trials conducted on cancer in India were usually designed by foreign companies with little or no consideration of the local context. Dr Ali is Director of the INDOX Cancer Research Network, co-founded in 2005 by David Kerr, then Professor of Cancer Medicine at Oxford, and Professor Vinod Raina at the All India Institute of Medical Sciences in New Delhi. It includes 12 cancer centres across India, and has been able to tackle ethical, regulatory, commercial and other practical issues in order to establish an Indian clinical trials service with a dedicated trials officer in each location.

'There is still a fear that Indian patients will be exploited or used as guinea pigs', says Dr Ali. 'We have tried to engage with the Indian government to mitigate that fear. Everything we do is in partnership with our Indian colleagues: the protocols are developed with them, the studies are conducted by them, and we publish the results as a group.' Since 2005 the network has participated in 20 international collaborative trials. For example, as part of a network across South and Southeast Asia, they are testing the effectiveness of a very affordable drug – aspirin – in preventing the recurrence of bowel cancer.

Dr Ali and his Indian colleagues are also trying to understand more about which Indians get cancer and why. They are collecting lifestyle and other data on patients with either bowel or breast cancer, who are then are matched with others of the same age and sex who do not have cancer.

'20 per cent of Indians are lifelong vegetarians', says Dr Ali. 'People are vegetarian because of their Hindu religion, so unlike in European or North American populations, vegetarianism does not tend to be confounded by other healthy behaviours. If we find that cancer rates are lower among lifelong vegetarians, that will be important in designing health policies to reduce the risk of cancer in future.'

The link with Oxford has brought many benefits. 'Our Indian colleagues can spend time in Oxford, learning from the expertise and experience of clinical researchers such as Professor Valerie Beral who set up the Million Women Study', says Dr Ali. Professor Raina has been delighted to see how the network has encouraged collaboration within India, as well as between India and Oxford. 'India is a vast country, and has different religions and languages', he says. 'INDOX has brought us together.'