Background: Discussions with Dr. Pal also helped us in understanding the current state of OSCC testing in the country. The testing methods involve using the patients’ saliva sample, which has to be stored in ice-cold conditions to avoid the denaturation of proteins. These saliva samples are then centrifuged. The supernatant is collected and stored for further testing. Post testing, samples are discarded in accordance with the standard biosafety guidelines as directed by the Government of India.
Feedback: About the daily workings of this procedure, Dr. Pal mentioned that this method is not the best one and we should find ways to improve upon it.
Implementation: We decided that the samples would be collected in reusable plastics vials that would be washed and autoclaved after use. This would make the process more sustainable by reducing the amount of waste being generated. We also arranged a meeting with the Institutional Bio-Safety Committee of IISER Mohali, who gave us the approval to begin the experimental work with proteins and proteases but not with salivary samples.
Read more from Dr. Pal:
Additionally, he gave insights on the demographics and the state of awareness amongst the people. He mentioned that for a normal person, with a risk of oral cancer, testing is recommended to be repeated once every year. While in cases of premalignant lesions, 6 months follow-up is recommended. They look for various symptoms amongst the patients to gauge the presence of oral cancer, some of which are stubborn ulcers in lips, redness or white patch in mucosa, a growth or lump inside the mouth, pain in mouth or facial region, loose tooth , etc.
Bound by confidentiality laws, Dr. Pal could not provide the data on the economic levels of these patients, however, affirmed that the vast majority of them came from low-income backgrounds and therefore, are not too aware to look for symptoms or to get their biopsy done if suspected. This means that he often detects cases which are Stage 3 cancers and it involves a much more intensive approach with multimodalities of treatment with combination of surgery, radiotherapy and chemotherapy.
Dr. Shefali Bansal, AIIMS Delhi
Background: We also reached out to Dr Shefali Bansal, MBBS from PGIMER, Rohtak and is now pursuing her MS from AIIMS Delhi.
Feedback: She confirmed Dr. Pal’s words that most patients affected by OSCC come for their first check-up when it is already in TNM (Tumor, nodes, and metastasis) stage 3. She shared her belief that OSCC is widely found in India because of the prevalent use of chewing tobacco and cigarettes and a lack of awareness campaigns; this does not make people consider the severe health implications of such products. Dr Bansal further added that the average cost of medications in stages 1 and 2 is around 50k INR, but it sky-rockets for the 3rd stage, reaching more than 2 lakh INR, a four-fold increase.
Implementation: Hence, it would be highly advantageous if patients were mindful of the symptoms that manifest the disease in the early stages and prevent the risk of developing a metastatic tumour. We therefore started planning an awareness talk by an oral cancer specialist for school students (mainly highschool) and their teachers https://youtu.be/6yHO3wpGbWw. The target audience were mainly students and teachers because we wanted to alarm impressionable minds of students, who are mostly not yet exposed to the practice of using addictive carcinogens, explain their severe health concerns, and make them aware about oral cancers. The teachers also need to be aware so that they do not chew Pan/Gutka and such things in front of their students, and also make their students aware about the problems from these and prevent them from building such habits. Furthermore, these people can also spread awareness of oral cancer among their elder family members, which is otherwise quite difficult.
Dev Nanda, Trashback
Background: As we were designing the hardware for our kit, we wanted to ensure we built an environmentally friendly diagnostic kit. Our main concern was the material we would use to print our 3D components. In this regard we spoke to a waste management startup, Trashback. We fortunately got to interact with the head of the company, Dev Nanda who has spent a lot of time on-ground collecting domestic waste and up-cycling it.
Feedback: Initially, we had started work with ABS (Acrylonitrile butadiene styrene) for our 3D printing. However after the interaction with Trashback, we came to know that ABS has very low recycling or reusable value. It is more likely to be upcycled. Upcycling is the creative reuse of waste i.e. to make other things out of than what it was initially used for. Instead, he suggested we use PLA.