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INDOX is a collaboration between Oxford and twelve leading cancer centres in India. It aims to develop effective and affordable cancer treatments in low and middle income countries, to improve the early detection of cancer, and to reduce the incidence of cancer by establishing the population specific risk factors.

Q: What is INDOX?

RA: INDOX is a collaboration between the University of Oxford and twelve leading cancer centres in India. It was established in 2005 to establish a partnership with colleagues in India and to develop common research protocols to look into common cancers in India.

Q: Why do you conduct epidemiological studies and clinical trials in India?

RA: INDOX was established with three main aims; one was to develop effective affordable treatments for cancer in India, and the second was to try and improve the early detection of cancer because people tend to present very late, when it is too late to treat them. The third was to try and reduce the incidence of cancer by establishing the risk factors that are important in that population. So clinical trials help us with the first of those aims, which is to find new and effective treatments that would be affordable to most people in India, and the epidemiological studies are really to look at the risk factors for common cancers in India.

Q: What are your areas of interest?

RA: My main area of interest is in colorectal cancer, or bowel cancer. We are looking to see if we can find new risk factors for this cancer. Colorectal cancer is the second most common cancer in the UK, in Europe and most of the world now. We believe that by looking at colorectal cancer in India we can discover more about the risk factors that are relevant there.

Q: What are the most important lines of research that have developed over the past five or ten years?

RA: For example with colorectal cancer there have been studies in the West that have shown conflicting results with regard to whether vegetarianism protects against colorectal cancer or not. In India, around 20% of the population are lifelong vegetarians; they don't do it for health reasons, they do it for religious reasons. We are interested to see if that will decrease their risk of colorectal cancer. They also have a habit of chewing tobacco as opposed to smoking tobacco, particularly amongst women and again we would like to see if that might increase their risk of colorectal cancer. The other main study we are doing is looking at aspirin, the secondary preventional treatment for colorectal cancer for people who have had their tumours removed. There has been indirect evidence from studies in the West that suggest it may reduce the risk of colorectal cancer coming back. So we are now conducting the first proper clinical trial to answer that question in India and other countries in Asia.

Q: Why does your research matter, why should we put money into it?

RA: Cancer is increasing worldwide but particularly in India the number of cancer cases is already two million per year, and that is projected to increase to three million per year over the next ten years. So there is a huge number of people that could potentially be afflicted by cancer, and we believe that through research we can reduce that burden of cancer and reduce unnecessary deaths and suffering from cancer.

Q: How does your research fit into translational medicine within the department?

RA: Looking at colorectal cancer, the incidence in India has historically been quite low and it may be something to do with vegetarianism, but it may also be something to do with their diet, the spices that they eat for example. Some of them act like aspirin, and it may be that those spices reduce their risk of colorectal cancer. If we can isolate within their diet what spice for example is protective, we could turn that into a medicine and that could be used in all populations to reduce their risk. With our aspirin trial, aspirin doesn't work in everybody and by looking at the genetics of the people that develop the cancer and their tumours we can see what type of patient is protected by using aspirin and which are not, so we won't have to unnecessarily treat people that will not benefit from aspirin, and avoid unnecessary side effects.

Raghib Ali

Cancer in South Asia

Dr Raghib Ali is the Director of INDOX Cancer Research Network. His main interest is in colorectal (bowel) cancer and other chronic, non-communicable diseases. Incidence of colorectal cancer in India has been relatively low historically; understanding why may help us establish risk factors and also lead to new treatments.

This podcast presents the research done by Dr Raghib Ali Baigent whilst working in the Nuffield Department of Medicine. Dr Ali now works at the Nuffield Department of Population Health.

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