SABAH-BORN OFFERS TO HELP SET UP CANCER HOSP FOR FREE

Sabah-born offers to help set up cancer hosp for free

Kota Kinabalu, November 02, 2010: A Kudat-born surgical oncologist who has a private practice in Portland, Oregon (Northwestern United States), said he would love to help the Malaysian health authorities set up the Sabah Cancer Hospital.

Dr Christopher Lim, whose areas of special interest are oncology, hepatobiliary (pancreatic diseases) and breast cancer, said he would not ask for any salary.

"Just accommodation, something to travel and airfare. That's all I need.

It's basically talking about giving back (to Sabah)," he told Daily Express in an exclusive.

Dr Lim, who had a short stint at Queen Elizabeth Hospital (QEH) in 1972 while in his second year of medical studies, was commenting on the Health Ministry's efforts to build a RM200 million cancer hospital in Sabah.

"It is not easy to start a cancer hospital as you need essentially a lot of things to be put in place. Firstly, you need the infrastructures.

"You have to provide the facilities and make them attractive enough.

You need a surgical oncologist, a medical oncologist and a radiation oncologist. These are the three sub-specialties that we have.

"You just cannot say, 'Oh, I will hire a surgical oncologist.'

You need support like nurses specially trained in giving drugs.

Besides, you need a research lab and trained lab personnel because when you give results to patients, they (patients) must have 100pc confidence that the lab results are correct. So, it's very difficult to do that.

"And then you need immunologists who can manipulate the immune system to mobilise and fight against cancer. And that is going to be the future of cancer care," he said when met at the recent Sabah College Reunion (1965-1967) here.

"I think if they are going to start a cancer hospital, they need to get it right.

Build the structure the people would benefit and get the right people to run it."

He also dwelled on the importance of being able to set up a registry to keep track of the incidence of various types of cancer in Sabah.

"For instance, Sabah has how many cases of breast cancer, how many cases of colon cancer. Sarawak has how many cases. How come there is a difference between the 13 states?"

On the high incidence of breast cancer in Sabah, he said it is not difficult to understand this situation. "As underdeveloped countries move into the developed rank, those things are going to come to the forefront."

Dr Lim also stressed that as we move into more personalised medical care, we have to know how to treat individuals for the type of cancer that they have.

"Right now, all our treatments are based on population studies.

We use a double-blind, controlled randomised study where thousands of women or men are entered into the programme.

"So, our standard of delivering the type of care needed, is based on that kind of study, which means you enter 200,000 or 300,000 women into a study. You follow them for five or 10 years, and then look at the results.

"At the end of the period, you said, OK, Treatment A is better than Treatment B. So Treatment A is used for everybody," he lamented.

Dr Lim pointed out that no two cancers behave in the same way in the same individual.

"For instance, if you look at breast cancer, there are five, six, seven, eight sub-types of breast cancer based on their immunology.

Therefore, if you just use the population-based decision, you are going to mistreat or under-treat or over-treat certain individuals," he cautioned.

Given the availability of special tests using special chemical stains that can recognise a certain type of cancer, the surgical oncologist said diagnosis is not so much a problem.

A bigger concern, Dr Lim said, is how to tailor the individual treatment for a particular patient. Like Mrs Smith might have a breast cancer but it is different from Mrs Jones'. So, the question is how am I going to sort out Mrs Smith's cancer so that I can treat it specifically."

According to him, tests which look at the human genome are now available in the western world.

"If I take out a breast cancer from a patient, I can send that cancer to a special lab that will look at 20 pairs of genes or 70 pairs of genes.

And then based on that, I can estimate the risk of the cancer coming back, on the individual, and whether this individual will need chemotherapy or not."

He said, for instance, every woman with breast cancer who has a positive lymph node always gets chemotherapy.

Dr Lim's intention is not to treat everyone with chemotherapy "because not every patient with a positive lymph node needs chemotherapy but that is the standard of care in 2010."

He added: "And because we use that kind of population-based, controlled study, we are going to over-treat a number of them.

"But if you look at the gene profile, you can look at the gene of that particular cancer, and then you know whether the patient will need chemotherapy. Hence, it is more personalised, individual type of care."

On the belief that the incidence of stomach cancer in Japan is linked to the people's fish diet, Dr Lim said it has more to do with the environment where the people live and what happens when a certain gene in that environment expresses up.

"The layman tends to blame it on the fish. That is the fallacy of epidemiology study because usually, if you look at the data from Norway, Iran and Japan, you will find that the people there are having stomach cancer. You think, Oh, they eat a lot of fish but that's not really a good scientific conclusion."

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Dr. Christopher N. H. Lim

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