Dr. Indraneel Mittra – Pioneers Early Detection of Cancer in Women

Dr. Indraneel Mittra, a surgeon at the Tata Memorial Hospital, is a pioneer in detecting cancer in the early stages. His research on cancer cells that began in the 1990s has placed him among the top oncologists in Mumbai. Today, his early detection of breast and cervical cancer in women is saving thousands of lives. Dr. Indraneel Mittra joined the Tata Memorial Hospital in 1982 as a Consultant Surgeon in the Department of Surgical Oncology. He was also Professor of Surgical Oncology and Chief of Surgical Breast Service at the hospital and the Head of Division of Laboratory Medicine. He is now Professor Emeritus but continues to head the Department of Surgical Oncology at the Tata Memorial Centre / ACTREC.

Research for Breast Cancer, Cervical Cancer in Women           

The research interests of Professor Mittra are wide-ranging and encompass clinical, laboratory, and public health research in cancer. Professor Mittra established the Translational Research Laboratory at ACTREC in the year 2009, and his current research interest lies in the biology of extracellular nucleic acids and their role in cancer initiation and metastasis. Professor Mittra’s research has led to the discovery that circulating nucleic acids are biologically active molecules and cause damage to the DNA of healthy cells by integrating them into their genomes. These findings have far-reaching implications for a multitude of human disorders like aging and cancer. 

In the public health research field, Professor Mittra is the founder of PI, one of the largest community-based randomized trials in early detection of breast and cervical cancer using low-cost technology approaches. The NIH-backed research findings have established for the first time that visual inspection of the cervix after application of 4% acetic acid can reduce mortality from cervical cancer by 31%. This research finding has the potential to prevent nearly 200,000 deaths globally every year.

Publications

Dr. Indraneel Mittra, along with other noted doctors, has jointly published several papers. His publications reflect the diverse nature of his research. They include: –

2018

• Is inflammation a direct response to dsDNA breaks? 2017
• Prevention of chemotherapy toxicity by agents that neutralize or degrade cell-free chromatin. Annals of Oncology.
• Cell-free chromatin from dying cancer cells integrate into genomes of bystander healthy cells to induce DNA damage and inflammation.
• Physical shearing imparts biological activity to DNA and the ability to transmit itself horizontally across species and kingdom boundaries

2016

• Evidence for cell-free nucleic acids as continuously arising endogenous DNA mutagens.
• Circulating nucleic acids: a new class of physiological mobile genetic elements.
• A paradoxical synergism between Resveratrol and copper (II) with respect to degradation of DNA and RNA.
• Circulating nucleic acids damage DNA of healthy cells by integrating into their genomes.

2014

• Effect of VIA screening by primary health workers: randomized controlled study in Mumbai, India.

2013

• Pullulan-histone antibody nanoconjugates for the removal of chromatin fragments from systemic circulation.

2012

• Nucleic acids in circulation: Are they harmful to the host?

2011

• Single-injection depot progesterone before surgery and survival in women with operable breast cancer: a randomized controlled trial

2010

• A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening.

2009

• Why is modern medicine stuck in a rut? Perspect Biol Med.
• Multicentricity of breast cancer: whole-organ analysis and clinical implications.

He has also published other fifteen papers between 1974 and 1997.

Ongoing Research Projects

Dr. Indraneel Mittra is currently involved with nine ongoing research projects, which are: –

• Genomic integration of circulating nucleic acids and DNA damage.
• Chromatin isolated from serum of cancer patients trigger genomic instability, inflammation and cancer.
• Chromatin from dead cancer cells integrates into genomes of living cells to induce DNA damage, inflammation, chromosomal instability and cancer.
• How histologically similar is the metastatic tumour to the primary?
• Pullulan-histone antibody nanoconjugates for the removal of chromatin fragments from systemic circulation.
• Chromatin from dead cells cause radiation induced by-stander effect.
• A paradoxical synergistic effect between Resveratrol and copper (II) with respect to degradation of DNA and RNA.
• The ability of R-Cu to degrade circulating chromatin in vivo.
• Sonication imparts biological properties to DNA and the ability to transmit itself horizontally across species and taxonomical kingdoms.

(Information source: httpss://actrec.gov.in/dr-indraneel-mittra)

Setting up the first dedicated Breast Cancer Unit in India

In 1982, setting up a dedicated breast unit in India was no easy task. The network of cancer registries under the National Cancer Registry Programme (NCRP) had just started to collect data and provide information on incidence and cancer patterns across the country. Dr. Mittra soon realized that most Indian women visited him only when the breast cancers were in stages III and IV. This drastically reduced their chances of recovery. As many as 21 percent of women who developed breast cancer in Mumbai died within the first year of diagnosis, suggesting that they already had the metastatic form of the disease.

Dr. Mittra wanted to do something. He had to find a way to detect early breast and cervical cancers. In the 1990s, he received funding for his research from a close friend and the World Health Organization (WHO) and began to conduct a study with 2000 women. Amongst the several modalities to screen cervical and breast cancers (the two most common cancers among women in India) – Visual Inspection Acetic Acid (VIA), and Clinical Breast Examination (CBE) emerged as low cost and feasible for population-level screening in India.

Results of the Study

“The results of the study showed a 30 percent reduction in mortality due to breast cancer in women aged 50 years and above. This degree of mortality reduction is similar to that of mammography. Although this study did not find benefit in women below the age of 50, it did find a 34 percent reduction of mortality in these women provided they regularly attended all four rounds of screening. These results started coming in after 20 years. Meanwhile, the results also showed a 31 percent reduction in cervical cancer mortality in the screening group than the control group across all age groups. Results for cervical cancer started coming after 12 years of follow-up. These results were finally published in 2014,” says Dr. Gauravi Mishra, a professor at the Department of Preventive Oncology, TMH, on behalf of Dr. Mittra.

Further on his Twitter handle, Dr. CS Pramesh, the Director of TMH, notes “a 31% reduction in cervical cancer mortality, using a low-cost and low-tech method, which [was] soon adopted by several Indian states.”

Dr. Indraneel Mittra – His invaluable contribution to cancer

Today, VIA screening prevents 22,000 cervical cancer deaths each year in India, and CBE saves 15,000 deaths from breast cancer each year in India. All this is at a fraction of screening cost, thanks to the research of Dr. Mittra. His research work has, directly and indirectly, saved the lives of thousands of women with breast and cervical cancer.