Margin Notes
Long-form notes on the questions that matter most when cancer enters your life — screening, second opinions, treatment sequence, family history, and how a plan is actually arrived at. Things there is rarely time to say properly in an OPD, written out here by Dr. Madhav Danthala.
14 essays, newest first. For television, press and the podcast, see Media.
All essays
Reading the WHO 2026 Cancer Report
Twenty threads from the new WHO Global Status Report on Cancer — the scale, the westernizing burden, catastrophic expenditure, the spending paradox, the access gap, what works, what is being forgotten, and what India cannot afford to import.
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The Tumour Board
A cancer plan is structured disagreement between a surgeon, a radiation oncologist and a medical oncologist. On what a tumour board actually is — and the quiet danger when that room never exists.
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No Oncologist Can Keep Up Anymore
Forty-one percent of trials worldwide are in oncology. NCCN moved 241 times in a year. That is not a knowledge base — it is a moving target. On the honest architecture of clinical AI in that reality.
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First, Do Not Cut
The oldest reflex in cancer surgery is being outlived by the evidence. Across breast, rectal, NSCLC, bladder, esophageal, gastric, melanoma and pancreatic cancer, neoadjuvant chemotherapy and immunotherapy now come before the scalpel — and peripheral practice in India is still measurably behind the shift.
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A Higher Risk Is Not a Verdict
ASCO 2026 took a hard look at multi-cancer blood tests, BRCA reports, polygenic risk scores, Signatera and Guardant Reveal. What a risk report actually means — and the sequence patients keep getting wrong.
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When the Trial Was Done in China
Toripalimab, tislelizumab, and serplulimab are already in Indian pharmacies. HARMONi-6 at ASCO 2026 and Julie Brahmer's discussant questions — on the slow shift in how the world reads Chinese oncology data.
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Forty Years of Saying No
A drug for pancreatic cancer at ASCO 2026 moved the survival curve for the first time in fifteen years. The forty-year story behind RASolute 302 — and why honest hope looks like incremental progress.
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Active Surveillance in Prostate Cancer
For low-risk Gleason 6 disease, watching is one of the most underused, evidence-based strategies in modern oncology. Who's a candidate, what the protocol looks like, fifteen years of data.
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Why Colonoscopy Now Starts at 45
Young-onset colorectal cancer is one of the fastest-growing cancers in Indian metros. The screening age moved for a reason. Who should start earlier, when FIT works, what to expect on the day.
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Lung Cancer in Non-Smokers
More than half of new lung cancer diagnoses in Indian women under fifty are in people who never smoked. Air pollution, EGFR mutations, and the diagnostic delay that costs months.
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Your Mother's Medical History Is Your Screening Map
Three questions to ask family on a Sunday afternoon. The answers can shift your screening calendar by a decade. A practical guide to family history, BRCA, Lynch syndrome.
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What an MRD Test Tells You
Two patients in "complete remission" can have very different prognoses depending on what measurable residual disease testing shows. Plain English on what it is and what your result means.
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Reading Your Pathology Report
A plain-English walkthrough of grade, stage, margins, IHC markers (ER, PR, HER2, Ki-67, PD-L1), and molecular testing — the document every treatment decision is built from.
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The Two-Oncologist Rule
More than one defensible plan often exists. A second opinion confirms the path — or surfaces an alternative. When to ask, how to ask, what second opinions actually change.
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