Introduction

Cancer has become one of the most pressing public health crises in India today. The lifetime probability of an individual developing cancer in the country now stands at 1 in 9, reflecting the critical scale of the problem. A 2024 report by the Parliamentary Standing Committee projected that, if current patterns persist, cancer-related deaths could rise by 20%, reaching approximately 880,000 annually by 2025. Coupled with the rising incidence of other non-communicable diseases such as tuberculosis, diabetes, and cardiovascular conditions, India is at risk of becoming the “cancer capital of the world.” This alarming trend necessitates immediate and wide-ranging intervention.

Current Status of Cancer in India

·       The cancer burden in India is marked by an upward trajectory in incidence and mortality. The Indian Council of Medical Research (ICMR) has estimated that by 2025, India will witness around 1.57 million new cancer cases each year. However, this figure may significantly underrepresent reality, given the widespread under-reporting and the limited reach of cancer registries.

·       Mortality rates from cancer have also shown a concerning rise, with annual increases ranging from 0.1% to 1%. One of the primary reasons for poor survival outcomes is the late-stage diagnosis, which severely limits treatment efficacy.

·       India faces a heavy load of specific cancer types. Among women, breast cancer has emerged as the most prevalent. Oral cancer, strongly linked to tobacco and betel nut consumption, continues to affect large segments of the population. Lung cancer cases are escalating, driven by smoking and deteriorating air quality. Cervical cancer remains a major killer, even though it is largely preventable through HPV vaccination.

·       There is considerable variation in cancer prevalence across different regions. Notably, the North-Eastern states report disproportionately high rates of stomach, oesophageal, and lung cancers. These trends are closely associated with prevalent risk factors in the region, including high tobacco and alcohol use and dietary habits.

Underlying Causes of the Rising Burden

·       Multiple interrelated factors are contributing to India’s growing cancer epidemic. Lifestyle transformations are a significant driver—urbanization has led to sedentary routines, reduced physical activity, increased obesity, and widespread consumption of processed foods, sugary items, and trans-fats.

·       Addictive substances play a substantial role. India is currently the second-largest consumer of tobacco products globally, according to the World Health Organization (WHO). Both smoking and smokeless tobacco, along with alcohol, are directly responsible for cancers affecting the lung, oral cavity, liver, and oesophagus.

·       Environmental degradation also adds to cancer risk. Air pollution, particularly particulate matter (PM2.5), is closely linked with respiratory and lung cancers. Moreover, industrial emissions and unsafe working environments expose populations to carcinogens.

·       Demographic and genetic elements further compound the issue. Increasing life expectancy means that a larger proportion of the population is living into age groups where cancer is more prevalent. Furthermore, limited access to genetic testing and screening delays early detection, especially for inherited cancer syndromes.

Challenges in Prevention and Care

·       India faces several systemic and structural challenges in managing its cancer burden. One of the most pressing is the issue of late detection. Fewer than 5% of people in the country are currently covered under the national cancer screening programme. Many individuals delay seeking medical help until symptoms become severe, thereby diminishing survival prospects.

·       The healthcare infrastructure is inadequately equipped to meet the growing demand. With only around 2,000 oncologists serving nearly 10 million cancer patients, the doctor-to-patient ratio is critically low. Additionally, the availability of radiotherapy equipment, oncology-trained nurses, and specialized treatment centres is limited.

·       The high cost of cancer treatment poses another formidable barrier. A large proportion of patients—up to 80%—find hospitalisation and chemotherapy financially inaccessible. Out-of-pocket expenditure (OOPE) continues to push millions into poverty each year, as documented by the NITI Aayog Health Expenditure Report (2021).

·       Public awareness about cancer is also alarmingly low. Cultural stigma, ignorance about the importance of early detection, and reliance on traditional remedies often result in delays in receiving appropriate care. Moreover, significant gaps in data collection due to insufficient cancer registries mean the actual burden may be far greater than currently estimated. To address this, the Parliamentary Committee has urged the government to declare cancer a notifiable disease.

Government Policies and Initiatives

·       To counter the crisis, several national-level initiatives have been introduced. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) aims to facilitate screening, early detection, and referrals through the primary and district healthcare systems.

·       Ayushman Bharat – PM Jan Arogya Yojana (PM-JAY) provides up to ₹5 lakh per family annually to cover secondary and tertiary care, including cancer treatment. The National Cancer Grid (NCG), comprising over 300 cancer centres, works to standardize treatment protocols and promote research collaboration.

·       The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) seeks to strengthen tertiary healthcare by establishing AIIMS-like institutions and upgrading existing medical colleges. Additionally, the government has announced plans to incorporate HPV vaccination for girls aged 9–14 under the Universal Immunisation Programme (UIP), a move that could drastically reduce cervical cancer incidence.

Global Context and Best Practices

The WHO’s 2024 report identified cancer as the second leading cause of death worldwide, with 20 million new cases reported in 2022. Countries such as the UK and Australia have implemented best practices worth emulating. The UK’s National Health Service (NHS) provides free, population-based cancer screening. Australia is nearing the elimination of cervical cancer through an aggressive HPV vaccination programme. Rwanda has emerged as a global leader in HPV vaccination implementation in resource-limited settings.

Strategic Way Forward

·       To effectively tackle the cancer crisis, India must adopt a comprehensive, multi-pronged strategy. Enhancing cancer registries by making cancer a notifiable disease and integrating data into digital health platforms will improve surveillance and policy planning.

·       Expanding screening services at primary health centres—particularly for breast, cervical, and oral cancers—is essential. Incorporating artificial intelligence tools can help scale up diagnostics. Public cancer hospitals need to be scaled up, with PM-JAY coverage expanded and the use of affordable, generic cancer drugs encouraged.

·       Preventive measures must be prioritized. Nationwide campaigns promoting tobacco cessation, reduced alcohol consumption, balanced diets, and physical activity should be reinforced, building on platforms such as the FIT India Movement. The planned nationwide rollout of the HPV vaccine must be implemented effectively, with a focus on adolescent girls, school-based delivery systems, and public awareness to reduce vaccine hesitancy.

·       Further, investment in biotechnology and indigenous medical innovations will help create cost-effective treatments. Decentralizing cancer care by setting up Comprehensive Cancer Care Centres at district and state levels is crucial for expanding access.

·       Public-private partnerships can play a transformative role in improving diagnostics, rehabilitation, and palliative care services. Mental health support, counselling, and pain management must be integrated into oncology care to improve patient quality of life. Lastly, international collaboration with bodies like WHO and IAEA can offer vital technical, financial, and research support.

Conclusion

India’s escalating cancer crisis poses both a health emergency and a developmental challenge. With future projections indicating a surge in cases and deaths, the country must shift from fragmented responses to a robust, integrated national cancer control strategy. Leveraging technological innovation, enhancing community engagement, and ensuring equitable access through universal healthcare are imperative if India is to avert the grim prospect of becoming the global epicentre of cancer.