Cancer in India: Screening exists, but why are patients still diagnosed late | India News
Cancer in India is often found late. By the time many patients are diagnosed, the disease has already advanced, when treatment is harder and the chances of survival are lower. Part of the explanation lies in how screening is organised in the country, and part lies in how people respond to early warning signs.The stakes are considerable. The Indian Council of Medical Research’s National Cancer Registry Programme estimated 13.92 lakh new cancer cases in India in 2020, up from 13.25 lakh in 2018, and about 7.7 lakh cancer deaths in 2020, according to figures the Union Health Ministry placed before Lok Sabha. The question that follows is how many of these cases could have been caught sooner.A public programme that exists, and a habit that has not formedIndia does run a public screening system. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, now called the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), was launched in 2010 in 100 districts across 21 states. In 2016, population-based screening was added for everyone aged 30 and above. It covers hypertension, diabetes and three cancers: of the oral cavity, the cervix and the breast.The design is meant to bring screening close to the community. Under the Health Ministry’s guidelines, an ASHA worker completes a Community Based Assessment Checklist. People aged 30 to 65 are then offered an oral visual examination and, for women, a clinical breast examination and a visual inspection of the cervix with acetic acid. Each is meant to be repeated once in five years. The ministry’s training module for staff nurses estimates that in a population of 1,000, about 370 people are eligible for oral cancer screening and about 182 women each for breast and cervical screening. The cervical test is offered at the primary health centre level to begin with.What the national survey foundUptake is low. The fifth National Family Health Survey, conducted between 2019 and 2021, asked adults aged 30 to 49 whether they had ever been screened for cancer. Among women, 1.9 per cent reported ever having had a cervical cancer screening test, 0.9 per cent a breast examination and 0.9 per cent an oral cavity examination. Among men, 1.2 per cent reported ever having had an oral cancer examination.The variation between states was wide. Tamil Nadu recorded the highest rates for cervical and breast screening, at 9.8 per cent and 5.6 per cent respectively. Cervical screening stood at 0.2 per cent in Gujarat, Assam and West Bengal, and in at least half of the states and Union Territories fewer than one per cent of women had ever been screened for it.Why cancers are found lateDr Prasad’s explanation has two parts. India has no mandatory screening programme, he said, and patients often ignore early signs, so they are diagnosed only when the disease is at an advanced stage.The Health Ministry’s 2016 operational framework for cancer screening makes the same point about late detection. It says cancers in India tend to be detected late, leaving little room for effective treatment, and cites five-year survival of 60.2, 76.3 and 73.2 per cent for early-stage oral, breast and cervical cancers, against 3.3, 14.9 and 7.9 per cent at an advanced stage. The figures come from a 2010 population-based study.The framework also stresses that screening is not an end in itself. It needs assured treatment, regular follow-up and linkages between every level of care, so that a person who tests positive can reach confirmation and treatment.Who should be screened, and whenDr Prasad’s recommendations differ from what the public programme offers, and he set them out group by group.As per the guidelines, Dr Prasad said, women should begin breast cancer screening at 40. Women who are sexually active should be tested from 21, mainly to prevent cervical cancer. Men between 45 and 50 can have a Prostate Specific Antigen test once a year. Men and women alike should have a colonoscopy once every 10 years from the age of 50. From 40, he said, both men and women should mandatorily undergo a master health screening.The two differ in scope, age and frequency. The national framework’s screening protocols cover three cancers, oral, breast and cervical, for people aged 30 to 65, at five-year intervals; prostate and colorectal cancers are not among them. The framework itself notes that breast screening yields much more in women over 40, but keeps the starting age at 30 for programmatic and operational reasons.Vaccination and cervical cancerDr Prasad also pointed to vaccination against cervical cancer for girls aged 9 to 14, which he said can prevent cervical cancer in women by up to 95 to 98 per cent. The Union Budget speech of February 2024 had announced that the government would encourage vaccination for girls in that age group.The national HPV vaccination campaign was launched in February 2026. It offers a free, voluntary, single-dose vaccine to 14-year-old girls, with parental consent, at government health facilities. The Health Ministry puts the annual cohort of 14-year-olds at about 1.2 crore girls, citing Registrar General of India estimates.By 11 September 2026, more than 80 lakh doses had been administered, the ministry said. Gujarat, Uttar Pradesh, Madhya Pradesh and Mizoram reported 100 per cent coverage of their identified target groups, while Bihar, Andhra Pradesh and Assam had crossed 90 per cent. Uttar Pradesh had vaccinated more than 22 lakh girls, the highest of any state.The barrier he names: AwarenessAsked whether cost, fear, lack of awareness or access keeps people from being screened, Dr Prasad said it is mainly lack of awareness, along with the belief that nothing will happen to them. “Anything can happen to anyone at any point of time,” he said.The Health Ministry’s 2016 framework makes a related point. Because awareness of health is low, it says, screening for conditions with no obvious symptoms is seen as unnecessary, particularly among the poor, for whom a day’s visit to a secondary or tertiary facility can mean a lost day’s wages. On the cost of treatment, the Health Ministry has told Parliament that care in government hospitals is either free or highly subsidised for the poor and needy.The urban and rural gapIn cities, Dr Prasad said, access and availability are plentiful, and a person with symptoms can reach cancer care. In tier two and tier three cities the best cancer care may not be available, he said, but screening is available in almost all government colleges and hospitals. Where tier one cities hold a clear advantage is awareness, because their residents have easier access to information about screening.The public cancer care network is meant to narrow the rest of the distance. Under the central government’s scheme for strengthening tertiary care for cancer, 19 State Cancer Institutes and 20 Tertiary Care Cancer Centres have been approved. The Centre and states share the cost in a 60:40 ratio, and 90:10 for the North-Eastern and hilly states, according to a reply in Rajya Sabha. In the Union Budget for 2025-26, the Finance Minister said the government would facilitate day-care cancer centres in all district hospitals over three years, with 200 to be set up in 2025-26.The case for a yearly check-upAsked for the one change that would do the most, Dr Prasad proposed mandatory health check-ups, once a year or at least once in two years, for everyone working in the government and private sectors.He expects the benefit to travel beyond the employee. This should also help in getting family members checked, he said, as many of them will come forward for testing. Cancer screening under the national programme, by comparison, is meant to be repeated once in five years.
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What it will takeThe pieces are not missing. A public programme offers screening for three cancers to people aged 30 to 65. A vaccination campaign is reaching 14-year-old girls through government facilities, and the Budget has announced day-care cancer centres for district hospitals. What the 2019–21 survey shows is a gap between what is offered and what people take up, with fewer than two in every hundred women aged 30 to 49 having ever been screened for cervical cancer.Dr Prasad’s account of that gap is a simple one: people do not think it can happen to them.
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