Disparities in oral cancer screening in India: reflections on NFHS 5 evidence and pathways forward

The recent article by Rahman et al. on oral cancer screening in India represents one of the most comprehensive national analyses of disparities in preventive oncology. Using NFHS 5 data, the study highlights the extremely low screening coverage of 4.4 per 1000 individuals, with paradoxically reduced uptake in states with high tobacco prevalence. This Letter to the Editor offers appreciation for the methodological rigor and public health significance of the work, while situating the findings within global evidence. Particular attention is given to the contribution of socio-economic determinants quantified through Fairlie decomposition, as well as the structural and cultural barriers that hinder screening implementation under NPCDCS. Drawing parallels with global experiences in oral and cervical cancer control, this commentary underscores the urgent need for risk stratified screening, integration of digital health tools, and culturally tailored awareness campaigns. It is argued that strengthening oral cancer screening in India is not only a medical necessity but also a moral imperative, with lessons that extend to other low and middle income countries facing similar burdens.