Cancer Screening in India: Lessons, Limitations, and Pragmatic Solutions for the Next Decade

Area of Science:

• Public Health
• Oncology
• Health Services Research

Background:

• Population-based cancer screening in India, endorsed by national policy since 2016, faces significant challenges in real-world implementation.
• Low screening uptake, considerable interstate disparities, and minimal population-level impact highlight a gap between policy intent and performance.

Purpose of the Study:

• To critically examine the effectiveness and limitations of screening programs for oral, breast, and cervical cancers in India.
• To identify strategies for redesigning cancer screening programs to achieve substantial reductions in cancer mortality.

Main Methods:

• A narrative review synthesizing evidence from Indian randomized trials, implementation experiences, and population-level data.
• Evaluation of screening effectiveness for oral, breast, and cervical cancers, focusing on the screening-diagnosis-treatment cascade.

Main Results:

• Screening uptake remains very low across India, with limited population-level impact, primarily due to failures in completing the screening-diagnosis-treatment cascade.
• Cervical cancer screening (Human Papilloma Virus testing) shows mortality reduction potential but is bottlenecked by referral and treatment issues.
• Clinical breast examination with streamlined diagnostics is more feasible than mammography; oral cancer screening is effective when targeted to high-risk groups and linked with tobacco cessation.

Conclusions:

• India's cancer screening strategy must prioritize completion of the screening cascade over mere coverage expansion.
• A pragmatic, resource-stratified framework emphasizing quality assurance, real-time data, and equity is needed for effective implementation.
• Shifting success metrics to outcome-based indicators (stage shift, time to diagnosis/treatment) is essential for meaningful cancer mortality reduction.