India must adopt a policy framework for early cancer detection

A cost-effective way of enhancing survival among patients is early detection. For example, the estimated survival rate for breast cancer patients is 99% if detected early, compared to 31% for late detection cases. For lung cancer, the survival rates for stages I, II, III and IV show a dramatic survival gradient of 65%, 40%, 15% and 5%, respectively (not adjusting for lead-time bias).

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A plausible reason for low survival rates in India could stem from the fact that most cancers (over 60%) are detected at stage III. In the US, most are detected at Stage I or II. India’s breast cancer survival rate it is only 68%, while rich countries have 90%+ rates; for lung cancer, India’s rate is merely 17% , far below the 60%+ rates in countries like Japan.

The term ‘cancer’ evokes shock and fear due to its high treatment costs coupled with poor chances of survival. The financial burden of treatment and care can force patients (and households) into acute misery and even insolvency. Our research shows that a potential reason for low detection is information avoidance reflected in screening hesitancy: ‘What if I test positive?’ It’s such a dreaded disease that even educated Indians resort to avoidance, a behaviour that parallels loss aversion in financial matters.

The consequences of late detection are devastating—not only for patients and their families, but also for healthcare systems. Delayed diagnosis results in longer and more invasive treatments, far higher out-of-pocket expenditure and a notable loss in healthy years of life. More than half of all economically destitute households depend on distress means (sale of assets, borrowings, contributions from relatives/friends) to pay for cancer hospitalization. 

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It also strains our healthcare infrastructure, as late-stage cases require more intensive medical resources, including a shift to palliative care. Hence, investments in boosting early detection are critical. In fact, research suggests that early screening of breast cancer can avert up to 105.8 ‘disability-adjusted life years’ and increase ‘quality-adjusted life years’ by 64.5 years per 1,000 women.

There is a good case for making cancer screenings mandatory—in the public sector to begin with. Government organizations can mandate compulsory periodic screening for all employees aged above 40. The cost is not prohibitive and can be either absorbed by a group health-insurance policy or shared between employers and employees. 

On the whole, this would work out more cost effective than government insurance schemes bearing the burden of cancers that are detected late. An increase in early detection rates would reduce the overall sum of oncology claims, relieving insurers as well as government resources. Importantly, it will reduce mortality rates. 

The social normalization of screenings can also lower psychological barriers around cancer, a leading cause of late detection. It will reduce loss aversion by reframing such checks as routine health measures rather than dreaded events.

Private organizations should also pursue such mechanisms with dedicated screening drives and campaigns. Greater life expectancy among high-income households also means they are at higher risk of late-age diseases. Hence, private-sector employers that mandate screenings would help mitigate the disease’s worst effects.

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Countries like the UK, Australia, South Korea and Canada have implemented national cancer screening programmes. In the UK and Australia, the government offers almost free screening for various types of cancers, including breast, cervical, colorectal or bowel cancers. South Korea’s national screening scheme covers high-risk cancers too. 

In Canada, several provinces run free screening programmes for breast, cervical and colorectal cancers. In these countries, although screening is not enforced, it is urged through invitations and follow-up reminders sent out routinely.

These initiatives have achieved significant success. In South Korea, the screening rates for breast, cervical and stomach cancer have risen above 70%. The UK has achieved similar success, with 70% of women aged 50-70 undergoing breast cancer screenings. In Australia, 50% and 68% of eligible women underwent screening for breast and cervical cancer, respectively, with bowel-cancer screening at 41%. In contrast, our screening rates remain abysmally low—cervical-cancer screening is at 2%, with breast and oral cancer at 1%.

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The principle of the idea is not new. The Indian state has built strong policy frameworks and addressed behavioural inertia for many health-based initiatives in the country; think of our vaccination drives and efforts against diseases like AIDS and leprosy. We must now develop a policy to boost screening rates and improve the prognosis of cancer patients in India. Millions of families will be saved from needless and avoidable agony should such a policy take shape.

The authors would like to thank Dr Ojas Krishnani (from Gadchiroli) and Dr Pranjal Pandey (from Delhi) for their useful comments on this piece.

The authors are, respectively, teachers and a student at FLAME University.