For a long time, the discussion about cancer in India has been centred on treatment, on setting up oncology centres, enhancing surgical and radiation facilities, and improving access to specialised care. Such investments are important and should continue. However, another aspect of the cancer care process deserves much more attention from policymakers: Early detection and timely treatment of the disease.
In cancer, the need for early treatment is crucial. If diagnosed early and treated promptly, cure rates are very high and the cost of treatment is low since onlÿ a single modality of treatment may be needed. Moreover, with treatment in the early stages, preservation of form & function is feasible. Hence, in oral cancer, speech and swallowing can be preserved, disfigurement can be avoided, in breast cancer, mastectomy can be avoided, in colo rectal cancer, colostomy can be avoided preserving the normal passage and in limb cancer, an amputation can be avoided.
As against this, when treatment is delayed, surgery will be more mutilating, the cost of treatment will be higher because radiotherapy & chemotherapy may also be needed with resultant high cost and cure rates are not good. In cancer delay is the real killer.
Unfortunately, it is the experience of most cancer centres that more than 70% of cases are present for treatment when they are already in stage 3 and 4 when treatments are more complex, costs are high and cure rates are poor.
{{/usCountry}}Unfortunately, it is the experience of most cancer centres that more than 70% of cases are present for treatment when they are already in stage 3 and 4 when treatments are more complex, costs are high and cure rates are poor.
{{/usCountry}}The aim of cancer policy should be to reverse these figures and shift from a situation where nearly 70% of patients present with advanced diseases to one where the majority of cancers are detected and treated at an early stage.
For many cancers, the difference between identifying the disease at an initial stage and finding it after it has spread can fundamentally affect treatment complexity and the likelihood of a favorable outcome. Yet early detection remains uneven in India, with many patients entering the cancer care system only after symptoms have continued or worsened.
This makes early detection and timely treatment not just a medical matter, but a health policy priority.
India should adopt a more systematic approach to cancer screening and early diagnosis. This does not mean testing every individual for every type of cancer. Screening should be evidence-based and targeted, with greater focus on age, risk factors, family history and cancers that have a significant impact on the Indian population.
The earliest opportunity often lies close to the patient, at the primary-care level. When someone has a persistent mouth ulcer, a suspicious lump, difficulty swallowing, a change in voice or other warning symptoms, they should be able to reach the appropriate specialist without navigating a complicated health care system. Primary-care doctors, community health workers and other frontline professionals need the training and tools to recognize red flags and make timely referrals.
The referral process also needs attention. Identifying suspicious symptoms is only the first step. If a patient then waits weeks or months for an appointment, diagnostic test or specialist consultation, the benefits of early recognition can quickly disappear.
A stronger national strategy should connect screening, diagnosis and referral rather than treating them separately. Clear referral guidelines, defined timelines and better coordination between primary, secondary and tertiary healthcare can reduce delays. Digital health systems can further help track referrals and ensure that patients do not get lost between stages of care.
Public awareness is most important. Cancer symptoms are often ignored because they are regarded as minor or routine problems. In head and neck cancers, a mouth ulcer that does not heal, swelling in the neck, difficulty swallowing or changes in the voice may initially seem harmless. Awareness campaigns should not create fear but help people recognise when a symptom requires medical evaluation.
There is also a wider equity issue. Access to advanced cancer treatment is concentrated in some urban areas, while people from smaller cities and rural regions may face additional travel, financial and logistical difficulties. Bringing early detection closer to where people live could help identify the disease sooner and make the subsequent treatment journey more manageable.
It is also necessary to assess what happens before a patient reaches an oncology centre. Cancer care metrics should not focus only on treatment facilities, machines or procedures. They should also measure early detection rates, the time from the first sign to diagnosis, referral timelines and where delays occur in the care pathway.
India has made considerable advances in its ability to treat cancer. The next step should be to invest with equal urgency in preventing patients from reaching an advanced stage before that capacity is required. The aim is not to reduce investment in treatment, but to ensure that treatment starts as early as possible, when it can have the greatest effect.
For cancer policy to become more effective, attention needs to move upstream from treating advanced disease to identifying risk, detecting disease early and ensuring that every patient receives appropriate care without unnecessary delays.
Implementation of screening programmes and referral systems that ensure timely treatment are easier said than done. What is doable is a citizen-focused awareness programme that educates people about the early signs and symptoms of cancer. Educate every citizen that cancer can be cured when detected early; that timely treatment can cost less and help prevent severe complications and deformities; and that, in cancer, delay can be the real killer.
The awareness programme must become a citizen's movement against delay in cancer treatment.
(The views expressed are personal)
This article is authored by Dr Sultan Pradhan, chairman and senior surgical oncologist, Head & Neck Cancer Institute of India (HNCII).