In June 2018, Rashida Ali was travelling with her nephew from Jammu to a wedding when their car crashed. Her nephew walked away with minor injuries. Rashida’s arm was badly damaged; she would spend the next seven months in recovery and still cannot move her hand fully. Her husband, Ishfaq, told Frontline that her survival was a miracle.

It was also, in hindsight, the reason she is alive. During the two months Rashida was in hospital, routine tests turned up something the family had not been looking for: stage 3 blood cancer. In the years before the crash, she had complained of fatigue and recurring fevers, Ishfaq said, but she had never been screened or referred to a specialist.

Eight years on, Rashida is in remission and lives with her two daughters. “It would not have been possible if I had not been screened that day,” she said. “The accident made it possible.”

Oncologists say her case is unusual only in its outcome. Most Indian women diagnosed with breast or cervical cancer arrive at a screening centre at stage 2 or stage 3, when treatment is harder, costlier, and less likely to work.

Cervical cancer is among the few cancers that can be largely prevented or treated when caught early. According to the Union Health Ministry’s response in Parliament last year, it kills about 75,000 Indian women a year. Global Cancer Observatory (GLOBOCAN) 2022 data put the figure higher still, at 79,906 deaths—roughly a quarter of the global toll.

“Cervical cancer is one of the few cancers that can be prevented through vaccination,” Dr Rahul Shukla, a Delhi-based medical oncologist, told Frontline. “Despite that, it is still the fourth most common cancer in India.” He attributes the gap to two failures: low awareness and limited screening.

National Family Health Survey-5 (NFHS-5) data, collected in 2019–21, bear him out. Only 1.9 per cent of women aged 30 to 49 in India have ever been screened for cervical cancer. Fewer than 1 per cent have been screened for breast or oral cancers. In most cases, by implication, surface only when symptoms become severe.

Rashida’s niece, Afshana, then 21, was diagnosed with breast cancer in Poonch last year after seven months of illness. After her treatment began, Rashida said she started walking through neighbourhoods with the local Accredited Social Health Activist (ASHA) worker, knocking on doors and showing women videos. “I had seen how much my niece and I suffered. The ASHA worker could at least do a basic visual check,” she said.

She said she rarely sees comparable effort from the State. “I live in a city, still I had no awareness. I have never seen a single advertisement on my phone, on TV, or on billboards about these cancers,” she said. Government camps, when they happened, were held on weekday mornings, far from where most working women and students could attend.

Why diagnosis comes late

Even patients with symptoms often see the wrong doctor first. “One reason cancer goes undetected early is that patients usually visit general physicians, MDs in medicine, or gynaecologists,” said Shukla. “They are trained in general practice, not in cancer. Reaching an oncologist late significantly hampers diagnosis.”

Nidhi Verma, 50, who runs a cloud kitchen in New Delhi, was diagnosed with stage 3 breast cancer in January 2024. Because she was heavy-breasted, she said, the asymmetry that eventually turned out to be a tumour did not look alarming, and her gynaecologist did not flag it. By the time she reached an oncologist, the cancer had progressed. “A lot of time could have been saved if I had gone to an oncologist earlier,” she said. She is now cancer-free, but spends close to Rs.1 lakh a month on hormonal therapy and follow-up to keep it from returning.

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Aayushi Malik, a 32-year-old student in Delhi originally from Sambhal in rural Uttar Pradesh, said the choice of doctor often does not feel like a choice at all. In her village, she said, the first stop in any health crisis is rarely a qualified doctor: it is the pharmacist at the local medicine shop. “In my village, we don’t really know the difference between a general doctor and an oncologist,” she said. “Women go to whoever is accessible.”

India has roughly 2,000 medical oncologists, according to industry estimates—against an estimated demand of more than 5,000. The shortage is sharper outside metropolitan cities, and even in Delhi, an appointment at a major public hospital can take months.

A 2023 analysis of NFHS-5 data published by BioMed Central (BMC), covering more than 7.25 lakh women across 707 districts, found that women from tribal regions were significantly less likely to be screened, and that women from poorer households reported much lower access than those with higher education and incomes. Women with higher educational attainment and resources were about 1.55 times more likely to be screened.

The disparities are also geographical. Tamil Nadu reports the country’s highest cervical cancer screening rate at 9.8 per cent and breast screening rate at 5.6 per cent, followed by Puducherry (7.4 and 4.2 per cent) and Mizoram (6.9 and 2.7 per cent). Gujarat, Assam, and West Bengal are at the bottom, with cervical screening rates as low as 0.2 per cent. Half of all States and Union Territories report cervical screening below 1 per cent.

Yasir Malik, a New Delhi-based researcher who studies tribal communities, said access is even worse for nomadic groups. “Tribal communities, especially nomadic groups who migrate seasonally, rarely receive these services,” he said. “Screening them would require mobile health units. In my research career, I have not seen such systems functioning effectively. When camps are organised, they are often one-off events, sometimes reduced to photo opportunities.”

Public health experts say the southern States got ahead because they began screening for non-communicable diseases at the primary care level in the mid-2000s, before the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was rolled out nationally. Their primary health centre networks were also better staffed. Female literacy and labour-force participation in States such as Kerala and Tamil Nadu have also long been higher than the national average.

Even Tamil Nadu, however, falls well short of the World Health Organization (WHO) target of screening 70 per cent of eligible women. Under the WHO’s 90-70-90 strategy for cervical cancer elimination, countries are expected to vaccinate 90 per cent of girls against the human papillomavirus (HPV), screen 70 per cent of women, and ensure 90 per cent of those diagnosed receive treatment. India lags not only its own targets but several lower- and middle-income countries: Kenya reports cervical screening coverage of 16.4 per cent, Vietnam 25 per cent, and Iran 52.1 per cent.

A 2024 community survey by researchers at the ICMR-National Institute of Epidemiology, in collaboration with the Tamil Nadu government and published in Scientific Reports, found that of 4,184 women aged 30 to 69, only about 10 per cent had ever been screened. Of those who were screened, 26 per cent tested positive, but only 15 per cent were referred for colposcopy, and 13 per cent actually underwent the procedure.

A 2025 epidemiological study in Cervical Cancer Burden in India found that despite Tamil Nadu’s lead on screening, its cervical cancer death rate has not declined since 2012—evidence that visual screening alone, without consistent follow-up and treatment, does not reduce mortality.

“This is a nationwide issue, though some States like Tamil Nadu perform better,” said Dr Urvashi Prasad, a public health expert and former Director at NITI Aayog. “Even there, drop-offs still happen. Many women get screened but never inform their families or seek further care.” Fear, lack of counselling, and a trust deficit, she said, drive much of the dropout.

Samiran Panda, a Distinguished Scientist Chair at the Indian Council of Medical Research (ICMR), said the gap between detection and treatment is often where the system falters. Even when patients are screened, he said, not all of them follow through to a treatment centre. Some, after a positive result, turn instead to alternative systems of medicine and lose months. Others run into a different combination of barriers: cost of care, distance to treatment, distrust of public hospitals, or an inability to afford private ones. “It is not always the case that people do not know what to do,” he said.

Panda said that public messaging around screening had to do more than tell people to get tested. It had to address the reasons they did not act on a result—a job that, in his view, called for behaviour-change communication in local languages, particularly in rural areas, alongside stronger referral systems and more oncologists in the public sector.

“Government messaging alone isn’t enough,” Prasad said. “People trust local influencers, community leaders, ASHA workers, Anganwadi workers, and teachers. Awareness has to be local, in people’s own languages, and sustained.”

Inequality does not end at the screening centre. Deeba, a Delhi-based lawyer originally from Jharkhand who was diagnosed with synovial sarcoma—a rare soft-tissue cancer typically seen in young adults—in 2020, said she has lost two jobs since her diagnosis. The cancer has spread to her lungs and spine. “I was practising law, but I had to leave because, during treatment, you cannot work as much,” she said. “I later started teaching students preparing for law entrance exams. I lost that job too.”

Employers, she said, often hesitate to hire cancer patients, and those who do offer little room for advancement. “If you are not earning, how do you continue treatment?”

Cancer treatment in India can run to Rs.40 lakh, Deeba said, and drug prices vary sharply. “The same drug can cost Rs.4,000 in one place and over Rs.12,000 in another,” she said. “At the biggest government-run hospitals, it can take two months before treatment can even start. In private hospitals, you are treated like a customer—you are charged for everything.”

Her experience tracks with the national data. The Economic Survey 2024-25 reports that out-of-pocket expenditure as a share of total health spending fell from 62 per cent in 2014-15 to 38 per cent in 2021-22. The National Health Accounts 2023, however, place the share at about 47 per cent of medical costs, meaning households still bear close to half the bill. A 2024 study by researchers at the International Institute for Population Sciences and the Tata Memorial Centre found that more than 84 per cent of cancer patients in India faced catastrophic health expenditure, and nearly three-quarters of families had to borrow money or sell assets to pay for treatment.

Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, eligible families are entitled to up to Rs.5 lakh a year, but only for hospitalisation. “Most cancer care—diagnoses, medicines, and follow-ups—happens outside hospitals,” Prasad said. “Those costs are not covered.”

Shukla said India’s health budget is the deeper problem. The Union government’s health expenditure is about 1.9 per cent of gross domestic product (GDP), short of the 2.5 per cent target set by the National Health Policy 2017. “This needs to increase,” he said.

For women, the costs run beyond money. “Treatment is expensive, especially newer therapies like immunotherapy, which are often imported. Even private insurance doesn’t cover everything,” Prasad said. “For many women, a cancer diagnosis leads to abandonment by their families. There are also social consequences: fertility issues, stigma, and job loss.”

The case for screening

Oncologists say much of this can be avoided if cancer is caught early. “Cancers such as breast, ovarian, cervical, and colon cancers have more than a 90 per cent five-year survival rate when detected at stage 1,” said Dr Kaushal Yadav, a senior oncologist in Delhi. By stage 3, survival can fall to as low as 30 per cent, depending on the type of cancer, he said. Early detection also reduces the financial burden, since less treatment is required.

Some cancers, including those of the pancreas and gall bladder, are aggressive even when caught early—five-year survival can be as low as 40 to 50 per cent at stage 1, Yadav said. Breast and cervical cancers are not in that category. “For early detection, rather than infrastructure, what is missing is initiative and intent from the authorities, and acceptance from the public,” he said.

A mammography machine is the standard tool for breast cancer screening, he said, but where it is not available, an ultrasound machine at a primary health centre can serve. Mammography units could be installed at all civil hospitals. For cervical cancer, the conventional Pap smear is a basic test that can be done once every three years; where even that is not possible, a visual inspection with acetic acid can be performed by an ASHA worker.

“The investigations for screening are not very costly,” Yadav said. “But still, people are not able to adapt to them.”

A vaccine against HPV, the virus that causes nearly all cervical cancers, has been on the market in India since early 2023, when the Serum Institute launched its domestically manufactured Cervavac. The Union government, in its February 2024 interim budget, signalled a national drive to vaccinate girls aged 9 to 14. As of 2026, however, the rollout has been delayed by procurement decisions, delivery planning, and the work of integrating the vaccine into the existing immunisation schedule.

Two State-level pilots offer some indication of what is possible. Sikkim, in 2018-19, became the first State to run a statewide HPV vaccination campaign through schools; according to administrative data, it achieved coverage above 95 per cent for the first dose and above 90 per cent for the second. Punjab vaccinated about 10,000 schoolgirls in districts including Mansa and Bathinda. Both showed that uptake was high when vaccines were free and delivered through institutional channels.

Vaccine hesitancy, said Panda, the ICMR scientist, remains a challenge that India will have to confront if the HPV programme is scaled up. He pointed to the resistance Indian families showed during the COVID-19 vaccine rollout and to earlier hesitation around routine immunisation—noting that the experience was hardly unique to India, and that countries such as the United Kingdom had faced similar resistance to the measles, mumps, and rubella vaccine. Parents would need to understand that girls should be vaccinated before adolescence, he said, and that information would have to be delivered in ways tailored to local contexts.

Shukla said the workforce gap also drives delay. “There is a shortage of cancer specialists in government hospitals, especially in Tier 2 and Tier 3 cities,” he said. “These doctors undergo nearly 14 years of training and are often better compensated in private hospitals. The pay gap discourages them from joining government institutions.” He called for higher healthcare spending and stronger public-private partnerships.

After the cancer

Even when treatment works, recovery is rarely clean. “After surgeries, especially in breast cancer, your body changes,” Verma said. “The medicines affect you deeply: your sex drive reduces, and your energy levels drop. Treatment ends, but it is not the case that everything goes back to normal.”

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Because her cancer was hormonal, doctors put her into medical menopause to enable certain treatments. “In natural menopause, the body adjusts gradually,” she said. “In medical menopause, everything happens at once. It is physically and emotionally overwhelming.”

Care, Prasad said, also tends to stop at the oncologist. “Ideally, treatment should involve a team—oncologists, nutritionists, physiotherapists, and mental health professionals,” she said. “Most patients don’t even know to ask for these services.”

The mortality picture reflects all of this. According to a study led by ICMR scientists and published in Cancer in January 2024, drawn from 11 population-based cancer registries, the five-year age-standardised relative survival for breast cancer in India is 66.4 per cent—among the lowest in the major economies. In the United States and Australia, the figure is more than 90 per cent; in the United Kingdom, Canada, Japan, and Germany, it is in the high 80s. Even China is above 80 per cent.

In India, one in three women diagnosed with breast cancer dies within five years.

Public health experts say the gaps are well understood. Awareness must improve—not just about cancer, but about its early symptoms and the screening tests that exist. Frontline health workers, especially ASHAs, are already stretched across maternal health, immunisation, and chronic disease, and need a clear referral pathway when a screening test comes back positive. “Screening without proper follow-up is a waste,” Prasad said.

Cervical cancer is one of the few cancers that can be largely eliminated with low-cost tests and an HPV vaccine. Both remain underused in India.

Without sustained investment in infrastructure, the cancer workforce, and outreach, public health experts say, the system will not keep pace with rising cancer cases. Patients continue to arrive in the final stages of illness. In the vacuum, misinformation thrives: some believe hospitals cause cancer; others avoid diagnosis out of fear of cost and stigma. For now, delay seems to be the norm.

Arsalan Bukhari is a freelance journalist who covers science, politics, and conflict.

Naila Tabassum is a PhD student based in Delhi.