While the economic cost of diabetes is almost eight times that of cancer ($11.4 trillion vs $1.4 trillion for 2020 to 2050), cancer is dreaded most by people, as it has the highest rate of Catastrophic Health Expenditure (CHE) due to the lower volume of patients. More than 42% of families dealing with cancer resort to distress financing, meaning they must actively sell land, livestock, gold, or take high-interest informal loans to pay for treatment and rehab (NSSO nd National Health Accounts data).
An individual in India faces a 1 in 9 (11%) lifetime risk of developing cancer. With about 1.6 million new cancer cases (and 900,000 deaths) annually, the disease is projected to reach 2.8 million annual cases by 2050. Despite this growing threat, national screening rates remain below 5%, leading to overwhelming late-stage diagnoses at stages III and IV. According to the World Health Organisation (WHO) benchmarks, early-stage treatment is 2 to 4 times less expensive than late-stage intervention, making grassroots early detection an economic and clinical necessity.
Cancer is, unfortunately, not easy to detect during the early stage, as symptoms manifest late. While certain changes like body weight loss take place at early stages of tumour growth, they can be easily attributed to other factors. People’s reluctance is another major challenge, as they fear loss of livelihood or intimate examination (cervical and breast cancer). With tertiary care infrastructure being highly centralised in large metros, rural patients have to travel 1000+ km to access the right treatment. Absence of local care infrastructure leads to massive non-medical expenses that include travel and multiple rounds of duplicate and avoidable testing. Anxiety of late stage discovery and limited understanding of the disease also exposes people to exploitation by touts.\
Most people run out of money by the time they discover the correct treatment path and have to make fresh efforts to raise funds for treatment, further delaying treatment and compromising outcomes.
- Identify and Focus on High-Risk Areas
With difficult early diagnosis, low volume of patients and high cost of diagnostics, it’s not easy and viable to create a robust diagnosis and diagnostic infrastructure in remote areas. Disease spread, however, has unique characteristics, and that also provides a possible pathway for early detection and treatment initiation.
Cancer in India is highly regionalised with unique high-risk areas that can be targeted for screening and infrastructure building. For example, the northeastern region of India, specifically states like Mizoram, Meghalaya, and Arunachal Pradesh, record the highest cancer incidence rates of oesophageal, stomach, lung, and nasopharyngeal cancers in the entire country, and the metropolitan areas of the country (with Delhi recording the highest urban cases) have seen a steep rise in breast, colon, and lung cancers due to sedentary lifestyles, obesity, and ambient air pollution. Similarly, certain rural areas have seen a high number of cervical and oral cancers.
With the help of AI, we can narrow down the high-risk areas to pin codes and villages and align infrastructure investments, training of GPs and screening programmes with that to maximise effectiveness.
2. Awareness and Screening – Leverage Non-Invasive Tools
Awareness is the first step to successful screening and diagnosis. Low screening rates (under 5% for major programmes) and lack of awareness also contribute to late-stage detections. There is a need to remove disease stigma and introduce lifestyle changes to enable early diagnosis and reduce incidents. School and college students have been used successfully for various social awareness programmes, and it could be an effective strategy here as well.
Effective screening needs to be non-invasive to make it more accessible. There are several diagnosis tools available that use observable phenotypes and behaviour to identify high-risk people. There are also several new points of care technologies available that use AI for screening and are non-invasive. Emerging innovations like Niramai Thermalytix (Rs150–Rs250 per test) provide AI-powered, radiation-free thermal breast cancer screening. There are others like GrivaVision for cervical cancer and oral cancer that are cost-effective and non-invasive. Screening can also proactively identify infection-induced cancers.
Over time, frontline workers can utilise the National NCD Portal for algorithmic risk scoring to identify high-risk individuals for targeted screening.
3. Diagnosis, Diagnostic and Treatment Infrastructure:
Screening without creating a follow-on diagnosis and treatment infrastructure reduces people’s trust in the process. Access to experts through the telemedicine network can augment GPs’ diagnosis capabilities in remote areas. They can then provide a verified path to diagnostics and treatment for patients, leading to early treatment and a cure. AI can also augment GPs’ ability to diagnose, but access to a remote expert would be a more reliable model.
Linking screening records to Ayushman Bharat Health Account (ABHA) IDs can prevent loss to follow-up.
Way Forward:
There is a need to make healthcare affordable by shrinking timelines of access
to emerging technologies. I4 Mentors Foundation is building a community of
healthcare disruptors and communities to enable collaboration and early access
to innovation.
(Dr Rajbir Singh, an Innovation Strategy Expert, is the founder of i4 Mentors Foundation.)