With over 2 lakh new breast cancer cases reported in India in 2024, Dr Sandip Bipte, consultant in breast surgery at P.D. Hinduja Hospital and Medical Research Centre, Khar, argues that the country’s challenge lies less in the number of screenings than in what happens after a suspicious finding. Despite 22.90 crore screenings, many women are still diagnosed late because of weak referral pathways, delays in imaging and biopsy, high out-of-pocket costs and an urban-rural divide in care. He calls for risk-appropriate screening, individual risk assessment for younger women, time-bound referral systems, affordable and uninterrupted treatment, and stronger cancer registries. He recommends measuring progress against WHO benchmarks: over 60% of invasive cancers diagnosed at Stages I-II, diagnosis within 60 days, and over 80% of patients completing treatment.
1. India reported over 2 lakh new breast cancer cases in 2024. What are the key factors driving this burden, and how well prepared is India to address it?
Dr Sandip Bipte: In 2024, the incidence of breast cancer in India was expected to exceed two lakh cases. Factors that contribute to the development of breast cancer include ageing, obesity, alcohol consumption, reproductive risk factors and genetic risk factors; however, most women have no identifiable risk factors. From a clinical perspective, our priority should be helping women recognise breast changes, seek assessment promptly and complete treatment. Awareness must be supported by accessible diagnostics, affordable care and clear referral pathways. Early diagnosis linked to effective treatment can improve outcomes.
2. India has conducted 22.90 crore breast cancer screenings. But is mass screening the answer? Should we focus more on targeted screening, risk assessment and early diagnosis?
Dr Sandip Bipte: Though 22.90 crore screenings reflect considerable effort by healthcare professionals, figures alone cannot define success. A more clinically orientated approach should be adopted. There must be organised screening according to age and risk groups, risk assessment of each patient and early investigation of any symptoms. High-risk patients with genetic susceptibility or a family history may need special attention, but screening must not be limited to those women. Any suspicious symptom should be investigated regardless of whether the woman has had regular screening tests.
3. Despite large-scale screening, many women are diagnosed late. Where are the biggest gaps in India’s diagnosis and referral system, particularly in public healthcare?
Dr Sandip Bipte: An essential component that has been neglected is the move from suspecting a breast abnormality to confirming the diagnosis. Misdiagnosis, repeated referrals, travel expenses and difficulty accessing the healthcare system have been identified in Indian literature as possible reasons for delay. In the public sector, the key issues that need to be prioritised include a proper referral process, timely imaging, biopsy, and following up with each patient until the workup is complete. A referral should ensure a visit. WHO suggests completing diagnosis within 60 days of presentation.
4. How does breast cancer treatment differ across Stages I to IV? What are the key treatment options, and how have newer therapies improved survival?
Dr Sandip Bipte: Management is based on the stage, the biology of the tumour and the patient’s general condition. Stage I treatment includes surgery, with radiation therapy and drugs when needed. For Stage II, surgery may be preceded or followed by chemotherapy. Stage III treatment usually begins with medicines, followed by surgery and radiation therapy with curative intent. Stage IV treatment is mainly palliative. Hormone therapy, chemotherapy, targeted treatments and immunotherapy are selected according to tumour characteristics. Newer HER2-directed treatments, CDK4/6 inhibitors and antibody-drug conjugates have improved survival in eligible patients; immunotherapy benefits selected groups. Treatment must remain individualised.
5. Breast cancer treatment can be expensive. How affordable are surgery, chemotherapy, targeted therapy and immunotherapy for the average Indian family? What can improve access to treatment?
Dr Sandip Bipte: Costs depend on the hospital, the stage of the disease and the duration of therapy. Both surgery and standard chemotherapy can be expensive for families; where indicated, targeted drugs and immunotherapy can add a far heavier financial burden. Travel, accommodation and time away from work add to these costs. It is essential to discuss costs and likely medical benefits right at the outset. Access can be improved through public oncology centres, quality generic and biosimilar medicines, support services and insurance guidance. Eligible households may receive help under PM-JAY, subject to package availability.
6. How can India bridge the urban-rural divide in cancer care? What role can district hospitals, regional cancer centres and government health schemes play?
Dr Sandip Bipte: India needs a connected cancer-care network that brings appropriate services closer to home. Initial assessment and coordination of diagnosis and treatment should be provided in district hospitals. Complex surgical procedures, radiotherapy and treatment planning may be carried out in regional cancer centres, with telemedicine support to the districts. Programmes such as PM-JAY can help reduce the cost of treatments included under the scheme. Clinically speaking, availability of medicines, timely appointments and patient navigators are equally important. This will ensure that patients make a minimum number of trips and continue their treatment without a break.
7. Are current screening guidelines adequately addressing younger women? What should women know about symptoms, family history and genetic risks?
Dr Sandip Bipte: India’s public programme includes clinical breast examination from the age of 30, but younger women also need individual risk assessment and prompt evaluation of symptoms. A new lump, nipple retraction, bloody discharge or skin dimpling should never be dismissed because of age. Women should share cancer histories from both parents’ families, particularly breast cancer at younger ages, ovarian cancer or male breast cancer. These may warrant genetic counselling and, where indicated, testing for inherited changes such as BRCA1/BRCA2. High-risk women may require earlier, tailored surveillance; routine mammography for every young woman is not the answer.
8. What three policy-level changes are most urgently needed to reduce breast cancer mortality in India over the next decade? How should we measure their impact?
Dr Sandip Bipte: I would prioritise three changes: strengthen primary-care breast assessment and risk-appropriate screening; establish time-bound referral pathways with district-level imaging and biopsy; and ensure affordable, uninterrupted treatment through public oncology capacity, financial protection and patient navigation. WHO benchmarks offer clear measures: over 60% of invasive cancers diagnosed at Stages I-II, diagnostic evaluation within 60 days, and over 80% of patients completing recommended treatment. India should strengthen cancer registries to track stage, survival and age-standardised mortality, alongside treatment abandonment and household expenditure. Results should be compared across rural and urban populations and income groups to assess whether access gaps are narrowing.