Cancer Screening in India: Lessons, Limitations, and Pragmatic Solutions for the Next Decade

This review critically examines the gap between policy intent and real-world performance of population-based cancer screening in India and identifies strategies for redesigning screening programs to achieve meaningful reductions in cancer mortality. This narrative review synthesizes evidence from Indian randomized trials, implementation experiences, and recent population-level data to evaluate the effectiveness and limitations of screening for oral, breast, and cervical cancers. Despite national policy endorsement since 2016, screening uptake in India remains extremely low, with marked interstate variation and a minimal population-level impact. The primary limitation is failure to ensure completion of the screening-diagnosis-treatment cascade. Cervical cancer screening has the strongest evidence base as randomized trials demonstrate mortality reduction using Human Papilloma Virus testing; however, scale-up is hindered by referral and treatment bottlenecks. For breast cancer, organized early diagnosis using clinical breast examination and streamlined diagnostic pathways is more feasible and equitable than population-wide mammography. Oral cancer screening shows high yield when it is targeted to high-risk groups and integrated with tobacco cessation programs. India's cancer screening strategy must shift from expanding coverage alone to ensuring completion of the screening cascade. A pragmatic, resource-stratified framework is needed, and it should emphasize quality assurance, real-time data systems, and equity-focused implementation. Success metrics should move beyond numbers screened to outcome-based indicators such as stage shift, time to diagnosis, and time to treatment to achieve meaningful reductions in cancer mortality.