Why India’s alarming cancer crisis can no longer be hidden

Last month, the Rajya Sabha’s Committee on Petitions, chaired by Narain Dass Gupta, presented its 163rd Report. The trigger was a petition dating back to 2017, when a Delhi resident urged Parliament to make cancer treatment affordable and widely available. After eight years of deliberations, including consultations with ministries, oncologists, regulators, cancer hospitals and NGOs — and site visits to cancer centres across 13 cities — the committee returned with several recommendations. Its first and most urgent: make cancer a notifiable disease across all states and Union Territories.The call is based on an unsettling reality. Despite cancer being the country’s second leading cause of death after cardiovascular disease, India has no legal requirement for doctors or hospitals to report new cases. Some states have already made cancer notifiable, but nationally the system is still patchy. Notification exists for infectious diseases such as tuberculosis and HIV, but not for cancer.The committee argued that this distinction, set by WHO, is no longer defensible: Cancer may not be contagious, but its social, financial and health burden is vast, and policy without full data is wrong and dangerous. The report stresses that reliable reporting is the foundation for targeted resource allocation, whether for radiotherapy units, palliative care centres, or insurance schemes, all of which remain scarce in many districts.The timing also coincides with a new analysis from the National Cancer Registry Programme (NCRP), which has underscored why this gap is so significant. Drawing on data from 43 existing registries, it noted how in 2024 India recorded an estimated 15,62,099 new cases and 8,74,404 deaths.How big is the gap?For decades, India has depended on NCRP, set up in 1981, to understand incidence and mortality. The registry now draws on 43 population-based registries across the country. But these cover just 18% of the population. This means that entire swathes of rural India are invisible in official cancer statistics. Urban centres like Delhi or Chennai appear “cancer heavy” not necessarily because more residents are sick, but because hospitals there are better equipped to diagnose and record. By contrast, districts such as Osmanabad in Maharashtra or Dima Hasao in Assam report very low rates, almost certainly a reflection of undiagnosed disease, not healthier populations.The committee called this a structural flaw: Policymakers are forced to extrapolate from fragments, creating a weak foundation for planning. With nearly 70% of cancers still detected at Stage III or IV, the report said, notification is essential if India is to push detection earlier, when treatment is less expensive and survival rates higher. Key findings of NCRP further highlight the problem● Gender divide: Women now account for 51% of new cases, but men for 55% of deaths.● Lifetime risk: One in nine Indians will develop cancer. In Mizoram, the odds double — one in five men, one in six women.● Hotspots:Aizawl, Mizoram: highest incidence nationwide (256.1 per 100,000 men; 217.2 women).Delhi: highest metro rate for men (146.7).Hyderabad: highest metro rate for women (153.8).●Leading cancers:Men: Oral cavity (113,249 projected cases), lung (74,763), prostate (49,998).Women: Breast (238,085), cervix (78,499), ovary (48,984).● Trends: Oral cancer is climbing sharply in several registries — Ahmedabad Urban saw an almost 7% annual rise in women. Breast cancer dominates metros, while cervical cancer remains concentrated in the Northeast.● Deaths: Among men, digestive system cancers (128,695), oral/pharyngeal (116,744), and lung (76,686) were the top killers. Among women, breast cancer alone caused over 100,000 deaths in 2024.How will the notification change things?This is not the first time parliamentarians have raised the alarm. In August 2023, the Standing Committee on Health and Family Welfare, chaired by Bhubaneswar Kalita, submitted its 147th Report on cancer care. It too urged the government to make cancer notifiable, warning that policy was being shaped on “incomplete and fragmented data”. The committee had also recommended linking cancer registry data with Ayushman Bharat health IDs, PM-JAY claims and hospital information systems, so that longitudinal patient records could be created.Two years later, the Committee on Petitions has taken the case further. While placing notification at the centre, it widened the agenda: recommending price controls on more oncology drugs, stricter quality checks on generics, expanded screening, inclusion of HPV vaccination in the Universal Immunisation Programme, CSR funding for radiotherapy centres, and even a cess on tobacco to finance cancer care. It also flagged the shortage of oncologists, suggesting compulsory service norms for publicly funded graduates, and called for decentralising radiotherapy units to districts.Declaring cancer notifiable would mean that every doctor and hospital, public or private, must legally report new diagnoses to health authorities. In practice, this could transform the fight against cancer:● A real-time national database capturing incidence, stage at diagnosis and outcomes.● Accurate hotspot identification — from gallbladder cancer in the Gangetic belt to stomach cancers in the Northeast.● Integrated systems, linking registry data with insurance claims, mortality records and Ayushman Bharat IDs.● Better accountability, with survival rates and programme outcomes monitored across states.● Sharper prevention, allowing targeted campaigns on tobacco, HPV vaccination or pollution-linked risks.● In short, it would bring cancer surveillance on par with communicable diseases, giving policymakers the full picture they need. The road aheadIndia now faces a critical decision. Notification would be the starting point for a complete rethinking of cancer management, shifting from reactive care in overcrowded tertiary hospitals to proactive screening and prevention in communities. It would also allow for region-specific strategies.But data alone is not enough. The 163rd Report emphasises that notification must go hand-in-hand with affordability and access, expanding drug price caps, ensuring the quality of generics, and funding cancer care infrastructure through CSR and public spending. Without this, notification will only expose the scale of the problem without giving patients the means to access treatment.Moreover, notification would help align India with its global commitments under Sustainable Development Goal 3.4 — cutting premature deaths from non-communicable diseases by one-third by 2030. With cancer incidence projected to touch 2.46 million cases by 2045, MPs warn that the cancer crisis cannot be fought in the shadows.