Every October, Indian cities turn pink. Public buildings are lit, brands adjust their logos, and thousands of women register for the Pinkathon. Behind the colour sits a disease whose numbers have been climbing steadily, and a screening and financing system that has not kept pace with them. This month's Health of the Nation looks at what the data says, what the Union and state governments have done, and whether the attention breast cancer receives is proportionate to the problem.
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| Source: Times of India |
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| Source: DNA India |
How large is the problem?
According to the Indian Council of Medical Research’s (ICMR) National Cancer Registry Programme (NCRP), estimated cancer incidence in India for 2024 stood at 15,33,055 cases, as per the data reported by the Ministry of Health and Family Welfare in the Lok Sabha, and breast cancer among women accounted for 2,27,152 of them. Based on these figures, breast cancer among women alone makes up approximately 14.8 per cent of all cancers diagnosed in India, and it is the most common cancer among Indian women. The same registry estimates that breast cancer deaths rose from 74,481 in 2019 to 82,429 in 2023, an increase of more than 10 per cent in four years.
The trend matters more than the snapshot. Some of the growth reflects a larger and older population, although that explanation only goes so far. A Lancet-published global analysis of 2023 data estimates that India's age-standardised breast cancer incidence has risen by about 127 per cent since 1990, which points to a genuine increase in risk rather than demography alone. An ICMR study published in 2024 found a heavier burden in Tamil Nadu, Telangana, Karnataka and Delhi than in the eastern and north-eastern states, and projected the national burden at 5.6 million disability-adjusted life years for 2025.
Indian women tend to be diagnosed at a younger age than women in high-income countries. However, they tend to be diagnosed at later stages of the disease. A hospital-based study at Tata Memorial Hospital in Mumbai found that 54 per cent of patients presented at stage III or IV, with a median age of 49. Late presentation drives both mortality and treatment costs, and it is one of the variables that policy can most directly influence.
Screening: large numbers, thin coverage
The Union government's principal instrument is population-based screening for oral, breast and cervical cancer among everyone aged 30 and above, delivered through Ayushman Arogya Mandirs under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). Breast screening at this level relies on clinical breast examination rather than mammography. The headline figures are impressive, and by April 2026, the programme reported 16.5 crore breast cancer screenings.
Household survey data presents a less flattering story. In the National Family Health Survey (NFHS) 5th round (2019–21), only 0.9 per cent of women aged 30 to 49 reported ever having undergone a breast examination. The two sources cover different periods and measure different things: the portal counts screening events, whereas the survey asks whether an individual woman has ever been examined. Neither, however, tells us how many women who screen positive go on to a confirmed diagnosis and timely treatment, and that is the figure on which outcomes actually depend.
Financing: better, but still out of pocket
Cancer has long been the most financially destructive diagnosis an Indian household can receive. An analysis of data from the National Sample Survey Organisation’s (NSSO) 71st round (2014) found that cancer caused the highest rate of catastrophic health expenditure of any disease, affecting 79 per cent of households with a cancer hospitalisation, while 43 per cent resorted to distress financing. The NSSO 75th round (2017–18) puts average cancer care expenditure at around ₹1.16 lakh, with wide gaps between public and private sectors. For example, in Tamil Nadu, out-of-pocket spending at a public facility averaged ₹8,448, compared with ₹2,49,086 at a private facility.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has changed this materially for its beneficiaries. By February 2025, the Union Health Minister reported about 68.43 lakh hospital admissions, worth ₹13,160.75 crore, authorised under cancer packages, and a study in The Lancet found that enrolment raised the likelihood of starting treatment within 30 days of diagnosis by about 90 per cent. The same body of research notes that diagnostics and follow-up care largely fall outside the scheme, so out-of-pocket costs persist precisely at the stage where breast cancer is cheapest to detect and treat.
The Union Budget 2025–26 added two further measures. It announced Day Care Cancer Centres in all district hospitals over three years, with 200 to be established in 2025–26, and it fully exempted 36 life-saving drugs, including cancer medicines, from basic customs duty. Both are welcome, although their value depends on execution, since a day care centre without trained oncology staff, or a duty exemption that does not reach the retail price, offers little to the patient.
What the states are doing
States carry most of the delivery burden, and several have gone beyond the national framework. Punjab's Mukh Mantri Punjab Cancer Raahat Kosh, running since 2011, provides up to ₹1.5 lakh towards treatment for resident patients, and in 2022, the state partnered with Roche Pharma India and Niramai Health Analytix on an AI-enabled breast screening project. Tamil Nadu has announced a ₹41 crore Women Wellness in Week programme that places a dedicated mobile unit in every district for breast and cervical cancer screening. Kerala offers the most instructive numbers. In the first two months of its Arogyam Anandaam campaign, launched in February 2025, the state screened about 14.9 lakh women and referred 49,583 for further tests. By April, 128 cancers had been confirmed, and 348 cases were still awaiting confirmation. Most women referred after a clinical examination will turn out not to have cancer, so the gap is not itself a failure. What the figures do not reveal is how many of those 49,583 women actually completed a diagnostic test, and that missing number is precisely the step that AB-PMJAY leaves largely uncovered.
Does breast cancer get too much attention?
To a degree, it does, and the reasons deserve scrutiny. Breast cancer's prominence is earned by its incidence and its death toll, so the issue is one of proportion rather than legitimacy. The pink ribbon owes much of its reach to a global, sponsor-friendly campaign culture that India imported wholesale, and public attention has not been distributed according to preventability. Cervical cancer, the second most common cancer among Indian women, is largely preventable through vaccination, yet India launched its national Human Papillomavirus (HPV) vaccination programme only in February 2026, some sixteen years after earlier efforts collapsed amid controversy. Oral cancer is concentrated among men and driven overwhelmingly by tobacco, and it has no comparable month, run or colour. One plausible reason is that its sufferers are disproportionately poor and its cause attracts blame more readily than sympathy.
There is also a risk that awareness becomes the product in itself. Corporate sponsorship of pink events buys visibility at modest cost, and much of the messaging, built around self-examination and mammography, speaks most fluently to urban and insured women. The woman most likely to present at stage III, by contrast, is often rural, poorer and far from a cancer centre.
What would make October count?
The evidence points to a few practical shifts. One of the most useful measures would be the share of breast cancers diagnosed at stage I or II, tracked and published for every state, because that figure shows whether screening and referral are actually working together. Bringing diagnostic tests such as mammography and biopsy within AB-PMJAY cover would remove the cost barrier at the point where it does the most damage. Much of the infrastructure already exists: any woman aged 30 or above can walk into an Ayushman Arogya Mandir for a free clinical breast examination, yet uptake remains low. Awareness campaigns could close that gap by measuring themselves against the number of women they bring to a screening point during October, and if the month's pink lights sent even a fraction of the women who see them through those doors, they would have earned their place.
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