Rising Oral Cancer Burden in India

General Studies Paper II: Health, Government Policies & Interventions

Why in News?

A recent study by the ICMR-National Institute of Non-communicable Disease Epidemiology (ICMR-NINE), highlights that male oral cancer cases in India are rising at an estimated annual rate of 1.20%, identifying India as a significant contributor to the global oral cancer burden.

Key Findings of ICMR-NINE Study

- Data Source: The Indian Council of Medical Research–NINE study used Global Cancer Observatory (GLOBOCAN) 2022 data to analyse cancer trends across 11 G20 countries, providing a comparative global epidemiological perspective.

Cancer Burden: According to the study, India faces a rising cancer crisis, recording 1.56 million new cases and 874,404 deaths in 2024.

If trends continue, cases are projected to reach 2.46 million annually by 2045.

Globally, the cancer burden is intensifying, with nearly 20 million new cases and 9.7 million deaths reported in 2022.

Rising Oral Cancer: The study highlights a consistent rise in oral cancer among men in India, with an annual increase of 1.20%, indicating a sustained upward trend.
- Oral cancer remains predominantly male-centric, whereas among women, different cancers dominate.
- Similar rising trends were observed globally: China (1.10%), Canada (0.94%), and USA (0.57%), showing oral cancer as a broader G20 public health issue.
- Among women, rising oral cancer incidence was noted in South Korea (2.17%), France (1.93%), and Canada (0.54%).
Risk Drivers: The study identifies tobacco consumption (especially smokeless forms) as the dominant driver, along with alcohol and betel nut use, deeply embedded in socio-cultural practices.
- A critical insight is that risk behaviours begin early in life, increasing long-term exposure and elevating lifetime cancer risk across populations.
- The majority of oral cancer cases are detected at advanced stages, leading to poor prognosis and higher treatment costs.
Breast Cancer: Across all analysed countries, breast cancer remains the leading cancer among women, with rapid increases in countries like South Korea (5.07%), Turkey (2.42%), China (2.03%) and India (1.83%).
Cervical Cancer: The study finds contrasting trends: India shows a decline (-4.19% annually) due to screening/vaccination, while China shows a sharp rise (6.11%).
- Other countries are South Korea (-0.20 %), Argentina (-1.62 %) and the US (-1.17%).

Know About Cancer:

Cancer is a disease where abnormal cells grow uncontrollably, invade nearby tissues, and can spread (metastasis) to other organs, disrupting normal body functions.
- Cancer cells differ from normal cells by rapid division, resistance to death signals, and ability to spread through blood or lymphatic systems
Cancers are broadly classified into carcinomas, sarcomas, leukemias, lymphomas, and others based on the type of tissue or cell origin.
Oral cancer refers to cancers developing in the mouth and throat tissues, including lips, tongue, gums, cheeks, and floor of the mouth.
- Most oral cancers arise from squamous cells lining the oral cavity, making it part of head and neck cancers.
- It can affect tongue, inner cheeks, gums, palate, lips, and throat, showing wide anatomical spread within oral cavity.
- Key drivers include tobacco use, alcohol consumption, and HPV infection, with combined exposure significantly increasing risk.
- Its common signs are non-healing sores, lumps, bleeding, difficulty swallowing, and persistent pain, often unnoticed in early stages.
- Oral cancer progresses from Stage I to IV, with survival strongly dependent on early detection, reaching up to 70–90% survival in early stages.
Other Types of Cancers: Lung cancer, Breast cancer, Cervical cancer, Prostate cancer, Colorectal cancer, Liver cancer, Pancreatic cancer, Brain cancer, Skin cancer, Blood cancer (Leukemia).

Oral Cancer Crisis in India

Epidemiological Explosion: India reports approximately 1.2 to 1.56 lakh new oral cancer cases annually, with more than 5 people dying every hour from the disease.
- Oral cancer ranks as the most common cancer among Indian men and the fourth most common among women.
Dominant Risk Factors: Over 90% of oral cancer patients in India have a history of tobacco use. Smokeless tobacco (SLT), including products like gutka, khaini, and zarda, is the primary driver, with SLT users facing up to a 20-fold increased risk.
Impact of Areca Nut: The cultural practice of chewing areca nut (supari) is a major contributor, as it is classified as a Group-1 carcinogen.
- Regular consumption often leads to Oral Submucous Fibrosis (OSMF), a precancerous condition with high malignant transformation rates.
Demographic Shifts: While typically a disease of the elderly, oral cancer in India is increasingly affecting the youth population (under 40 years).
- Factors like early initiation of tobacco habits and HPV infections are contributing to this cataclysmic shift toward younger working-age individuals.
Regional Hotspots: Incidence rates vary significantly, with Ahmedabad, reporting the highest male incidence at 30.7 per 100,000.
- Northeastern states like Meghalaya and Mizoram also face a disproportionately high burden, often double the national average.
Diagnostic Delays: Nearly 70% of cases are detected at advanced stages (Stage III or IV). This delay is caused by poor awareness and limited screening, with only 1.2% of men and 0.9% of women participating in national screening programmes.
Economic Toxicity: The annual economic loss due to oral cancer in India is estimated at $5.6 billion.
- Out-of-pocket expenditure (OOPE) for treatment typically ranges from ₹80,000 to over ₹2,30,000, often leading to catastrophic health expenditure for up to 96% of families.
Mortality and Survival: The five-year survival rate for oral cancer in India remains low, at approximately 50%, primarily due to late-stage presentation.
- In 2024, oral cancer was projected to account for a significant portion of 8.74 lakh total cancer deaths in the country.

Government Initiatives and Policy Response

NPCDCS Screening Framework: The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) mandates mandatory screening for oral, breast, and cervical cancers for all individuals over 30 years of age.
- This community-level intervention has conducted over 32.8 crore oral cancer screenings to date, diagnosing approximately 1.87 lakh cases.
Ayushman Bharat Arogya Mandirs: Under the National Health Mission, Health and Wellness Centres (now Ayushman Arogya Mandirs) have been strengthened to provide frontline screening.
- Over 7.19 lakh ASHAs and 2.25 lakh ANMs have been trained to perform visual inspections and facilitate referrals to higher tertiary centres.
Financial Shield via PM-JAY: The Ayushman Bharat PM-JAY scheme provides a health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalization.
- This initiative significantly reduces the catastrophic out-of-pocket expenditure for oral cancer treatments, which can otherwise exceed ₹2 lakh.
Tobacco Control under COTPA 2003: The Cigarettes and Other Tobacco Products Act (COTPA) serves as the legal backbone for preventing oral cancer.
- Policies include a total ban on e-cigarettes, mandatory 85% pictorial warnings on packages, and specific state-level bans on gutka and pan masala.
National Cancer Grid (NCG): The National Cancer Grid (NCG), managed by Tata Memorial Centre, links over 250 cancer centres to standardize care.
- It offers a Virtual Tumor Board for expert consultations and a specific Tobacco Control and Cessation Certificate Course for healthcare professionals.
Infrastructure Expansion: The government is establishing State Cancer Institutes (SCIs) and Tertiary Cancer Care Centres (TCCCs) nationwide.
- Currently, there are 770 District NCD Clinics and plans to set up 200 Day Care Cancer Centres in district hospitals during 2025-26.
Health Minister’s Cancer Patient Fund: The HMCPF provides one-time financial assistance of up to ₹2,00,000 to patients living below the poverty line (BPL).
- This fund is specifically designated for treatment at 27 Regional Cancer Centres across India.
Indigenous Medical Innovation: In April 2024, India launched NexCAR19, the nation’s first indigenous CAR-T cell therapy.
- While primarily for blood cancers, such breakthroughs in the Department of Health Research signal a shift toward making advanced oncology care affordable and self-reliant.
National Oral Cancer Registry (NOCR): The National Oral Cancer Registry is a critical initiative by the Indian Dental Association to collect data on precancerous lesions.
- It helps map regional hotspots, such as Ahmedabad, which has the highest male incidence at 30.7 per 100,000.
Customs Duty Exemptions: The Union Budget 2025-26 exempted 36 life-saving cancer drugs from Basic Customs Duty.
- This policy aims to lower the retail price of essential medicines, ensuring that advanced pharmacological interventions remain accessible to a broader demographic.

Way Forward

Robust Primary Screening: Strengthening Primary Health Centres (PHCs) is the critical first step.
- Training frontline workers (ASHAs/ANMs) to perform Oral Visual Examinations (OVE) can identify precancerous lesions, such as OSMF.
High-Tax Fiscal Barriers: Implementing stricter tax regimes on smokeless tobacco (SLT) acts as a proven deterrent.
- Research suggests that increasing taxes on products like gutka and khaini directly reduces initiation rates among the vulnerable youth and lower-income demographics.
Digitized Awareness Campaigns: Modern awareness initiatives must move beyond static warnings.
- Leveraging social media influencers and localized video content can effectively communicate the lethal link between Areca Nut (Supari) and cancer to the younger, tech-savvy generation.
Tele-Oncology Integration: Utilizing Tele-medicine to link rural PHCs with Tertiary Cancer Centres allows for remote expert consultations.
- This digital bridge ensures that suspicious cases in remote areas receive specialist validation without the need for immediate, costly travel.
Mandatory School Education: Integrating oral hygiene and tobacco-risk education into the school curriculum is a vital “Way Forward.”
- Educating children early prevents the habit formation that accounts for nearly 90% of adult oral cancer cases in India.
Tobacco Cessation Support: Expanding the National Tobacco Quitline (1800-11-2356) and providing accessible Nicotine Replacement Therapy (NRT) at the community level is essential.
- Behavioral counseling significantly increases the long-term quit rates compared to unassisted attempts.
Point-of-Care Diagnostics: Investing in low-cost diagnostic tools, such as fluorescence imaging or AI-based mobile apps, enables immediate on-site screening.
- These tools help differentiate benign spots from potentially malignant disorders during routine health check-ups.
Policy and Enforcement: Strict enforcement of COTPA Section 6, which prohibits tobacco sales near educational institutions, is mandatory.
- Combined with a ban on loose sales, these regulatory measures are essential to curbing the accessibility and affordability of carcinogens.