A global study finds 38% of cancer cases are preventable, with tobacco, infections and alcohol major drivers. Experts warn India’s low screening uptake and vaccine gaps are worsening late-stage diagnoses.
For decades, a cancer diagnosis has been viewed by many as an unpredictable strike of lightning, an unavoidable misfortune of genetics or age. However, emerging global data and clinical reality tell a far more provocative story.
According to recent report published in Nature Medicine, a team led by researchers at the International Agency for Research on Cancer at the World Health Organisation, more than a third of all cancer cases are rooted in preventable risks.
The report reveals that nearly 38% of new cancer cases in 2022—around 7.1 million out of 18.7 million—could have been avoided through lifestyle changes and public health measures. Leading causes include tobacco use (15%), infections (10%), and alcohol consumption (3%), highlighting opportunities to curb the cancer epidemic.
In India, these modifiable factors drive over one-third of cases, mirroring worldwide patterns but amplified by local challenges like tobacco and infections.
The architect of an epidemic: Lifestyle and policy failures
While genetic predispositions exist, the primary drivers of the cancer crisis are often found in our daily habits and social environments. Global health trends indicate that tobacco, alcohol and chronic infections remain the leading culprits. In the Indian context, these factors create a perfect storm that overwhelms healthcare infrastructure.
Dr. Nitesh Rohatgi, Principal Director of Medical Oncology at Fortis (Gurgaon), emphasised that after two decades of clinical practice, the most striking realization is how many cases were entirely avoidable. “A large proportion of the cancers I see every day never needed to happen,” Dr. Rohatgi said. He pointed out that tobacco alone is fuelling a massive epidemic of lung, oral and head-and-neck cancers.
Beyond tobacco, the “quiet accelerators”—alcohol and lifestyle-related risks—are driving a surge in liver and gastrointestinal malignancies. Furthermore, many cancers are triggered by chronic infections, such as HPV and Hepatitis, which persist despite the existence of effective vaccines. For experts like Dr. Rohatgi, these are not just medical issues; they represent a “predictable consequence of policy failure and social acceptance.”
The “missed opportunities” of proven screening
The tragedy of the modern cancer crisis is not a lack of technology, but a failure to utilise what is already proven. Evidence-based strategies such as Mammography for breast cancer, Pap smears for cervical cancer and colonoscopies for those over 50 have the power to catch the disease in its infancy. Yet, in many regions, the adoption of these life-saving tools remains dismal.
Dr. Rohatgi characterised these as “missed opportunities” rather than experimental hurdles. He highlighted that simple oral examinations for tobacco users or low-dose CT scans for chronic smokers could fundamentally change the survival landscape. “What breaks me most as an oncologist is not aggressive cancer—it is late diagnosis,” he added. “Patients walk in when the disease has already spread… This is not because cancer is silent; it is because we are not listening early enough.”
India’s screening shortfalls
Proven tools like mammography for breast cancer, Pap smears for cervical cancer, oral exams for tobacco users, low-dose CT for smokers and colonoscopies for those over 50 remain underutilised in India despite their effectiveness. Dr. Rohatgi called this a critical lapse, noting that low adoption rates turn preventable diseases into overwhelming clinic burdens. Infections like HPV and hepatitis continue claiming lives needlessly as vaccines sit available but unused.
The tragedy lies not just in risks but in delayed detection, with patients arriving at advanced stages where treatments fail and costs soar. Cancer symptoms often go ignored until metastasis occurs, a pattern Dr. Rohatgi found heart-breaking after years in oncology. In high-risk groups, emerging blood-based multi-cancer tests show promise as adjuncts, though not replacements for established methods.
Beyond traditional borders: The future of early detection
To bridge the gap between preventable risk and late-stage tragedy, the medical community is looking toward the next generation of diagnostics. While traditional screening remains the gold standard, emerging technologies like blood-based multi-cancer detection (MCD) tests are offering a glimpse into a future where high-risk populations can be monitored more effectively.
While Dr. Rohatgi acknowledged that these new tools are still evolving and “imperfect,” he argued that dismissing them would be a mistake. To significantly reduce cancer mortality, the strategy must shift from a reactive stance to a proactive intervention. This involves a three-pronged approach: aggressive prevention, better adoption of current screening methods, and the responsible integration of new diagnostic technologies.
The ultimate takeaway is a call for a shift in mindset. As Dr. Rohatgi added: “If we are serious about reducing deaths, we must stop reacting late. Cancer is not inevitable. Delay is.”
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