Mumbai: She was educated, professionally accomplished and financially secure. Yet when she noticed a lump in her breast, she waited eight to nine months before getting it examined. There was no pain, no obvious discomfort and, in her mind, no immediate reason to worry. By the time she sought medical attention, the cancer had progressed to stage IV and spread to her liver, lungs and bones.
The case, recalled by Dr Meenu Walia, Chairman, Medical Oncology, Max Super Speciality Hospital, Patparganj, highlights a troubling reality in breast cancer, which is delayed diagnosis is not confined to women who lack access to information or healthcare. Even educated and financially secure women can dismiss a painless lump or postpone a medical consultation while managing work, children and family responsibilities. And when that delay stretches from weeks into months, the consequences can be devastating.
The numbers reveal the larger gap. In 2024, breast cancer caused approximately 694,000 deaths globally, according to the World Health Organisation (WHO). Around 70 per cent of these deaths occurred in low- and middle-income countries, underlining the stark differences in breast cancer outcomes across healthcare systems.
WHO’s first country-wise survival estimates show five-year survival rates of 87.3 per cent in high-income countries, 88.5 per cent in the Americas and 84 per cent in the European region.
In India, five-year survival during 2017–2021 was 65.7 per cent, compared with a global median of 77.8 per cent.
The gap is therefore not only about what happens after a woman reaches a cancer centre. It is also about what happens before she gets there — whether a symptom is taken seriously, how quickly diagnosis follows and whether timely treatment is accessible.
This Breast Cancer Awareness Month, ETHealthworld examines why India continues to trail the global breast cancer survival curve, the gaps in early detection and screening, and what needs to change.
Why survival is low
Oncologists say survival outcomes are often determined well before treatment begins. Dr Ashwin K R, Head of Department of Surgical Oncology and Consultant, Surgical Oncology and Gynecological Oncology, Aster Whitefield Hospitals, says the single biggest factor behind high mortality among Indian breast cancer patients is the stage at which the disease is diagnosed.
“In India, a large share of women, especially in rural areas, arrive at stage III or IV, when the tumour is locally advanced or has already spread. Often a woman noticed the lump when it was small and treatable, but reached us months later. Low awareness, hesitation to seek care and poor access to cancer centres all play a part.”
But delayed diagnosis is not only a rural or access-related problem.
The case of the Delhi woman recalled by Dr Walia illustrates how a delay can occur even when a woman has education, financial means and access to healthcare.
When asked why she had waited several months despite noticing a lump, the patient said the lump had not caused pain or any other symptoms. By the time she was investigated, the cancer had already spread beyond the breast.
Such cases, doctors say, point to a deeper behavioural and social barrier: the tendency to treat the absence of pain as reassurance and to postpone medical attention until symptoms become disruptive.
Dr Walia says this can be particularly pronounced among women who routinely put family responsibilities ahead of their own health.
“For an Indian woman, everything else comes before her health. She thinks that taking care of herself is selfish. Her children’s exams, family functions and family duties always come first, and her health comes last. As women, we take pride in that, and we feel tremendous guilt if we put ourselves first.”
She says this pattern is reflected in cases seen routinely in clinical practice.
“That is why so many women neglect themselves. Many come to us with a lump in the breast, and when we ask why they waited so long, the answer is often, ‘My child had board exams, and I didn’t want to disrupt the household.’ These are real cases we see in our OPD almost every day.”
The consequence is that a disease that can be managed more effectively when detected early may reach a stage where treatment becomes considerably more complex.
The screening gap
Doctors agree that India needs stronger organised systems for early detection if it is to narrow the survival gap.
Countries with established screening systems have built mechanisms around regular invitations, quality-assured imaging, follow-up and referral. In the UK, women are invited for mammograms every three years from age 50, while US guidelines recommend mammography every two years from age 40.
India, however, has yet to build a comparable nationwide breast cancer screening system.
WHO’s Global Status Report on Cancer 2026, which surveyed 130 countries, classifies India among 45 countries with no breast cancer screening programme or implementation strategy.
India does have a government population-based initiative under the national Non-Communicable Diseases (NCD) programme. The programme includes clinical breast examination by health workers for women over 30. However, coverage remains extremely low.
The National Family Health Survey (NFHS-5, 2019–21) found that only 0.9 per cent of women aged 30 to 49 had ever undergone a breast examination for cancer.
The challenge, however, is not simply about introducing mammography nationwide.
According to Dr Ashwin, India would first need to build the healthcare capacity required to support a quality screening programme from detection through treatment.
“This is very different from a quality-assured mammography programme with invitations, repeat screening and reliable follow-up, like those in many Western countries. Scaling mammography to India’s size would need thousands of machines, trained radiologists and quality control. Most importantly, it would need the capacity to carry out imaging, biopsy, pathology and treatment for every abnormal result.”
There is also an age-related challenge, he points out.
“There is also an age mismatch: mammography works best for women over 50, while many Indian women develop the disease younger.”
That makes the question of what constitutes an effective screening strategy for India more complex than simply replicating programmes designed for Western populations.
Dr Indoo Ammbulkar, Director and Head of Department, Medical Oncology, HCG Cancer Hospital, Mumbai, says the country’s enormous variation in healthcare access is another major barrier.
“India has a very large and diverse population, with major differences in healthcare access between urban and rural areas. This makes implementing a uniform nationwide screening programme challenging. We also need trained healthcare workers at villages, towns and at community levels as well as diagnostic facilities and systems for follow-up.”
In other words, screening cannot work as a stand-alone intervention. Detecting an abnormality is only the first step. Women must also be able to access diagnostic imaging, biopsy, pathology, specialist consultation and treatment without falling out of the system.
Beyond screening: building a prevention mindset
For doctors, closing India’s breast cancer survival gap will therefore require more than increasing the number of machines or launching another awareness campaign.
It will require women to seek medical attention earlier, healthcare workers to identify symptoms and refer patients promptly, and health systems to ensure that women who enter the diagnostic pathway are able to complete it.
Dr Walia believes the first hurdle is not necessarily infrastructure, but intent.
“The first thing that stands in the way is intent. There has to be a higher intent to push preventive health forward. We need more organised efforts and need to start valuing human life more.”
That intent will need to translate into sustained public-health action — from improving awareness of breast symptoms and encouraging timely consultations to strengthening screening where appropriate and ensuring that abnormal findings do not disappear into an overstretched healthcare system.
For India, the survival gap is ultimately not just a cancer-care challenge. It is a challenge of timing.
A woman who reaches treatment when the disease is still localised has a very different set of options from one who arrives after the cancer has spread. The difference between the two can begin with something as simple as taking a painless lump seriously.
India has made significant advances in cancer treatment. The next challenge is ensuring that more women reach that treatment early enough for those advances to make a difference.
